Ask the Medicare Specialist

QUESTION:

from Ron in Greensburg:

I didn’t get around to looking at new Medicare plans before December 7th. Am I stuck with what I have for 2018? ANSWER:

December 7th was indeed the end of Medicare Open Enrollment, the time everyone on Medicare has the opportunity to shop for other plans or companies and make changes for 2018. However, there are many who will have other opportunities to change plans during an Election Period that starts January 1st, and others who can make changes anytime throughout the year. Let me explain those scenarios.

First, anyone who is currently on PACE or PACENET, a state program that provides prescription assistance for those 65 or older, can change plans anytime. Also, those who newly qualify will also get that opportunity immediately. Currently the income limits for PACENET are $25,108 for an individual, and $34,716 for a married couple. Assets are not considered. So, if you have savings, stocks, bonds, etc., you can still qualify if your income is under the above figures.

PACENET not only can save people thousands of dollars in drug costs, but also opens up an opportunity to enroll in a $0 premium Medicare Advantage Plan that has the lowest out of pocket costs of any plan of its kind in the Western Pennsylvania market. The staff of The Health Insurance Store will be happy to help determine if you qualify for PACENET, and submit your application at no charge. That can be done in person or over the phone at either of our locations.

There is also another Medicare enrollment period coming up that I feel isn’t utilized often enough. It’s called the Medicare Advantage Plan Disenrollment Period (MADP), and runs from January 1st to February 14th. During this time, those who are enrolled in a Medicare Advantage HMO or PPO can choose to go back to original Medicare and purchase a Supplement. We meet so many people who have HMO’s or PPO’s and are paying $100 to $295 per month for plans that expose them to over $6,000 a year in medical bills. During the MADP period, those folks could purchase a true Medicare Supplement that is designed to pay the 20% that Medicare doesn’t cover. That means there is virtually no out of pocket medical costs and the monthly premiums are often less than Advantage Plan HMO’s and PPO’s. Supplements also allow you to utilize practically any doctor and hospital in the entire country.

We know there are thousands overpaying for their HMO or PPO because every single day during this past Open Enrollment Period we helped people enroll in a Supplement that eliminated medical bills and lowered their monthly premium. We were also able to help others choose another HMO or PPO that saved them literally thousands per year in premium while lowering their potential out of pocket expenses. I know it sounds too go to be true. It’s not. We have been doing this for 10 years now and it never ceases to amaze me just how many people are overpaying for plans that don’t provide as good of coverage as lower priced plans.

If you currently have an HMO or PPO Medicare Advantage Plans, please be aware you DO NOT have a Supplement. They ARE NOT secondary to Medicare. They ARE NOT designed to pay the 20% Medicare doesn’t pick up. On most Advantage plans, hospitalizations of five days or longer come with a bill of over $1,000. Chemotherapy is generally over $1,000 per treatment. Skilled Nursing can cost $150 or more per day. Those who have Supplements would not pay a dime for any of those same medical services.

I highly recommend that those who can take advantage of the MADP that starts January 1st, those who are on PACENET, or think they may qualify, call and talk to one of our licensed agents to see if there is an opportunity for you to save money now, rather than wait until 2019.