Earlier posts concentrated on the pluses and minuses of private Medigap insurance (the left hand side of the "Medicare and You" decision tree--see image) as a supplement to your Original Medicare. You can buy Medigap insurance in Massachusetts any time -- effective the first of the following month -- so you are not under the gun the way those of you thinking Part C are (it is not true that you can buy Medigap any time in many other states so be careful if you are reading this from out of state or are not a legal resident of Massachusetts).
About half of you who buy Medicare supplement insurance individually in Massachusetts are under the gun to make a Part C decision by December 7th if that is the way you have decided to go (the right hand side of the decision tree).
Let's start with the pluses and minuses of zero premium plans. There are 14 public Part C Medicare Advantage health plans with built-in drug coverage (see Note) available on the Cape for 2014 and two of them -- one from Tufts and one from Blue Cross -- are zero-premium. How can the insurers charge no premium you ask? What's the catch?
The answer is that insurance companies that administer Part C Medicare plans receive a capitated payment for you and have negotiated prices with their network of providers ahead of time. (That's the way all capitated plans -- mostly HMOs -- work; it has nothing to do with Medicare.) Conversely the insurance companies that administer Original Medicare Parts A and B and their own private Medicare supplemental plans get paid only each time a service is provided and they have to pay a rate set by the government. (Of course, these are all the same insurance companies.)
The plans with zero premium usually get to that price by offering a higher annual out of pocket (OOP) limit and/or higher copays than most Part C plans (but still much less than A and B by themselves and with A and B your OOP is unlimited). In this particular case, the Tufts and Blue Cross zero premium plans have a $6700 out of pocket max whereas their other Part C plans cap your annual expenses at $3400. The two zero-premium plans have higher co-pays as well. They may or may not have more constricted provider networks for their zero-premium plans (check in particular that Cape Cod Hospital is in their network for the zero-premium plan).
Find out what's happening in Barnstable-Hyanniswith free, real-time updates from Patch.
More to come on Part C soon, including more on provider networks and why choose a local insurer such as Tufts vs. a national insurer such as AARP.
NOTE: There are also plans with no built-in drug coverage, designed for people on Medicare who get their drug coverage from a former employer or the VA or some other "creditable" source. The word is "creditable" not "credible" and it's important.
