Cass County Medicare Choices

There are limited choices for Medicare Advantage plans in Cass County - rural counties always get the short end of the stick. Take Dallas or Miami, for instance, with eight or nine carriers and 60-80 plans available. Compare that to Cass County with around 25. Medicare Supplements are a different story with any number of companies and the standard plans available. With Medicare Supplements (commonly called “medigap” plans) it is simply a matter of price. The plans are the same regardless of the carrier; a G with Mutual of Omaha or Aetna is simply more expensive than a G with Physician’s Mutual. I’m going to do some comparisons this week with the goal of helping you minimize your medical financial risk. You might be surprised. Remember one thing when it comes to pure medical after 65: Pay premium and nothing beyond $257 for the federal deductible or pay nothing for premium, and copays for everything.

Still, there are ways to skin this critter. Medicare Supplements: The Gold Standard for Medical Choice - but it leaves out a lot, too.

On page 76 of the “Medicare and You” book, you can see this chart, and more. Medicare Supplements have specific benefit menus and are often called the ‘letter plans’. They range from a plan A, which is the only plan you can get if you’re under 65 and on Medicare, at a pricey $500ish tag. But hit that magical age of 65 and it goes down to around $130 a month. Have a look at this chart and there are a couple of things to notice. First, look at the Skilled Nursing benefit: it’s not available on A or B and reduced on K and L. So, you have some serious money to pay if you take these plans. Plan A is honestly not worth it. A good Medicare Advantage plan will give you more coverage with a reasonable max-out-of-pocket (MOOP) and copays. There is one caveat: cancer. If you have cancer, you will have facility restrictions with Medicare Advantage. For instance, you won’t be able to use MD Anderson, generally speaking. They have dropped all but two plans. Many people end up with a plan N, for not much less than a full G which covers 100 percent of everything except the federal deductible of $257. Plan N leaves you exposed for about 15 percent of costs under Part B excess charges. “What the heck are excess charges?!” That is the amount that your doctor/facility charges over and above what Medicare normally contracts to pay. Doctors love medigaps because they get paid more - and you will love them if you want choices: any doctor, any hospital, any outpatient center, any cancer center... any, any, any, any. And pay zero on a G. A word about one company in particular, Physician’s Mutual, for which I am the only authorized agent in Cass County. PM, unlike all other companies, is typically less expensive in the long run. Their 10-year average increase annually is about 3-4 percent. Compare that to about 14 percent average annually with other companies. So, your ability to keep your Medicare supplement is a lot easier. They also stop charging increases at age 80, cover thermal mammograms, offer a free fitness membership, and give some nice discounts for autopay, non-tobacco, and 10 percent for having a household member 60 or older. Another unique feature of this company is their Innovative Plan G, which has a vanishing deductible after the 3rd calendar year: you start out about $30-40 less than a full G, and most members only spend about $600 a year average for those first few years. You also get the right to change plans within the company during the first two years; so if you come up against a medical problem and don’t think you want to pay that deductible, just call and say “I want a full G” and the first of the next month you will have it, no questions asked. To the best of my knowledge, they are the only company offering this selection of benefits and company policies. Be sure to call me for a quote - you will probably be pleasantly surprised.

Medigap “Holes” Medigaps do not cover dental, vision, hearing, longterm care after 100 days, cosmetic surgery (breast reconstruction, for instance), private duty nursing, drugs/ medications, acupuncture, massage therapy or most chiropractic, or the full cost of foreign travel medical, though some plans do cover 80 percent. If you’re going to travel abroad, be sure to get a G or at least an N. To support these additional needs, consider some supplemental coverage - I have plans that cover 70 percent on dental with a vision/hearing rider, for a reasonable cost, around $50/ per person. For those who can afford the cost of a supplement, with the additional coverage mentioned, you’re in great shape to handle anything major or minor with very little inconvenience financially. But over time it will get expensive.

DRUG coverage is not included in Medigap plans and you MUST get a drug plan even if you don’t need drugs. There are plans for $0 premium out there - get one. Otherwise, you can face a lifetime penalty.

You can take a Medicare Supplement if: You’re in your IEP (Initial Enrollment Period), up to 3 full months before and after your birth MONTH, if you have both A and B Original Medicare - and its guaranteed issue regardless of pre-existing conditions. It can start immediately.

If you have passed the IEP, but haven’t retired yet you can get one ONLY with both A & B so if you don’t have B yet, you’re still able to get one with a guaranteed issue right as soon as you have both A and B.

If you can pass underwriting, which varies from company to company.

You have lost your Medicare Supplement because the company folded, dropped the plan, etc, and you need to find another one - that is also a guaranteed issue.

