| Thu, Feb 02, 2012 @ 09:00 AM

Choosing a Medicare Plan: How Leroy Decided

Posted by Medicare Made Clear

For those with chronic conditions like diabetes, a Medicare Advantage Special Needs Plan (SNP) with built-in prescription drug coverage might be the best option for medicare coverage.Medicare offers a lot of choices. To find the plan that’s best for you, you’ll need to compare your needs with what’s available. In this post, you’ll meet Leroy1 and learn why a Medicare Advantage Special Needs Plan (SNP) was a good fit for his needs.

About Leroy

Leroy is about to turn 65. He has had serious health problems for years. He suffers from diabetes and high blood pressure. To help manage these conditions, his doctor has told him he needs to lose a considerable amount of weight. Leroy takes insulin and blood pressure medication every day. In the past, he has also had some trouble with interactions of the drugs he is taking.

Leroy’s Medicare Wish List

  • Expert help managing his health problems
  • Help managing diet, exercise and weight
  • Discounted prices on prescription drugs

  Leroy’s Choice – Medicare Advantage Special Needs Plan (SNP)

The Medicare Advantage Special Needs Plan (SNP) Leroy chose is designed especially for people with diabetes. To be eligible for an SNP, an individual must qualify for Original Medicare. Specific SNPs may also require individuals to meet other eligibility requirements, like having a chronic medical condition. Qualified individuals are able to enroll in a SNP at any time during the year, rather than waiting for the Medicare Annual Enrollment Period or other enrollment window. Some features that make this SNP a good choice for Leroy include:

  • Built-in prescription drug coverage
  • Access to a care manager who will create a plan for coordinating his care
  • Help with finding out if he qualifies for financial assistance with Medicare costs
  • Discounted prices on the prescription drugs he takes
  • Help with adopting a healthier lifestyle

Cost Sharing

Premiums (2012 figures):

–          $99.90 per month Part B premium

(If you receive Social Security, this will be automatically deducted from your monthly check.)

–          $24 per month Medicare Advantage Special Needs Plan premium*

–          Total: $123.90 per month

*Hypothetical amount

Leroy pays his cost sharing as determined by the plan. Each plan is different. His total spending depends on the services and prescription drugs he uses. Remember: this is just an example. Costs vary from plan to plan. Contact the plan you’re interested in to see what your costs might be.

Make an Informed Decision

Leroy did his homework and got what he needed in a Medicare plan. It’s a good idea to understand all the parts to Medicare and research specific plan types so when it’s time to make your plan selection, you can make an informed, confident choice.

1 Fictional character created to show a specific set of Medicare needs and coverage options.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact Medicare Made Clear at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.

Resources:

Medicare Advantage Special Needs Plans – MedicareMadeClear.com

Medicare Basics – Medicare.gov

General Medicare Enrollment and Eligibility – Medicare.gov

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