We each make choices every single day of the week.
Choices such as what time we get up, what we eat for breakfast, and what we wear are made every morning.
Choices as to where we work, the friends we socialize with, where and who we live with are made with happiness in mind.
Choices as to what we read or watch on television before heading to bed may or may not affect how we sleep.
When working with clients on their Health or Medicare Insurance needs, the choices they make can affect where they get their healthcare.
With working with Life Insurance clients, the choices they make can affect their budget, their lifestyle should something happen, and can affect their family for years to come.
Often this question is asked of me, “If this were you, what would you do”? It’s difficult to answer that question because every person is different. What would work for you may not work for me.
Let me give you an example:
A client that will be eligible for Medicare wants to know which choice is best for her – either a Medicare Supplemental plan or a Medicare Advantage Plan. In this case, she is 65 years old. Here are some of the costs associated with each plan:
Plan G Medicare Supplemental Plan – $136.05 a month – On this plan, she would have to pay a deductible of $135 each year. Other than the deductible, there are no other out of pocket costs. She doesn’t have a network for this plan so as long as the hospital/physician take Medicare, they would take this plan.
Medicare Advantage Plan – $0 (That’s right, there is no premium for this plan) – With this plan, however, there are out of pocket costs associated with it. For instance, there would be co-pays for physician visits of $20 unless it is a yearly physical, there would be a co-pay of $295.00 per day for hospital visits for days one through six. There would be co-pays for X-rays, lab work, physical therapy, etc. The total out of pocket maximum for this plan is $6,700 each year. With that said, there are many people that never hit that maximum.
In this example, you are looking at costs associated with each plan and then weighing which plan would work better for you.
With the Medicare Supplemental Plan, your out of pocket costs for the premium would be $1,632.00 ($136.05 X 12) plus the deductible of $135.00 for a total of $1767.60.
With the Medicare Advantage Plan, it’s difficult to know how many times you will go to the doctor, have a hospital stay, etc., however, in this case, she looked at her last three years of healthcare to come up with a figure. She went to the doctor approximately three times a year (physical and sick visits). If she was to go to the doctor in the next year three times, she would be pay $60.00 ($20.00 X 3). She didn’t have any hospitalizations in the last three years and we never know what the future holds, but in this case, she added another $885.00. She did this by calculating an average stay at the hospital which is three days and then the co-pay of $295.00 per day. Adding all of this up, she would have an out of pocket expense of $945.00 based on these figures.
In the end, she chose the Medicare Supplemental Plan because she wanted to have access to a larger network if she needed it. She had a history of cancer in her family and was more comfortable with that plan.
Another person would have chose the Medicare Advantage Plan and would have been perfectly comfortable with their choice.
Many times, a call will come in and they want to compare what they are offered either through COBRA or a retirement plan.
In these cases, we look over what they have and do a side by side comparison of other plans that are offered to them.
In many cases, people will likely choose a less expensive plan. A less expensive plan, however, may not be the best option because of the out of pocket costs associated with the plan.
At Balanced Care, we stress the importance of educating you on what is available to you even if that means you don’t purchase a plan from us. This happens often if the potential client is offered a retirement health plan with a lower premium and/or deductible.
In the end, you will have a choice to make.
It’s our goal to keep it as simple as possible. You are purchasing an insurance product that will provide protection for you and your family when you need it the most.
With Balanced Care, nothing is more important than that choice.
Terri Trepanier is the owner of Balanced Care Health and Supplemental Insurance and a licensed insurance consultant and broker with Associated Brokers. Licensed in both Maine and NH, her specialty is working with small businesses, individuals, and families with their health and life insurance needs. She is certified to offer health plans both on and off the exchange and is contracted with every health insurance company that offers plans in both New Hampshire and Maine. Her other passion is assisting Medicare beneficiaries with their Medicare Supplemental, Medicare Part D Prescription Drug Plans, and Medicare Advantage plans. Terri has seen firsthand the importance of insurance products and how they help families. Her goal with Balanced Care is to “Insure Security and Peace of Mind One Family at a Time”.