Q: My wife and I will soon be 65 and eligible for Medicare. In 2008, I can save $192.80 per month if we don’t get Medicare Part B. Is it true that my HMO will cover us only if we have Medicare? Are there other benefits to our having Medicare?

A: To receive HMO and/or PPO, you must have Medicare Parts A & B, or you will pay a higher contribution for the HMO or PPO plan.

Eligible Medicare beneficiaries do not pay a monthly premium for Part A, which covers hospital confinements, but you have to pay a deductible. You must pay a monthly premium for Medicare Part B, which covers outpatient medical services.
If you waive Medicare, you will be responsible for portions of your medical expenses that Medicare should pay, about 80 percent of approved expenses and your 20 percent coinsurance.

You might “save” the $192.80 monthly cost for Part B. However, you could spend much more for uncovered medical expenses.

With Medicare, you are eligible to enroll your spouse and you in a Medicare Advantage plan, available only to Medicare-covered retirees. These plans replace Medicare and the HMO or PPO. They provide similar, and sometimes more, benefits as the HMO & PPO, but usually for lower out-of-pocket costs. All plans have the same copayments for prescription drugs. Ask a benefits division representative for a medical plans comparison for Medicare-covered retirees.
See the brief comparison chart of medical plans for Medicare-covered retirees below.

Q: Because I don’t live in Texas, I am not eligible to participate in the HMO. I am paying about $1,200 per month for my wife and me to have the PPO. When we turn 65 in March 2008 and are covered under Medicare, the PPO rate will likely decrease but still be expensive. Do we have a choice for a less expensive medical plan?

A: You may join the Aetna private-fee-for-service Medicare Advantage Plan, which is in all 50 states and is similar to the PPO. However, the Aetna PFFS does not have a network of providers. Any doctor that accepts Medicare reimbursements and agrees to Aetna’s terms and conditions can participate in the plan, probably your doctor and about 95 percent of all U.S. doctors. You will pay a monthly premium to the city. You will also pay your monthly Medicare premium, which will be $96.40 per person in 2008. By electing the Aetna PFFS plan, you can save more than $300 per month for the remainder of 2008, probably see the same doctor, and pay lower our-of-pocket costs when you receive medical services. (See chart.) The PPO rate can change May 1, 2008. The Aetna rate can change Jan. 1, 2009.