Let’s talk health insurance because NOW is the time to sign up

Nikki Sommer, a nurse with Key West Surgical Group, joined Good Morning Keys on KeysTalk 96.9/102.5 FM for Medical Matters this morning.

Last week’s brunch to unveil the PicoSure Pro Laser turned out well.

Sommer said, “One of the clients we did last week has texted me she’s really excited. We had recommended to wait four weeks. She goes, why do I have to wait four weeks? Can’t we do it sooner? It hasn’t even been a week and she’s noticed a big difference in her skin. She’s really excited. She had melasma. So she said the dark spot that was with me my whole life is now gone.”

One issue with medial matters is insurance. Open enrollment is now through January 15 to get affordable health care.

Sommer said, “Medicare eligible patients, it is open enrollment. It started October 15 and it will run through December 7. So that is just around the corner. So if you are 65 or older, and you can sign up for Medicare, now is the time to do it. Don’t get stuck without benefits for 2024.”

There are four types of Medicare – and they are all for people 65 or older.

Sommer said, “It gets very confusing, especially when you’ve kind of worked somewhere where they just put three plans or two plans in front of you and you pick one, and that’s the one you have. So now Medicare it kind of can become a little bit more complicated. So part A, that is when somebody asks you Do you have Medicare Part A, that’s what’s going to cover you in the hospital for inpatient, if you need to be admitted to the hospital, you want to make sure you have Part A.”

Part B is the outpatient medical coverage.

Sommer said, “That’s what you need to go see the doctor in their office, that’s what’s going to cover your visit.”

Part C is an advantage plan that has some extra benefits and Part D is the prescriptions.

Sommer said, “The main ones are A, B and D. Because you want to make sure you have a prescription drug plan. Why it gets complicated is years ago, Medicare was the blue and white card, strictly covered 80 percent. Then you can either pay 20 percent out of pocket and then that’s where you would have like AARP or other supplementals, or maybe your previous employer, if you were able to keep their coverage like if it was Cigna, Blue Cross Blue Shield, United Health Care, they give you the option to make that your secondary.”

Medicare Advantage is another choice versus Medicare itself.

Sommer said, “This is where things have gotten tricky over the years. Medicare has become private as well as you can keep the government plan which is the blue and white card, and then you can choose your secondary yourself. Blue Cross Blue Shield and United Healthcare, they have what is called Advantage Plans where it’s kind of like an all in one. They usually tend to have lower monthly premiums. However, depending on the coverage in and out of the network, the patient can be subjected to higher co pays, coinsurance, or deductibles. So when you’re picking these plans, you need to make sure that your provider takes the plan that you are going to choose and if it’s in network or not because HMO plans I don’t think are accepted by any doctor in Monroe County. I’m almost positive. We have certain clients that have United, and they have an HMO plan. We’ll take it, but they’re going to be subject to higher deductibles, co pays and coinsurance. It depends on the area. I’ve had other people tell me they have their plan, and they live in another state and it’s not a problem.”

The differences between the packages can definitely muddy the waters.

Sommer said, “A lot of times, patients will call and they will say, oh, I just got my Medicaid, they mean Medicare. Medicaid is not Medicare.”

Medicaid is a state administered plan and Medicare is a federally administered plan.

Sommer said, “So if you do have Medicaid in the state of Florida and you are traveling outside, it will not be accepted.”

Commercial plans through employment or open market are not to be confused with the marketplace.

Sommer said, “Depending on your employer contribution, premiums can be lower than the open market. With most commercial plans they are deductible or a copay plan. What are the differences between these plans? Our lovely officer manager who is pretty much an expert in this, she will have conversations with people over their insurance because she gets the prior approval for their surgeries, I can tell that the person on the other end of the phone feels like she’s talking in a foreign language, because they don’t understand the plan. She does walk them through it. She spends a lot of time walking them through it. It’s important when you’re picking a plan to go through with a fine tooth comb and make sure you’re picking the plan that’s really appropriate for you.”

A deductible is an important factor.

Sommer explained, “A deductible is the amount you pay for your covered health plan services before your insurance pays. So usually, some plans are 70/30, 80/20, 60/40, meaning your insurance will pay 60 percent and you are responsible for the 40 percent or 70 or 30 or however it goes. You’re responsible for the lesser of the two usually, but in there, you might have a deductible is what you have to meet. Copay is the fixed amount.”

For more information, click here: https://www.keywestsurgicalgroup.com/