UNITED STATES─Dear Toni: My mother has recently been laid off and losing her company benefits effective August 1.  I need help finding a Medicare Advantage plan that can better meet her medical needs.

She receives $1,350 on her Social Security check and cannot afford to purchase a Medicare supplement. Can you please advise me what I can do to help my mother make a better choice in picking a Medicare Advantage plan?  I look forward to what you have to discuss since you counsel people every day on the maze of Medicare.

Thank you, Becky from Katy area.

Hello Becky: I know how confusing enrolling in the right Medicare Advantage plan is for your mother because I talk to clients every day who ask the same question. I also help my own mother with her Medicare Advantage plan!!

Here is step by step advice on what you can do to help your mother make the correct choice for her Medicare Advantage plan or Medicare health plan as it is called in the Medicare and You Handbook.

1)       Talk to your mother’s primary care physician or specialists to see which Medicare Advantage plans, they are still accepting.

2)       Go to www.Medicare.gov which has the best tool for helping you narrow your search for a Medicare Advantage or Medicare Part D drug plan.

  • Click on “Find Plans” which is next to “What’s Covered” and click on “Continue without logging in” then follow the steps. You can use the plan finder to compare the different Medicare Advantage plans or even compare standalone (Part D) Medicare Prescription Drug plans. The Medicare Supplement area is a little confusing and may not be a good option to view.

3)       With Medicare HMOs, there is less out of pocket, but you may have more restrictions because some Medicare HMOs must have “Referrals” and some HMOs have “Open Access” options which says that you can go to any specialist without referrals.

5)       Medicare PPOs and PFFS plans may have less restrictions, but may have more out of pocket when choosing out of network VS in-network providers.

6)       Areas in the summary of benefits for Medicare Advantage plan you need to review:

  1. Maximum out of pocket-This is the most she will have to pay in a year. Many are not aware that Medicare Advantage plans have maximum out of pocket.
  2. Inpatient hospital care:

-Some plans have a single co-pay such as $300 or $500 per stay for inpatient hospital stay (example only)

-Some plans may be $150 co-pay per day for days 1-5 with a maximum of $750 maximum stay if you are inpatient hospital for more than 5 days. Some plans may have more out of pocket (examples only)

  1. Outpatient services/surgery

-Some plans have 1 co-pay for $100 per stay (example only)

-Some plans have 20% or 30% outpatient charge for out of network charge (example only)

  1. Ask what the co-pay is for Chemotherapy or radiation. This may meet maximum out of pocket.
  2. Prescription drug has a formulary with co-pays so make sure her prescriptions are covered.
  3. Skilled nursing out of pocket-this varies with each Medicare Advantage plan. Plans are $175 co-pay per day for 21 to 100 days which can be a maximum $3500 if you are in the hospital for over 21 days (example only)

To understanding the maze of Medicare and discover which Medicare plan meets your needs, call the Toni Says® Medicare office at 832/519-8664 or email info@tonisays.com.

Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the  Medicare Survival Guide® Advanced book and bundle package for the Toni Says® readers and friends at www.tonisays.com.