business matters
Insurance broker Caroline Kyne of Associates Benefit Corporation in Butler Township

Health care plans for retirement

Take time to weigh all your options

Local insurance agents recommend people consider their health care and prescription medication needs when shopping for government-funded insurance to cover them after retirement.

Medicare Supplement Insurance that is available to Medicare subscribers charges higher premiums, but no copayments, and provides large, national medical networks. Part D prescription drug coverage must be purchased separately.

Medicare Advantage plans, alternatives to Medicare, have lower premiums, higher copayments and require patients to see medical providers in a defined network, but many include prescription drug coverage.

Insurance broker Caroline Kyne of Associates Benefit Corporation in Butler Township there is a lot to consider when selecting retirement insurance, and she spends a lot of time explaining options to people.

“I think a lot of what I do is education,” Kyne said.

People must have Medicare Parts A and B to qualify to buy Medicare Supplement Insurance, also known as Medigap because itcovers gaps in Medicare insurance.

Medigap, which is purchased from private insurance companies, has plans A-N that cover various coinsurance payments, copayments and deductibles. Plan F is considered the most comprehensive because it covers Medicare Part B deductibles. Plan G is the second most comprehensive because it doesn't cover those deductibles.

When someone buys a Medicare Advantage plan from a private insurer, the government pays that company a monthly fee. That fee is the reason there are low or no monthly premiums in some Advantage plans, Kyne said.

“The company you go with adopts you from the government,” Kyne said.

However, some Advantage plans cost hundreds of dollars a month, she said.

Advantage plans require copayments for all services and most Medigap plans do not require copayments or coinsurance payments.

Medigap plans allow subscribers to go to any medical provider in the country in the Medicare network, and nearly all doctors are in the network, she said.

Advantage plan subscribers are limited to the providers in their plan's defined network.

Medigap subscribers have to bring their original Medicare card, Medigap card and Part D card to medical appointments, but Advantage plan subscribers carry only one card, Kyne said.

People receive a guaranteed authorization to buy Medigap plans when they sign up for Medicare. People who switch from an Advantage plan to Medicare could be denied Medigap due to existing health issues or could be charged higher premiums, she said.

Advantage plans include a cap on copayments, said Tim Powers, an insurance agent for HealthMarkets Insurance Agency in Butler.

“They have an annual maximum out of pocket in each plan. The financial risk is capped at certain level,” Powers said. “You have a small annual deductible and then your Medicare medical expenses are covered. There are no networks and those are national plans with national coverage.”

He said he talks to retirees to determine what their prescription, health and doctor visit needs are and proposes 10 plans that fit their needs.

“We can look and see what plan fits what their future health care need will be. It's more education than sales, We tell them what's on the market, what fits them best. Once they make a decision, we help them fill out the application,” Powers said.

He said his firm helps about 250 seniors select, renew or change plans at no cost during the annual open enrollment periods for Medicare and Medicare Advantage, and supports them throughout the year.

“If they have questions or don't understand billing or are put on new prescription or unsure about out of pocket costs — we support them throughout the year. We'll find answers to their questions,” Powers said.

Neither Powers or Kyne charge seniors for helping set up their Medicare or Advantage plans. The brokers are paid by insurance companies.