My Medicare plan sign up date is fast approaching.
Should I find an Independent Insurance Broker that specializes in NJ Medicare plans ? If so, would someone post their favorite brokers ?
I have a list of plans from NJ State Health Insurance, would someone comment on some of the "better" plans in Essex county ?
I do prefer PPO plans (usually associated with a higher premium and out of pocket).Does the library or nearby senior centers offer any assistance in figuring out what plans that best suit my needs ?
NJ SHIP has offices in Summit and Florham Park. They can advise. Possibly even by phone.
Unclear from your post if you have yet even made a decision between Original Medicare and Medicare Advantage.Other resources for advice must exist.
Link is for the Senior Resource Directory published by SOMA Two Towns For All Ages. Check page 13 for Health Insurance Coverage resources. SHIP is what you are looking for. Their navigators will help you select the plan that works best for you.
Thank you dickf3 and Joan.
I'm leaning toward a Medicare Advantage PPO plan.
Would either of you know whether the SHIP Performance Ratings of NJ Medicare Advantage Plans are reasonably valid ?
If your experience is anything like mine, you probably have gotten lots of advertisements. There are multiple Medicare Advantage plans and Medicare supplement plans. Most provide coverage nationwide, so just looking at Essex County is not the main criteria. In my experience, the main decision is whether to go with the Medicare Advantage or the traditional Medicare part B with the supplement. Medicare supplements have different options and costs. You also need to consider the drug prescription insurance part D. None of these are free. You should talk with doctor(s) about what they can work with best. So, I did my homework on this and came up with the health insurance that works best for my wife and I. The Medicare booklet that Medicare will send you is very useful. I do know people who used brokers and were very satisfied and there may not be any cost for this broker service. If you are just turning 65, you also need to sign up for Medicare part A.
from Bob again: It is usually very helpful to talk with friends who have had to go through this process. It was confusing to me at first and took a while to better understand all the options. I did go to the Library and heard the presentation from the SHIP person and this helped. But my best advice came from a good friend and also from my doctor. The doctor may not be able to recommend any particular company, but the doctor may have an opinion on Medicare Advantage versus Traditional Medicare part B plus part D. Also, some doctors do not take Medicare, so you have to pay them direct.
After years of having good health and prescription insurance on my job, I now have good Medicare plans, but there are costs such as Medicare deductible, monthly costs for supplement plan G, and part D prescription insurance. I had a little shock over the costs of some of our prescriptions. All-in-all Medicare is great. But it does not cover everything, so do your homework.
As you are leaning toward Medicare Advantage, an advisor who is patient, diligent, knowledgeable and scrupulously honest is imperative. Unless cost ( for your medical care in years to come) is no object.
RobertRoe said: I had a little shock over the costs of some of our prescriptions.
I had a little shock over the costs of some of our prescriptions.
The entire US health care industry is thankful that costs such as these are not more widely known. Particularly by those with “good health insurance”. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.89
No one has mentioned one important fact about Medicare Advantage. If you choose Medicare Advantage, you essentially are making an irrevocable decision because you will not be able to qualify for a Medigap policy, which you need on traditional Medicare. Only four states, and NJ is not one of them, provide some level of guaranteeing enrollment at a later time with pre-existing condition protection.
A few things to consider when selecting a Medicare Advantage Plan:
Even with a PPO plan, there may be network considerations. If you like the doctor(s) you are using now, make sure they will accept the plan you choose and that they are in network for your plan.
Some plans may not offer coverage outside of the geographical area they serve. If you have a second home, travel a lot (pre-COVID anyway), make sure the plan you select will cover you in these alternative locations.
Take a close look at what services each plan offers. They are not the same. Make sure you are getting what you need now. There are annual transfer periods which will enable you to switch plans later if your needs and/or services covered change over time.
Read the list of covered drugs carefully to make sure the medications you take regularly are covered.
Look at the gross cost of each plan. Some may have lower premium but a much higher deductible or co-pay. Others may be more expensive up front but have lower deductibles/co-pays. Choose one that fits your budget plus your needs.
Customer service can be an important factor most don't consider when searching for a plan. If you have a problem with billing, finding a specialist you need, getting approval for medications not on the covered list, etc. having a phone number you can call to get the problem resolved quickly is a huge help.
Some plans may require that you receive your medications by mail or from one of their preferred pharmacies to get the best price on your medications. Make sure you will be able to continue using your preferred pharmacy if this is important to you.
We have had for several years quite excellent care through the United HC AARP Medicare Advantage hmo.
All of our doctors are in Summit Medical Group where there are choices of sites and optional doctors. Primary Care physician visit $5, Specialist $25 ER visit $90. The doctor's fees are waived during the pandemic. Other than the basic amount taken out of our Soc Sec there is NO monthly premium. I am just completing 4 weeks of PT at an SMG facility in Slringfield. Excellent!
We also just had our yearly in home nurse visit designed especially to screen for chronic issues such as diabetes.
I am full throated advocate for HMO care and this is an excellent one!
Thank you all for posting such great information !
In thinking about your Medicare plan question my thought is that if you do not have good knowledge or friends or SHIP to help you, then a broker is a good way to go. I have friends who did this and they were well satisfied. Unfortunately, I do no know any brokers or how to contact them. I expect that someone on this site can relay us this information.
As some have already said/implied, avoid Medicare Advantage plans. There is nothing free in these plans. You may pay little to nothing for a copay for a routine medical visit, but you may have an exorbitantly high copay for something related to mental health, as an example. I recommend plain-Jane Medicare and getting a supplemental insurance policy to pay copays and deductibles. Speaking from experience.
Point counterpoint. Medicare Advantage plans typically have a yearly limit on out of pocket costs for all medical care. Original Medicare does not. It is a big if, but if one was hospitalized for a couple of hundred days, that could be bankrupting with original Medicare. Not so with Medicare Advantage. Of course, the MA insurer could (and very well might) pressure the providers it contracts with to get that patient out of the hospital pronto, so a real long stay might never occur. Even if it was in the patient’s best interest not to leave. Whereas Original Medicare would need to to say “not medically necessary”, and have that stick.
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