Are all Medicare plans the same? No, they are not.

By: Lupe Bruneman, HCMBA
Ph: (786) 322.8633

Para leer en Español

When you’re looking for information regarding Medicare and what health plan to choose, you may happen to ask your neighbor, a friend or a family member.  They may tell you about certain benefits that you didn’t know about and you obviously wonder if you can get these benefits too.  This article will help you understand some of the major differences between Medicare health plans and their products, and why these are NOT all the same:

1. According to Medicare.gov, In Dade County alone, there are 19 health plan companies offering 97 different Medicare products. So even if you speak to someone and they mention the name of a plan, each plan can offer several different products. For example, HEALTH PLAN “A” can offer 4 DIFFERENT BENEFIT PRODUCTS. Someone can say they are enrolled with HEALTH PLAN “A”, but they may have a different product than you. In that case, their benefits will be different.  Choosing a health plan product depends on your specific situation.
2. If someone is considered low-income, they may be entitled to Medicaid. The income guidelines are set by the State of Florida Department of Children and Families. If this is the case, their benefits are going to be much richer than yours because they have Medicaid. Many people don’t share the fact that they have Medicaid because this information is typically considered very personal as it involves their finances. They may still share they are insured by “HEALTH PLAN A” and you think you should be eligible for their same benefits, but if you don’t have Medicaid, then their benefits will be different than yours.
3. If you take a lot of medications, this could affect your out-of-pocket costs negatively, even if you are in the same plan as someone else. This is because each plan product provides a different budget to cover medications. For example, even if 2 people are enrolled in HEALTH PLAN A, if your product is different than theirs, their budget might be $6,000 and your budget might be $4,500.  This means they are going to have more medication coverage than you.  Also, if they have Medicaid and you don’t this means they have complete coverage for their medications, while yours is limited to the budget stated by the plan. After you’ve spent the budget amount, your out-of-pocket costs will increase. 
4. Most Primary Care physicians have contracts with different Medicare insurance companies. So even if you have the same doctor as someone else, if you are in a different plan, your benefits will be different.

Keeping all this in mind when you talk about your healthcare choices will ensure you understand everything that may be available to you.  If you have questions, please call an experienced, licensed and trained Broker.  At Advocate Health, we can help you. Call us any time and please STAY HEALTHY!