Membership at Assurance Healthcare & Counseling Center of Yakima, WA can work alongside Medicare perfectly, you just want to structure it correctly so you aren’t paying too much out of pocket each month.
Why keep Assurance Membership? Hopefully you’ve already experienced that we are simply doing healthcare differently. We can get you in quickly, spend the time with you that you need, and cut down on referrals to specialists dramatically.
Get Professional Advice: Our Recommendation…
Talk with a trusted Medicare broker, and let them know you want to keep your Assurance Healthcare membership. If they say that our membership cannot work with Medicare or doesn’t make sense, we recommend finding another broker, as our membership can work with Medicare, you just need to find what works best for your specific situation.
If you aren’t sure who to use for a broker, we recommend Rick MacDermid at Senior Solutions.
They are conveniently located in our same building! You can also call them at (509) 494-4288. Tell them that you are a member with Assurance Healthcare & Counseling Center, and that you’d like to include membership as part of your healthcare plan alongside Medicare. He’ll take care of you!
If you want to navigate things yourself, here is what we recommend…
If you want to research on your own…
If you are convinced that purchasing a supplement to Medicare is best for you (see our recommendations below), make sure you do not purchase an HMO or EPO plan.
HMO / EPO plans lock you into using specific providers, and if we (providers here at Assurance) need to refer you to a specialist outside of our clinic, HMO / EPO plans will not allow us to refer. You would then be required to see another primary care physician in order to refer you to a specialist. This becomes an enormous headache because other primary care providers are often 3-6 weeks out from an appointment, and they would be doing the same work we’ve already done.
Some key questions to ask a broker…
- If my primary care provider is out-of-network, can they still refer me to specialists with this plan?
- If I vacation outside of Washington State (if you intend to), does this plan “travel” well?
- What is my TOTAL cost per month on this plan? Including Original Medicare?
Resources…
Before reading below, here are some resources that could help you in your decision to craft a health plan that works best for you…
- Medicare Overview (Assurance Version): PDF Download (NOTE, This is likely outdated, and will be updating this soon! This is as of July 2024).
- 2024 Medicare Costs: Official Medicare Document
Our recommendations for pairing Assurance with Medicare…
Updated July 2024:
Overall, we recommend you speak with a knowledgeable broker (again, Rick MacDermid with Senior Solutions is our current trusted source, although there may be others out there).
Option 1) Assurance Membership, plus Original Medicare and a PPO Supplement. In the past couple of years, some select Medicare Advantage plans have become available in Yakima that are a good combination of $0 cost (you have to pay Original Medicare fees still) and a PPO plan. Ask your broker if these exist, and if they might work well for you. Our main question here is whether they “travel” well if you plan on leaving Washington State for vacations or other reasons.
Option 2) Assurance Membership, plus Original Medicare (including Part D), plus a Medigap (Part C) plan. Overall, you should look for a Medigap plan that doesn’t cost more than $80 per month above your Original Medicare costs. This would limit your out-of-pocket amount to the deductible that the Medigap / Part C supplement allows.
Option 3) Assurance Membership, plus Original Medicare (including Part D). We have a longer explanation of why this could work for you…
This plan works for those that are in fairly good health, are financially stable, and looking for the best care at the most reasonable price. The only thing this plan leaves out is the ‘supplement.’ You will mostly be responsible for 20% of ‘medicare-allowable charges’ (the key is medicare-allowable), which in most cases is quite affordable.
Let’s use a specialist visit (orthopedic surgeon, urologist, etc.)as an example…
Specialist Visit Example
Specialist Office Visit Charges: $220 (or sometimes up to $480)
Medicare Part B Allows: $80 (no matter what they charge!)
Medicare Part B Pays: $64
Patient (or supplement) Pays: $16
NOBODY PAYS THE DIFFERENCE BETWEEN WHAT MEDICARE ALLOWS AND WHAT THE OFFICE CHARGES! That $140+ is paid by nobody, and simply goes away.
Medicare has already done the work of SETTING prices (they don’t negotiate prices – they SET prices), which is good for you as the patient.
Now, let’s use an example of a knee surgery…
Knee Surgery Example
Hospital + Provider Charges: $16,000
Medicare Parts A+B Allow: $6,000
Medicare Parts A+B Pay: $4,800
Patient (or supplement) Pays: $1,200
Again, THE $10,000 DIFFERENCE BETWEEN WHAT IS CHARGED AND WHAT IS ALLOWED IS PAID BY NOBODY – IT GOES AWAY.
In our opinion, it makes little sense to pay ~$100 per month for a supplemental plan that ends up paying a small fraction of the cost of service.
This plan cost will depend on your income. Part A has already been paid through your wages, so long as you have worked 40 quarters of your lifetime.
Here is a link to Medicare’s Plan Costs.
If you’d like to schedule a meeting and hear more information about Medicare in general, feel free to call our office to schedule an appointment or reach us through our contact page.
Frequently Asked Questions…
I currently have a plan with my employer… should I stay with them?
As with most things, it depends. Your Human Resources contact should know more about whether it makes sense to continue on your employer’s plan or to sign up directly with Medicare. If you’re unsure who to speak with, ask to speak with their insurance broker or agent.
I currently have Health Sharing / Medical Cost Sharing plan – should I sign up for Medicare or continue with them?
In nearly all cases, you’re better off signing up for Medicare now (your premium will continue to increase the longer you wait after age 65 to sign up with Medicare – which they call a ‘penalty’) and considering one of the above options. Some medical cost sharing plans won’t work after age 64, and other health sharing ministries turn into an expensive supplemental plan.
For example; with Liberty HealthShare, they have an option that looks a lot like a supplement, but the price increases after you turn 65. We would recommend dropping Liberty HealthShare and signing up for Medicare alone using one of the above options. If you really believe in what Liberty or your Health Sharing Ministry is doing, we recommend donating to them to help others.
Samaritan Ministries is one health sharing ministry that DOES allow members to remain with them after age 65. Consult with one of their representatives if you would like to remain a member with them, or sign up after age 65.
What if I wait to sign up for Medicare after I turn 65?
Medicare calls it a penalty, but it looks more like an increased premium – for every 12 months you wait after age 65 to join Medicare, you’re charged an extra percentage. You’ll get the best rate if you sign up for Medicare starting at age 65 – and the time to sign up is during the 6 month period surrounding your 65th birthday (3 months before to 3 months after).
Why would I purchase Part D if I get cheap medications through Assurance?
This is a very, very good question, and many people choose to not purchase Part D. Part D is often so inexpensive ($16 per month for a good plan), that if there happens to be a medication that we’re not able to supply to you at a cheaper rate than Medicare, you’re able to get that through part D. Signing up for part D years after you turn 65 also results in a ‘penalty’ (we call it an increased premium), so it’s often easiest to just get that when you turn 65 when it’s most affordable.