Ask the Medicare Specialist
QUESTION:
From Don: I and thousands of other US Steel Retirees are confused. We are provided an Advantage Plan. Calls to US Steel, Aetna, and the United Steelworkers Union all end up with the same response. “If you drop, change, or enhance the plan, you can never get it back”. We have no dental or eye protection that retired seniors drastically need. Is there any plan or supplement available that won’t break the bank? We all agree that our Aetna policy is better than what some others have. Do you have any advice for me and all the other USX retirees?
ANSWER:
There is much to cover on this topic. Let’s start by clarifying Don’s statement about what happens if you drop the US Steel retiree plan. He is indeed correct that if one opts out to go on an Advantage Plan HMO/PPO or a Supplement and Part D plan that is offered to the general public, you can never get the US Steel plan back. That’s the policy for almost all retiree Medicare plans.
As far as what Don refers to as enhancing, I think what he means by that is getting another Medicare Advantage Plan that has dental and vision benefits. You cannot do that. You can only have one Advantage Plan at a time. Enrolling in another would trigger an automatic cancelation of the US Steel plan.
The same holds true with a Supplement. You can’t have both an Advantage Plan, be it through a company your retired from or one you purchased on your own, and a Supplement,
Don asked about purchasing an individual dental and vision plan to help with those costs. I want to clarify some important information before I give my feelings on dental and vision policies. Medicare and Medicare Advantage Plans both cover medical conditions of the ears, eyes, or mouth. In other words, Glaucoma, Cataract, Macular Degeneration, an eye or ear infection, a broken jaw that needs surgically repaired, etc., are covered. It’s only cosmetic dental, vision, and hearing that aren’t on Supplements, or might not be with Advantage Plans. In Don’s case there are no benefits to help pay for cleanings, crowns, root canals, fillings, routing eye exams, glasses, routine hearing exams, and hearing aids.
I have searched far and wide for a dental plan to sell for 13 years. The bottom line is this. There isn’t one worth buying because you will always pay more out premiums than you will ever get back in paid claims in any three to five-year period. I could sell dental and vision plans just for the sake of increasing my commissions, but I refuse to offer products that aren’t going to be beneficial to my clients. My advice is to pay as you go. A cleaning and X-Ray generally runs from $100 to $125. You can also investigate getting care at dental schools that need subjects for their students to work on. Many of our clients have done that and services can be low or no cost. There is also a free dental fair every summer in Pittsburgh. This past year it was held at PPG Paints Arena. Anyone can walk in and get free services such as cleanings, fillings, and extractions. In addition, there are dental clinics that provide services on a sliding fee scale based on income. Remember why we buy insurance; to protect our assets. It’s why we have auto, home, and health insurance. That being said, you aren’t going to file bankruptcy if you need a root canal. The only dental and vision plans that offer a bit of value are those provided by an employer. And even if you could buy those plans on your own, a root canal or crown would only be paid for at 50% and the annual limit on benefits on most plans is only $1,000.
Don, you are correct. Your plan is very good compared to others available on the open market. If I recall, it has a Maximum Out of Pocket (MOOP) of just over $1,000, compared to as much as $6,700 on many other HMO’s or PPO’s. The price you pay, $70, is also very fair for a plan with a MOOP that low.
Unless your premiums and/or your MOOP go up substantially, I would not recommend anyone opt out of that US Steel plan. I give the same recommendation for retired teachers or Pennsylvania Public School employees on HOP who get the $100/month premium assistance.
There are plenty of retiree plans that aren’t competitive, however. If you would like us to review your plan for an opinion and to compare it to others, we are happy to help with that and there is no fee for a consultation.
If you choose to leave a retiree plan and can opt out any time during the year, you can change outside of Medicare Election Periods. In addition, those who leave a retiree plan get what is known as Guarantee Issue rights. This provides a one-time opportunity to enroll in a Supplement without having your current or previous medical conditions considered. Your application can’t be denied or priced higher than healthy people of the same age.
If you have any questions regarding this or any other Medicare topic, please give us a call or email me personally at aaron@getyourbestplan.com. My live radio show is this Monday from 1:15 to 3 on WMBS Radio Uniontown. You can listen via their website at wmbs590.com. You can also catch the replay on our website. Also, please consider following us on Facebook to see our podcast schedule that will be coming out soon, as well as other important FYI’s regarding Medicare and health insurance.