Apr 3, 2018 By Jim Blair for The 5 min read

There is still a huge number of people who are turning 65 every day.

These are still the Baby Boomers. About 6 months before these people turn 65, their mailboxes start to fill up with solicitation after solicitation from both familiar and unfamiliar companies with different types of Medicare plans they feel you should have.

There are also announcements of seminars and informational meetings to explain the plans they have.

In this column, I am going to explain the basics and advise you on what you should and should not do while considering your Medicare plan for the first time.

Just about everyone is eligible for Medicare when they turn 65. There is Part A and Part B. If you continue to work, and have employer group coverage that is qualified, in most instances you don’t need to take the Part B. Part B is the part you pay for.

In the simplest terms, Part A covers hospital stays, skilled nursing, home health care and hospice. Part B covers doctor visits, lab, medical equipment, some types of drugs. Both A and B have a deductible. Both A and B have cost sharing.

If you had just original Medicare A and B, you would still need to sign up for Part D, which is prescription drug coverage which again you pay for.

In light of the above, most people opt for some type of supplement to fill in the gaps. There are two types of supplements. Medicare Advantage, and Medigap. Here in western Pennsylvania, the most popular plans are the Medicare Advantage plans.

Medicare Advantage plans are Part C. Most of these plans cover all the bases, including prescription drug coverage. They all have to cover what original Medicare covers. They all cover things Medicare does not cover, like dental, preventative vision, some types of chiropractic care, some types of podiatry not covered by Medicare. They also have additional benefits like gym memberships and travel benefits.

They all have an out-of-pocket maximum, which means if you reach that amount, you pay nothing for the balance of the year for your medical expense. Medicare Advantage plans are guaranteed issue, which means they can’t turn you down. There is only one exception, and that is if you are on kidney dialysis. These plans are also very reasonable. The most popular plans have been the $0 premium plans. That is correct, $0 premium. You get all these benefits and you pay nothing except your Part B to medicare. There are both HMOs and PPOs in our area. HMOs require you to get services in network only. PPOs have both in- and out-of-network coverage, but out-of-network services cost more.

Medigap plans are all standardized plans offered by a variety of companies. The most popular plans are plan F, G and N. They all work the same way. Medicare is billed first and your Medigap company pays all or most of what Medicare did not pay. In Plan F, whatever Medicare does not pay, the plan pays.

Keep in mind, these types of plans only pay what Medicare pays. There are no extra benefits like in Medicare Advantage. They are also more expensive and the premiums increase with your age. They are guaranteed issue when you first become eligible for Medicare coverage. In addition to the Medigap plan, you will also need to enroll in a standalone drug plan.

As you can see, going on Medicare and picking what plan you need is not all that easy. With the constant bombardment of solicitations and information from all sides including friends relatives and the neighbor down the street, you need some professional help. So here are some suggestions on how you can make an informed decision.

Attending seminars, educational events and requesting information from one company will give you just that, one company and one type of plan. A better option is to ask a company your interested in if they have a broker who can help you. You might want to meet with a couple of brokers to discuss all your options. You want to be sure the providers you want to use are part of that companies network. You will want him or her to see what company covers your prescriptions the best. You will want to see if the fitness facility you would like to attend is part of the plan benefits. You will want to compare types of plans and what they offer as additional benefits. There is no one-size-fits-all, and that is why it is advisable to have help. The ideal broker is someone who represents all of the most important providers in our area. He or she should be well versed in original Medicare, Medigap plans, Medicare Advantage and standalone drug plans.

Remember you can change your plan every year during the annual enrollment period from Oct. 15 to Dec. 7. Remember all plans are guaranteed issue first time. Medigap plans are medically underwritten after your initial enrollment.

One of the best things about becoming eligible for Medicare is that the cost of your healthcare is drastically reduced. You do not need to spend a lot of money on a supplemental plan. The plans with $0 premium have the same out-of-pocket maximum as the $300 plans. Co-pays will be lower with the $300 plans, but it is going to take a lot of lower co-pays to make up the $300 you pay out each month for your premium.