Living Local — Finalizing My Medicare Advantage Plan

Finalizing my Medicare Advantage Plan

I will turn 65 this January, so I was able to sign up for Medicare as of October 1via https://www.ssa.gov/. Like most people my age, I will not consider going on Social Security for at least another year, so I went straight to the Medicare Enrollment section. The initial signup went very smoothly and I quickly received word (and later a card) that I had been accepted into Medicare.

Note: From here onward, all the decisions I made are based upon my personal circumstance. I’m a healthy self-employed single male who spends 90% of my time in the Las Vegas area. I’m not currently under treatment for any chronic conditions and I don’t have an existing close relationship with any physician.

From the get-go, I signed up for both Plan A (Hospital, free) and Plan B (Medical, $433 every quarter). The next step is to decide what additional coverage I may need, including Part D (Prescription Drugs), a Medicare Supplement Plan (a.k.a. Medigap), or a Medicare Advantage Plan (private insurance that replaces A & B and includes drug plans and other benefits.)

In general, Medicare Supplement plans are designed to cover Medicare deductibles and require additional funds. Medicare Advantage doesn’t require funds above and beyond what I’m already paying for Part B. However, you’re restricted to use network doctors and hospitals and need a referral to see specialists (through your “primary doctor”). It should also be noted that Southwest Medical, one of the valley’s largest medical providers, does not accept new patients with traditional Medicare, but only through specific Medicare Advantage plans.

To guide me through this mess, I turned to Marcia Simpson, a certified Medicare counselor, who operates a booth at the Fantastic Indoor Swap Meet on Decatur Boulevard. Based on the mail I received and some initial searches on the web, there are an abundance of Medicare counselors in the Las Vegas Valley and I recommend that everyone dealing with Medicare use one, as they’re free of charge to the applicant.

Before meeting with Marcia, I had already done considerable research into both Medicare Supplement and Medicare Advantage plans and had settled on a MAP through AARP and United Health Care. Though I didn’t tell her of my choice, Marcia suggested the same plan, but one that also included Walgreens for no or low co-pay generic prescription drugs.

My Medicare Advantage plan is accepted throughout the valley. Besides no co-pay and a $1,000 out-of-pocket medical-care maximum, my plan also includes up to $1,000 in covered dental, a fitness program through Renew Active, a Personal Emergency Response System, and a $240 credit on approved health products through Walmart.com. As someone who believes in taking full advantage of already purchased or earned benefits, I will be thoroughly investigating all aspects of the plan over the next few months, but so far so good.

Marcia also gave me a list of primary doctors with strong ratings who are in both my network and neighborhood. I chose one. According to Marcia, I can change personal physicians at any time and if my circumstances change, I can switch plans during open enrollment periods (October 15 – December 7).

As I said at the beginning, this MAP works for me, but if you’re currently part of a private health plan through your employer, have a chronic condition that requires specific treatment or medication, or are a snowbird who spends large parts of the year elsewhere, you may want to consider other alternatives.