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.
Get Professional Advice: Our Recommendation…
If you want some help navigating Medicare, we suggest setting up a meeting with 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),
DO NOT purchase an HMO or Medicare Advantage plan.
These 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 or Medicare Advantage 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.
Medicare Advantage Plans are tempting because of the cost, but our experience has been that they lack in value – especially in the Yakima area – because of their extreme limitations of providers accepting those plans.
*Note: Some Medicare Advantage Plans could possibly work with Assurance Membership – but they are usually purchased through a broker. Right now our only trusted broker that is familiar with our membership is Rick MacDermid with Senior Solutions – so please check with him first!
Before reading below, here are some resources that could help you in your decision to craft a health plan that works best for you…
Our recommendations for pairing Assurance with Medicare…
Option 1) Assurance Membership, plus Medicare Part A + Part B + Part D (mostly known as “Original Medicare” plus Part D)
This plan is 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. Currently, the starting cost is $144.60 for plan B, and anywhere from $16-64 for part D. 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.
Option 2) Purchase Assurance Membership, plus Medicare Part A + Part B + a non-HMO Supplement (and Part D if not included in Supplement).
This plan is for those who don’t mind spending extra monthly (generally $60-150 more than Option #1) in order to ensure that no surprises will come later with one-time payment for surgeries, hospital stays, etc.
Do not purchase an HMO Supplement plan! If you wish to continue using an Assurance Membership, it is much easier if you purchase a PPO plan, as we can still refer you to specialists and coordinate your care as your primary care physician with a PPO plan, but not with an HMO plan.
The plans that we’ve heard work best are Plan G and Plan N. These are both considered “Medigap” plans – and no matter what company you purchase these plans from, they are required to have the exact same features. So a higher price WILL NOT mean ‘better’ coverage!
Where can you purchase those supplemental plans? Again, we recommend Rick MacDermid with Senior Solutions.
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.
But, if you would rather not pay that monthly premium, we do all we can to get you inexpensive medications!