Mistake #5: Getting the Same Medicare Plan as Your Spouse

Medicare health insurance is a very personal product. And, other than a household discount from some Medicare supplement companies, there are no discounts for choosing the same plan as your spouse.

In this fifth article in our Medicare Mistakes Series, we’ll cover why buying the same coverage as your spouse is rarely the best move.

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• Medicare Advantage plans allow you to exchange your Original Medicare benefits for a private health plan with extra benefits. The best plan is the one that has benefits that you can use (and afford!).
• Medicare supplement insurance covers the gaps in your Original Medicare coverage (i.e., deductibles, coinsurance, and copayments).  If you have poor health, getting the most coverage you can afford is wise. If you are healthy, buying too much insurance may be wasteful.
• Medicare Part D covers prescription medications in cost tiers laid out in a formulary. The best Part D plan is the plan that provides your specific medications at the overall best price.
• Al la cart secondary coverage for dental, vision, and hearing may help extend your budget.

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When Medicare time rolls around, most couples tend to view coverage jointly even though enrollment is an individual responsibility. This often means that one person or the other does not have optimal coverage.

The best way to evaluate coverage is by the individual. You must determine what each person needs and the best way to get it.

It’s conceivable that Original Medicare and a Medigap plan will best serve one person while the other can get the most through Medicare Advantage. It all depends on your health, finances, and priorities.

Cover Your Major Medical Needs First

In our first article in this series, we discussed Medicare costs. As an 80/20 system, Medicare pays about 80 percent of your major medical costs[mfn referencenumber=1]Medicare.gov, “What’s Medicare?”, Accessed January 15, 2022[/mfn]. How you pay for the remaining 20 percent is up to you. You have three options:

1. Pay out-of-pocket
2. Buy additional insurance[mfn referencenumber=2]Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?”, Accessed January 15, 2022[/mfn]
3. Qualify for state or federal assistance[mfn referencenumber=3]Medicare.gov, “Medicaid”, Accessed January 15, 2022[/mfn]

Contrary to popular belief, Medicare Advantage is not additional insurance. Medicare Advantage plans are still based on an 80/20 split. You pay your 20 percent out-of-pocket when you use health care services. However, with Medicare Advantage, a failsafe mechanism caps your annual out-of-pocket costs on major medical services.[mfn referencenumber=4]Medicare.gov, “Costs for Medicare Advantage Plans”, Accessed January 15, 2022[/mfn]

Original Medicare does not have a maximum out-of-pocket (MOOP) limit[mfn referencenumber=5]Medicare.gov, “How Original Medicare works”, Accessed January 15, 2022[/mfn]. However, you can buy additional insurance, called Medigap, to cover some of the gaps in Original Medicare[mfn referencenumber=6]Medicare.gov, “How to compare Medigap policies”, Accessed January 15, 2022[/mfn].

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With Original Medicare and Medigap, you control your out-of-pocket costs by purchasing the coverage you need. The best coverage is a balance between fixed costs (monthly premiums) and long-term benefits (deductibles and copayments covered by insurance).

If you can’t afford your 20 percent share, you are institutionalized, or you have certain qualifying chronic health issues, then Medicare, Medicaid, and Social Security have assistance programs that can help. We cover these programs in another part of this series.[mfn referencenumber=7]Medicare.gov, “Special Needs Plans (SNP)”, Accessed January 15, 2022[/mfn][mfn referencenumber=8]Medicaid.gov, “Health Homes”, Accessed January 15, 2022[/mfn]

How do you know which route is best for you?

This series’ fourth article discussed why people with chronic health issues should not join a Medicare Advantage plan. Unless you receive government or retiree benefits that help pay your copayments and/or premiums, Medicare Advantage can be very expensive if you have chronic health conditions. However, healthy seniors can get much value from a Medicare Advantage plan that offers secondary benefits.

The only way to know which option is best for you is to sit down and calculate your estimated costs. How frequently do you see your doctor(s), go to the emergency room, need an ambulance, or have inpatient hospital stays?

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Cover Your Medications Second

The pharmaceutical industry in our country is out of control. Fortunately, the Medicare Part D program was put into place in 2003 and has since been reformed again by the Affordable Care Act.[mfn referencenumber=9]CMS.gov, “History”, Accessed January 15, 2022[/mfn]

When you buy a Part D plan you are able to get your prescription medications at predictable cost based on the plan’s formulary. The formulary is nothing more than a list of covered medications organized into cost tiers.[mfn referencenumber=10]Medicare.gov, “What Medicare Part D drug plans cover”, Accessed January 15, 2022[/mfn]

If you and your spouse both take regular medications, each of you should shop for the plan with the best overall cost on your medications. It might turn out to be the same plan, and it might not. It might also mean you use different pharmacies because each plan has its own preferred pharmacy relationships.[mfn referencenumber=11]Medicare.gov, “Using your drug plan for the first time”, Accessed January 15, 2022[/mfn]

If you are enrolling in a Medicare Advantage plan that includes Part D coverage, and you have regular prescriptions, don’t forget to check your costs. People often look at the secondary benefits in a plan, like dental and vision, and forget to see if their prescriptions are covered.[mfn referencenumber=12]Medicare.gov, “How do Medicare Advantage Plans work?”, Accessed January 15, 2022[/mfn]

If you don’t have any regular prescriptions your choice is easy. Go for the cheapest plan. If you do start taking medications down the road, then you can shop the best plan. However, don’t make the mistake of not getting Part D because you don’t have prescriptions now and want to save money. There are penalties for not joining.[mfn referencenumber=13]Medicare.gov, “Part D late enrollment penalty”, Accessed January 15, 2022[/mfn]

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Cover Your Secondary Health Needs Last

It’s easy to get caught up in looking at our health care needs holistically while our budgets have a different idea of what’s possible. By breaking things up by importance, it’s easier to set priorities and make better decisions based on what we need and what we can afford.

Original Medicare covers medically necessary health care services, which does not include routine care for dental, vision, hearing, and other minor medical needs[mfn referencenumber=14]Medicare.gov, “What’s not covered by Part A & Part B?”, Accessed January 15, 2022[/mfn]. If a Medicare Advantage plan meets your major medical needs, and you can find a plan that includes the extra benefits you need, that’s great. If not, you can buy a dental, vision, and hearing plan a la carte through DentalPlans.com. They have over 40+ plans to choose from and offer 1-month free (use promo code 1FREE).

The MedicareWire staff researched available dental savings plans and recommends looking at what these five plans offer:

1. Aetna Vital Dental Savings
2. Cigna Preferred Network Access
3. CVS iSave Dental Savings
4. Careington Care 500 Series
5. DentalPlans.com (1 Month FREE!)

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Need Help Deciding?

Free, friendly, professional advice is a phone call away. Call 1-855-728-0510 (TTY 711) and talk with one of our licensed insurance agents about your Medicare plan needs. 

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