Ask the Medicare Specialist

QUESTION:

Is there another Medicare enrollment period coming up? I thought it ended on December 7th?

ANSWER:

Yes, there is. Open Enrollment (OEP) has been brought back after an eight-year hiatus. And it couldn’t have come at a better time with all the confusion stemming from the UPMC /Highmark battle.

OEP is going to run from January 1st through March 31st. Let’s go over what you can do during this time. Most importantly, you can switch from one Medicare Advantage Plan HMO or PPO to another. So, if you have a Highmark plan and didn’t change to another company that will provide network access to UPMC doctors and hospitals, you will have another opportunity to do that. Highmark is still insisting that their members will be able to use UPMC providers after June 30th of next year when the contract between Western PA’s healthcare giants will end. Technically that’s true. Logistically it’s very misleading.

Although Highmark is making it sound like those on their HMO and PPO plans can continue to access UPMC providers just as they do now, that simply isn’t the case after June 30th. Those on Security and Freedom Blue plans will not be able to set appointments by calling their doctor’s office. They will be routed to a central booking department. There, the total cost of that service will be estimated based on Medicare’s reimbursement schedule. That amount will need to be paid up front before an appointment can be scheduled. Whether the cost for that service is $200, $2,000, or $22,000, you will not be able to get services from a UPMC provider unless it’s paid in full.

I know this fight has gotten ugly and put many of us in the middle, which doesn’t seem fair to me and countless others who have voiced displeasure (put mildly). I know how unhappy people are that it’s come to this. But at this point I want to make sure our seniors have access to the doctors and hospitals they need or want. In addition, I hope to also put an end to the overcharging for HMO’s and PPO’s that has gone on for years. Advantage Plan companies, one in particular, has made huge profits preying on seniors’ fears. Over the past 10 years they have increased premiums on some plans by as much as 400% to 500% while raising out of pocket maximums, which represents the most money one can be billed in a calendar year, from $3,400 to $6,700. If you are one of the thousands of people who are fearful of leaving the only health insurance company you’ve ever known and didn’t make a change due to the anxiety that thought causes, you can still choose a more competitive plan in January. Very simply put, it’s my professional opinion that not one single person should be paying more than $95 for an HMO or PPO medical plan and throwing money away by doing so. In addition, no one should be enrolled in a plan that has a per day co-pay for hospitalization or has an Maximum Out of Pocket over $4,900. If you do, your plan isn’t competitive, and you are exposed to unnecessary medical bills. OEP provides a mulligan, or a do-over if you will for those who didn’t get the proper advice or stayed on their plan out of fear or confusion. Another great opportunity that can be utilized during OEP is moving from an Advantage Plan HMO or PPO to a Supplement. This has been more popular than ever this year, once again, due to the Highmark/UPMC ordeal. The motivation and logic of going with a Supplement is twofold. One, Supplements eliminate virtually all bills for Medicare covered services. Two, it ensures access to both UPMC and AHN as well as every other medical hospital in the country, both today and in the future. I have no firsthand knowledge of what UPMC intends to do in the next few years. I am speculating here. I am a bit concerned that they could decide not to renew contracts with companies like Aenta, United, Humana, etc., when those current contracts expire, meaning they would only treat those who have UPMC insurance or Medicare. Those with any other insurance would be either shut out or forced to pay more money at UPMC doctors and hospitals. This is a trend happening in other parts of the country, not just Pittsburgh. I’ve been telling people they may want to prepare for this now, while they are healthy enough to pass underwriting. Remember everyone. Supplements companies, except when one goes on Part B for the first time and a couple other exceptions, can discriminate based on your current and previous health and deny your acceptance. So, if you’re thinking if UPMC were to decide not to take any other insurance plans in a few years you will move to a Supplement at that point, it won’t be that easy. Unless you can predict the future and know you won’t be diagnosed with a condition that would keep you from getting accepted in the next few years, you might want to consider a change during OEP, which runs January 1st to March 31st.

For a no cost consultation over the phone or at one of our office locations, give us a call or visit us on the web.