The Challenge:
Help Joe and Alice make decisions about Joe reverting to Medicare, now that he is turning 65, Alice is 63 and their twin daughters are 24.
The Solution:
A combination of education, coaching, analysis, and research of available Medicare and private insurance options for Joe, Alice and their family.
The Result:
Joe retired and reverted onto Medicare Parts A & B, along with a Medigap plan and a Part D Prescription Drug plan. Alice and one daughter remained on Joe’s employer-sponsored plan via COBRA while the other daughter obtained health insurance through her full time employer.
One Size Doesn’t Fit All
Joe decided to retire when he first became eligible for Medicare. He went through the process of enrolling in both Medicare Parts A & B two months before he turned 65, so that his eligibility began on the first day of his birthday month.
Because Joe manages multiple medical conditions and uses significant amounts of healthcare services, it made sense that he would elect a “Medigap Plan.” This plan, which carries with it an additional, associated cost, would pay all medical bill balances after Medicare pays approximately 80%. Also, since Joe and Alice plan to live a few months of each year out of state, he needed benefits outside of a restricted network. He did not want the requirement of obtaining referrals, so a Medigap plan, along with Medicare Part A & B, afforded him that flexibility.
For Joe, a more restricted Medicare Advantage HMO or PPO plan (also called Part C), in lieu of traditional Medicare A, B, & D, did not make sense. Although possibly less expensive on a premium basis, it posed restrictions he did not want to live within.
Part D is Separate
Joe’s choice to enroll in Medicare Parts A & B and a Medigap plan meant he needed to conduct a careful analysis of his Part D Prescription Drug Plan options. He needed to identify the most cost effective plan that included his preferred pharmacy in its network. The analysis was based on the specific drugs he takes, including their dosage and frequency.
Joe learned that although his monthly premium was reasonable, he would still incur significant out of pocket expenses. He was able to predict when he would hit the donut hole thus allowing him to budget accordingly.
Making sense of complicated circumstances
Joe hired us to make sense of a complicated set of circumstances. Our systematic process took into account:
- His preferences for how he likes to access healthcare
- His level of utilization of the healthcare system
- His preferred providers, hospital and pharmacy
- His future plans to live elsewhere for part of the year
- His budget relative to cost options
- The healthcare needs of his family
Specifically, we:
- Provided a comprehensive list of questions that Joe, Alice, and their daughters answered. This allowed us to consider the needs of each member of the family separately.
- Conducted an initial meeting during which we educated Joe and Alice about Medicare; what the options are; what it covers and does not cover; and coverage levels.
- Analyzed all options and made specific recommendations for each family member, including estimates regarding future healthcare costs. We prepared a spreadsheet to outline expected costs for premiums, deductibles, co-pays, co-insurance and out of pocket expenses.
- Guided Joe through enrollment in Medicare Part A & B and enrolled him via online access in the appropriate Medigap and Part D Prescription Drug Plan.
- Interacted with the HR department at Joe’s employer to facilitate COBRA coverage for Alice and one of their daughters.
- Reviewed the health insurance options for Joe’s second daughter, taking into account her preferences and planned utilization of the healthcare system, and helped her make a selection.
Outcome:
Joe and Alice are very pleased with Joe’s Medicare choices. Alice will be eligible for Medicare just as her COBRA benefits come to an end and at that time we will identify the best Medicare options for her and assist with enrollment.
At that time as well, we hope that the daughter who is currently on COBRA coverage will have options through her own employer. If not, we will research options via the State Health Exchange, identify eligibility for any form of subsidy and assist with the enrollment process in an appropriate and cost-effective plan.