Retirees all face one particularly complicated decision – Medicare.
Daunting enough to turn most stomachs, it’s often a confusing and time-consuming topic.
A clear explanation of the basics can help make the decision more straightforward, although not without challenges. And this year, we need clarity more than ever with the passing of the Inflation Reduction Act. 
This year, it’s a MUST for retirees to review their plan, as everyone is impacted. Using professional help in this case may be one of those rare, but clear, no-brainers of life, as it helps navigate the confusion without costing a penny.
Medicare is a health insurance coverage available to folks when they reach age 65, and those younger who qualify for Social Security Disability Income. Now for a simplified approach to the options.
Original Medicare:
Medicare encompasses Parts A & B and are very comprehensive, but there are holes in coverage, creating potential out-of-pocket expenses. One hole includes the Part A deductible and copays for hospital stays, skilled nursing care for rehab residential facilities, and hospice, as well as the Part B deductible and copays.
Most of these holes can be filled with Medicare Supplement plans, known as Medigap. The Center for Medicare Services designed these plans to fill various combinations of the holes. Plan designs are identical and offer identical coverage regardless of which carrier offers them, so consumers can compare the plans as well as, considering the premiums.
With Medicare Part C, also referred to as Medicare Advantage. This plan option usually has little to no upfront premium cost for the plan, other than the Medicare Part B premium which still needs to be paid. A potential negative is between copays, deductibles and coinsurance payments, annual out-of-pocket max could be as high as $8,300. Other benefits Part C Plans may offer are the ancillary benefits, such as reduced costs or partial reimbursement for eye exams and glasses as well as hearing aids, and maybe even dental benefits that are not covered by Medicare. They also offer prescription drug coverage. Keep in mind, it is very important to make sure your Dr’s, specialist and Hospitals are part of the Network you choose. 
Medicare Supplement plans don’t cover prescription drugs. Enter Medicare Part D for prescription coverage. Unlike the Medicare Supplement plans which have standard plan designs, every carrier offers its own plan designs. Part D prescription coverage is complicated and difficult to compare as designs vary by premiums, different copayment amounts for different tiers of medication (generic, brand or specialty), and different protocols for step treatment, when the insured might have to be prescribed a generic to see if it works before a brand-name medication is authorized for coverage.
The most notable provisions to the Inflation Reduction Act are in the areas of the prescription drug price reform, affecting Part D:
- The infamous “Donut Hole” has been eliminated in 2025. Once $2,000 has been paid by the member, then they enter the catastrophic phase where they pay nothing for Medicaid-covered Part D prescriptions for the rest of the year.
While the goal is to lower prescription drug expenses for consumers these changes could result in higher plan premiums in 2025.
Deciding whether to select Part A, plus B, and possibly supplements and D, or choose Part C, requires consideration of many options regarding which plan benefits a person most. Consumers can select plans designs independently, but there is no cost savings for doing that. It is wise to use the expertise of a professional who is licensed to sell the full spectrum of Medicare Supplement and Medicare Advantage plans. With the significant changes this year, it’s important to get help early so you can see how the new legislation affects you and weigh your options.
While Medicare planning is the no-fun part of retirement, there is help for the journey.