If you are on Medicare Advantage now, you can switch for January. If you wait until January/February/March Open Enrollment, you can switch then also. But not after that for the rest of the year. Anything to do with Medicare Advantage falls under very strict guidelines, and there are too many SEPs (Special Election Periods) to get into here. DO NOT DROP YOUR MEDICARE ADVANTAGE UNTIL YOU HAVE BEEN APPROVED.

If you are struggling with premium payments on your Medicare supplement that are becoming financially burdensome, I can help you.

Medicare Advantage Plans for Cass County Medicare Advantage (MA or MAPD with Prescription Drug coverage) can work really well for a lot of people - if you understand how it works. It’s a copay system - much like your coverage when you were working and had a plan with copays, deductible and co-insurance, like an 80/20 plan at work. The government prefers you to be on an MA/MAPD because you’re sharing the cost with them. There is little or no premium (that’s your monthly cost, usually deducted from your Social Security check for convenience), but you will pay copays and have a max outof-pocket annually. Here’s a comparison of the three (3) major carriers in Cass County.

As you review this chart, ask yourself some questions because you’re going to see some BIG differences between Christus and the others.

Are you using the Christus System already? Are you paying MORE to use it? Do you have doctors in Dallas/Ft. Worth, Shreveport, Tyler, Houston, or San Antonio? Christus has over 2500 specialists in these cities.

Is it worth 10-15 minutes to check and see if Christus is right for you?

Christus is not right for everyone. If your doctors are not in-network and you have a problem changing, if you use MD Anderson, or if you need a PPO because of extensive time spent outside of Texas and you need primary care in another state, it is not a good fit for you. Otherwise, Christus could be a cost-effective choice to reduce your medical financial risk and liability. They also have a track record of approving procedures quicker than the others, helping out financially when people can’t afford copays and are on very limited incomes, and generally trying to help the communities.

Medicare Advantage “Holes” All MA/MAPD plans have 3 “holes” financially: Inpatient hospital, outpatient surgery, and skilled nursing. These can be managed easily with an appropriate Hospital Indemnity Plan for as little as 50 cents a day. Christus doesn’t have a hospital copay - a gift to our senior citizens who take these plans. Their max out of pocket is relatively low, between $4200 and $4900, compared to $9250 with United Healthcare. They do coordinate care with Medicaid but do not offer groceries, which United Healthcare does - so they are the preference for dual eligible members (people with Medicare and Medicaid). Humana performs poorly as a dual eligible or chronic plan with lesser amounts and max out of pocket ranges between $3400$8500. But they have one of the only chronic plans in the county, and if you do not have a chronic condition, you will not get groceries in 2026 so be sure to get with me about that if you’re on a dual plan right now.

One thing to remember about Medicare Advantage is that the smaller the office, the lower the copay. Your doctor’s office will be $0 - whether that’s a visit, a lab, a shot or an x-ray. Go to a specialist office and it’s more. An urgent care, it’s more, an ambulatory surgical center - it’s more. An Outpatient hospital/clinic... it MORE. And yes, the Hospital.... you got it... more. So, keep it small, stay in network, and you’re good. Pair your MA/MAPD plan with a good hospital indemnity and for under about $75/month you’ve got almost full coverage. MAPDs include drug coverage. Some plans have a Part B Rebate as high as $130 a month back into your check - there are a lot of options.

There are many considerations when choosing a plan - and everyone is different. Different medications, needs, issues - it is always better to have your existing plan reviewed for 2026 changes in copays, benefits, and rules against available plans. Take the time - maybe 20 minutes - to do a review with me either at Walmart on Tuesdays and Thursdays from 8:00 a.m. - 5:00 p.m., make an appointment if you need me to come to your home, or give me call. You might have the best plan you can get... but it’s better to be sure.

Whichever path you choose, whatever company suits you best for your situation, I am here to help you achieve your goal, manage your medical risk, keep you from spending more than you have to, and make sure you know how to make the system work for you - not leave you at the mercy of it. For plan reviews, quotes on hospital indemnity, medigap or Medicare advantage, please reach out. I’ll answer questions on text too! I’m here for you.

Wishing everyone a beautiful Thanksgiving, You can still call or text 430-999-2271 on Thanksgiving; I might be in a turkey coma at my sister Vonda’s house, but I will still answer the phone. December 7th is coming up quickly.

Amelia (Amy) Gunstanson is a Navy Veteran with 30 years’ experience in life and health insurance, the last 6 years in Medicare specifically. She is the Principal Agent/ owner of Medicare Thrive in Atlanta, TX, serving Cass and surrounding areas. She is federally certified, licensed in 20 states and appointed/certified with many major carriers including Kemper Life, Humana, United Healthcare, Physicians Mutual, Christus, Aetna, Cigna Blue Cross and more. You can call or text questions or requests for appointments to 430-999-2271 or on the web at www.medicarethrive.com.