Most seniors enjoy Medicare, which is our government’s health insurance plan. Original Medicare (Medicare Part A and B) has been viewed as somewhat limiting. Many seniors enroll in a Medicare HMO (often referred to as a Medicare Part C or Advantage HMO Plan) in an effort to reduce their out-of-pocket medical costs.
For example, Mrs. Smith is eligible for Medicare, and has chosen a Medicare Part C Advantage HMO Plan rather than the original Medicare Part A and B. She is now insured by a private insurance company, such as Kaiser, Blue Shield 65, Secure Horizons, or any one of a number of other companies. Mrs. Smith believes that the new Medicare Part C Advantage HMO has more benefits and will reduce her out-of-pocket expenses. If, however, Mrs. Smith has a catastrophic illness and requires skilled nursing care, she can only go to a nursing home that has a contract with her new Medicare Part C HMO. Mrs. Smith knew the HMO limited her choices in doctors, but didn’t realize that her choice in skilled nursing facilities was also very limited.
There is a tremendous difference in nursing homes regarding quality of care, quality of facility, location, etc. If Mrs. Smith had her original Medicare Part A and B, she could have chosen from a much larger group of skilled nursing facilities. If you are considering a Medicare Part C HMO, carefully consider the benefits. On its face value, the offered benefits may be attractive, but the nursing homes available to you under these plans may be less than acceptable and the locations may not be desirable.
In the alternative, Mrs. Smith could keep her original Medicare Part A and B, and purchase a Medicare Supplement Policy, usually referred to as a Medigap policy. Medigap is designed to pay for services not covered by Medicare such as co-insurance, co-payments, deductibles and other costs. Mrs. Smith also has the option of choosing from one of 12 different Medigap policies that are available to her.
Confused or overwhelmed? There are specialists who can guide you in your choices. One specialist, Helene Lederman, of CIS Insurance Services, Inc., can assist in choosing the correct supplemental policy for your needs and your situation. If a Medicare Part C HMO is your preference, Helene can also assist by comparing the benefits offered by each company.
Many of us have said, “It will never happen to me – I would die before I go into a nursing home.” Some things, like illnesses and disease, are out of our control, but choosing the best Medicare insurance for your situation is within your control.
For more information, Helene Lederman of CIS Insurance Services, Inc. can be reached at 661-799-2730 and Jane M. McNamara, Esq. can be reached at 661-287-3260.