Mistakes To Avoid During Medicare Open Enrollment with Danielle Roberts, #229
How does Medicare Open Enrollment work? Do you need a supplement plan? How do you choose between a Medigap or Medicare Advantage plan? Navigating these questions can be overwhelming.
That’s why Danielle Roberts—co-founder of Boomer Benefits and the author of “10 Costly Medicare Mistakes You Can't Afford to Make”—joins me in this episode to help you avoid common pitfalls during Medicare Open Enrollment.
You will want to hear this episode if you are interested in...
[1:42] How Medicare open enrollment works
[3:45] Do you need a supplemental plan?
[5:13] How CMS changes impact plans
[9:37] Comparing Medigap vs Medicare Advantage
[12:41] The typical annual rate increase
[15:21] How Medigap plans work when you move
[16:12] When to choose a Medicare Advantage plan
[19:34] How Medicare Part D works
[21:38] How to choose between Medigap vs Advantage plans
[24:06] How to choose a broker to work with
[27:05] Start researching your Medicare options early
[28:06] How to get a free copy of Danielle’s book
Do you need a Medicare Advantage or Supplement plan?
Original Medicare involves cost-sharing for deductibles, copays, and coinsurance, covering 80% of your medical costs while leaving the remaining 20% for you to pay indefinitely. With no out-of-pocket limit, expenses for treatments like dialysis, chemotherapy, or durable medical equipment can skyrocket. To mitigate these costs, you can choose between two options: Medigap or Medicare Advantage plans.
Medigap vs Medicare Advantage
Here’s how the two differ:
Medigap (Medicare Supplement Plans): These plans allow access to every Medicare provider nationwide without requiring referrals or designated primary care providers. Medicare pays its portion, and Medigap covers the rest. Plan G and Plan N are the most comprehensive and popular options.
Medicare Advantage: Known for lower premiums, these plans operate through HMO or PPO networks, meaning you must use in-network providers and ensure your medications are on the formulary. Many plans also include additional benefits like dental, vision, hearing coverage, and gym memberships.
When deciding, it’s crucial to weigh your healthcare needs, budget, and provider preferences. Danielle also explains how rates can vary by state and what to expect for annual premium increases.
How Medicare Part D works
Medicare Part D plans cover prescription drugs but have significant variability. They are required to cover specific drug classes but only need to offer two medications per therapeutic category. Premiums range widely, from free plans with higher deductibles and copays to robust options around $40–$60 per month.
When selecting a plan, account for potential future health needs since changes are only allowed once annually. Looking ahead to 2025, the out-of-pocket limit for Part D plans will be $2,000, which provides additional security for high-cost prescriptions.
When to Choose a Medicare Advantage Plan
In some states, such as Florida, high Medigap premiums make Medicare Advantage plans an appealing alternative, especially for healthy individuals or those on fixed incomes. These plans typically mirror group health insurance plans you may have had before turning 65, with defined costs for specific services and an annual out-of-pocket cap.
Starting in 2025, the maximum cap for in-network services will be $9,350. If you anticipate difficulty covering this amount, consider these options:
A Medigap plan, which provides comprehensive coverage with no annual cap.
Working with a broker to find a Medicare Advantage plan that aligns with your financial and healthcare needs.
How to Choose the Right Plan
Deciding between Medigap and Medicare Advantage comes down to evaluating your financial situation, healthcare needs, and comfort with network restrictions. Danielle outlines a step-by-step process in the episode to help you make an informed decision.
Medicare decisions are complex, but with the right guidance, you can avoid costly mistakes. Tune in to learn how to select the best plan for your unique needs.
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