What are his medications and the copays under a Medicare Part D plan vs. the employer plan?

By Cheri Brown

Cheri Brown

Dear Medicare Cheri,

My husband will be retiring in 2023 and he’ll be 70 in January. I still work and my plan was to cover him with my work insurance. Not sure that is the best plan. The family plan PPO is about $572 per month with my employer.

But I got to thinking maybe Medicare with supplement PPO is better?

Signed,

Need Guidance

 

 

Dear Guidance,

Let’s start with definitions:

PPO’s are Preferred Provider Organizations. You stay in the preferred network and you pay significantly less than if you go out of the preferred network. They generally have high maximum out of pockets, as well as deductibles. Usually, this type of plan doesn’t require a referral to see a specialist.

Medicare Supplements don’t have a “network,” so you go to any doctor who accepts Medicare and if you go to a doctor who doesn’t accept Medicare — it is not covered.

There are several types of Medicare Supplement plans. The one I sell most frequently is the Plan G.

Plan G has a small deductible ($226 for 2023) and afterwards covers Medicare A and B costs at 100 percent.  This type of plan doesn’t require a referral to see a specialist.

To understand which path to choose, compare the monthly premium costs, the costs should he need healthcare, and most difficult, estimate your husband’s healthcare needs.

  • Let’s start with your monthly costs: how much will the Family Plan cost for your husband only (the cost for the family minus your cost alone). Then compare it to the cost of a Plan G plus the Medicare Part B premium.

If you make less than $194,000 per year in 2021 his Part B premium is $164.90 per month in 2023.

A Plan G for a 70-year-old man may be purchased for less than $160 per month. He will also need a Part D plan which varies greatly depending on his medications, the premium ranges from less than 10 to more than 100 dollars a month.

  • Should your husband need healthcare, what would it cost under the two plans?

With a Medicare Supplement Plan G and Medicare, he would pay $226 for A and B covered healthcare, then nothing more as Medicare and the Medicare Supplement would pay for the remainder.

What type of coverage does your company offer? What are the deductibles, maximum out of pocket costs? And does your company offer a healthcare savings plan for spouses to cover the deductibles?

What are his medications and the copays under a Medicare Part D plan vs. the employer plan?

  • Finally, what type of healthcare needs do you believe your husband will have in 2023?

To discuss this further, or any other questions you may have, please call or email me for an appointment.

To see the Medicare Part B premiums and deductibles for 2023 go here: www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly

Cheri Brown is a licensed insurance agent with decades of experience with Medicare health insurance plans. She can be contacted at (408) 476-0034, [email protected] and through her website www.cheri-brown.com.