By: Lupe Bruneman, HCMBA
Ph: (786) 322.8633
So, you happen to be speaking to your neighbor, a friend or a family member about their Medicare plan, and they mention benefits you are not receiving, and you obviously wonder why this is happening. There are several reasons why this could be:
1. In Dade County alone, there are 14 health plan companies offering 83 different Medicare products. So even if the person you’re speaking with gives you 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 can be less than yours, or richer than yours. It depends on their specific situation.
2. If someone is considered low-income according to State of Florida Income guidelines set by the Department of Children and Families, they may be entitled to Medicaid benefits. If this is the case, their benefits are going to be much richer than yours because they have Medicaid and you don’t. 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 you are not if you don’t have Medicaid like they do.
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. STAY HEALTHY!