Medicare Advantage for PSHB Members: 5 Things You Need to Know About This Option

Key Takeaways:

• Medicare Advantage plans can provide PSHB members with an alternative to traditional Medicare, offering potential savings and additional benefits.

• Understanding eligibility, coverage options, and costs is crucial when deciding if Medicare Advantage is right for you.

Understanding Medicare Advantage as a PSHB Member

If you’re part of the Postal Service Health Benefits (PSHB) program and approaching Medicare eligibility, you might be wondering if a Medicare Advantage plan is the right fit for you. With changes in how postal retirees enroll in health benefits, it’s important to know your options and how they compare to traditional Medicare. Here’s what you should keep in mind about Medicare Advantage and what it means for PSHB enrollees.

1. Medicare Advantage vs. Traditional Medicare: What’s the Difference?

Medicare Advantage (Part C) is a private insurance alternative to Original Medicare (Parts A and B). These plans bundle hospital, medical, and often prescription drug coverage into one plan. Many also offer additional benefits like dental, vision, and hearing coverage.

Key Differences Between Medicare Advantage and Traditional Medicare:

• Network Restrictions: Medicare Advantage plans typically require you to use a network of doctors and hospitals, whereas Original Medicare allows you to see any provider who accepts Medicare.

• Costs and Out-of-Pocket Limits: Medicare Advantage plans set annual out-of-pocket limits, whereas Original Medicare does not, meaning there is no cap on expenses unless you have supplemental coverage.

• Additional Benefits: Many Medicare Advantage plans offer benefits that Original Medicare does not cover, such as fitness programs and routine dental and vision care.

2. Are You Eligible for Medicare Advantage as a PSHB Member?

To enroll in a Medicare Advantage plan, you must:

• Be enrolled in Medicare Parts A and B.

• Live in the plan’s service area.

If you are a retired postal worker enrolled in PSHB, you may already be required to enroll in Medicare Part B to maintain your PSHB coverage. This requirement makes you eligible for Medicare Advantage if you choose to go that route.

Enrollment Periods to Keep in Mind

• Initial Enrollment Period (IEP): Starts 3 months before your 65th birthday and lasts for 7 months.

• Annual Enrollment Period (AEP): Runs from October 15 to December 7, allowing you to switch from Original Medicare to Medicare Advantage or make changes to your existing Medicare Advantage plan.

• Medicare Advantage Open Enrollment Period: From January 1 to March 31, letting you switch to another Medicare Advantage plan or return to Original Medicare.

3. How Does Medicare Advantage Work with PSHB Coverage?

PSHB enrollees who choose Medicare Advantage may experience different coordination of benefits than those who stick with Original Medicare.

• Reduced PSHB Premiums: Some PSHB plans may offer lower premiums if you enroll in a Medicare Advantage plan.

• Out-of-Pocket Costs: Medicare Advantage plans include out-of-pocket maximums, which may help with budgeting compared to the unpredictable costs of Original Medicare.

• Prescription Drug Coverage: Many Medicare Advantage plans include Part D drug coverage, potentially replacing the prescription coverage you’d receive under PSHB.

However, it’s crucial to verify whether a Medicare Advantage plan works with your specific PSHB benefits. Some PSHB plans may provide additional cost-sharing assistance for those who enroll in Medicare Advantage, while others may not.

4. Costs to Consider When Choosing a Medicare Advantage Plan

While some Medicare Advantage plans can reduce overall healthcare spending, costs will depend on the specific plan you select. Key costs include:

• Monthly Premiums: You still need to pay your Medicare Part B premium in addition to any Medicare Advantage plan premium.

• Copayments and Coinsurance: Out-of-pocket costs vary depending on the services you use and whether you stay within your plan’s provider network.

• Out-of-Pocket Maximums: Medicare Advantage plans set a limit on the amount you have to pay for covered services in a given year.

Before enrolling in a Medicare Advantage plan, compare costs carefully to ensure it aligns with your budget and healthcare needs.

5. Should You Enroll in Medicare Advantage?

Medicare Advantage may be a good choice if:

• You prefer a structured plan with predictable out-of-pocket costs.

• You want extra benefits like dental, vision, and hearing coverage.

• You are comfortable with network restrictions and provider requirements.

On the other hand, staying with Original Medicare and PSHB might be better if:

• You want flexibility in choosing doctors and hospitals nationwide.

• You already have supplemental coverage through PSHB that fills in Medicare’s gaps.

• You require specialized care that might not be fully covered under a Medicare Advantage plan’s network.

How to Decide?

Consider the following questions before making your choice:

• Do you frequently travel or split your time between locations? Medicare Advantage plans typically have regional provider networks, while Original Medicare offers nationwide coverage.

• Do you need specific specialists or treatments? Make sure any Medicare Advantage plan you consider includes your preferred doctors and hospitals.

• What are your expected healthcare costs? Compare premiums, copayments, and deductibles to determine which option is more cost-effective for you.

Making the Right Choice for Your PSHB Coverage

As a PSHB member, you have important decisions to make when it comes to Medicare and your healthcare coverage. Medicare Advantage offers a structured, potentially cost-saving alternative to Original Medicare, but it also comes with provider networks and different cost structures.

Before making a switch, evaluate your healthcare needs, compare plan options, and determine which coverage setup best suits your lifestyle. If you need assistance, getting in touch with a licensed agent listed on this website can help you navigate your Medicare and PSHB choices with confidence.