If you are approaching 65 or even if you are 65 or older and have already selected a Medicare plan, you may be wondering, “Which Medicare plan is right for me?”
Medicare Plans age 65 to 70
I have never met Mr. and Mrs. Average. But I have read studies which claim that until age 70 they are better off paying the lower premiums for a Medicare Advantage plan. The trade-off for the lower premiums is a higher co-pay: 20% of “everything.” During their relatively health 60s, Mr. and Mrs. Average may not have a lot of medical expenses. They may also enjoy Medicare Advantage plan add-ons: vision, dental, in some areas, even gym membership. Today about 1/3rd of people signing up for Medicare choose a Medicare Advantage plan.
Medicare Plans at or soon after age 70
At or soon after age 70 Mr. and Mrs. Average may find that their co-pays rise to the point that they outweigh the lower premiums. They may also begin to develop more conditions which are not covered by physicians who are “in network.” M.D. Anderson, for example, does not accept Medicare Advantage.
For Mr. and Mrs. Average, and for anyone whose income is so low that Medicaid pays part or all of the Medicare premium, “traditional” or “original” Medicare may become a safer bet…when paired with Medicare Part D (prescription drugs) and a Medicare supplement policy, often called, “Medigap.” A Medigap plan is designed to help cover the co-pays.
Some even include travel plans which pay for 80% of bills when you travel outside the county for up to 60 days (Medigap C, D, F, G, M and N).
Almost no Medicare plan covers hearing aids, eyeglasses, private duty nursing or long-term care. You must budget to pay for these out-of-pocket or, for long-term care, buy an insurance policy or rely on Medicaid.
More doctors, hospitals and nursing homes accept traditional Medicare than do Medicare Advantage, meaning it may be the best choice from the start. If you start with Medicare Advantage, traditional Medicare is not obliged to accept you if you decide to switch later and, if you have developed a health condition, is unlikely to do so.
The Medicare open enrollment period is October 15 – December 7. You can switch policies then.
For more information, go to www.tdi.texas.gov, www.medicare.gov or, in Central Texas, Capital Area Agency on Aging. You can also make an appointment to visit a counselor at the Capitol Area Agency on Aging by calling (512) 916-6054.
Estate Planning attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.
She assists families of people with special needs, people planning for the retirement years and people administering estates.