Ask the Medicare Specialist
QUESTION:
Annual Election Period is over. What do people on Medicare need to be aware of during the rest of the year?
ANSWER:
I think one of the biggest mistakes those on Medicare can make is to just sit back and wait for the bills to come in and then pay them as they do. In today’s health care climate, we need to be proactive in so many areas.
The first is ensuring you have the best value in plan in terms of benefits and premiums whether you have an Advantage Plan HMO/PPO or Supplement. This past AEP, with only one or two exceptions, we didn’t recommend Advantage Plans that had a premium over $50/month. We also almost never advise clients to choose plans with a “per stay” hospital copay that can result in bills between $900 and $1,800 for a four to six-day admission. The most popular plans among our clients for 2021 also include comprehensive dental that covers not only cleanings and X-Rays, but extractions, root canals, crowns, periodontal, partials, and dentures. Make sure you’re taking advantage of all the extras your plan offers including the dental, eyeglasses and OTC allowances, as well as others. Review your Summary of Benefits to verify co-pays and all your ancillary benefits.
If you don’t have a plan that meets these criteria, you have some comparing to do. You still may be able to make a change for 2021. Many people qualify for SEP’s (Special Election Periods) that allow those who qualify to move to a new plan or company anytime during the year. You may also be able to move from an Advantage Plan to a Supplement as well. With a quick call to the office or an email we can let you know if you may be eligible. Don’t assume you won’t!
Although Part D is not as easy to change outside of AEP, this was a critical year to ensure it was evaluated. One of the most popular companies moved their members to a plan with almost triple the premiums and higher co-pays! Don’t pay too much for Part D! 95% of our clients have premiums between $7 and $25 for the benefit year 2021. Paying more for Part D does not ensure better value or less total out of pocket costs or lower co-pays.
Supplements can be changed year-round and are not restricted by Enrollment Periods. We’re recommending almost everyone consider Plan N if they qualify to make a change and we recommend it to approximately 95% of those going on Medicare for the first time who choose the Supplement route. Plans F and C are an absolute rip-off and anyone who can move from either of those plans needs to do so asap.
I’m concerned that rates for Plan G are going to rise more rapidly in the coming years. One item I’ve only mentioned only once before is G will be the plan those who have Guarantee Issue rights (GI) will enroll in. In the past it was F. Those who get GI rights don’t have to go through underwriting or have their medical history taken into consideration to be accepted like others do. People who qualify for GI are generally less healthy and higher utilizers of medical services which results in Supplement companies paying out more claims, ultimately leading to rate increases. I’m predicting in 10 years, Plan G on average, will cost as much as $1,000/year more than N.
A horribly common mistake seniors make is paying erroneous bills. It’s so important for those on Advantage Plans to understand what their co-pays are for all medical services. I can’t even comprehend how much money is wasted paying bogus medical bills in the US. Always question any invoice that has even the slightest appearance of being wrong. Call your insurance company first to see what they say prior to sending a check. And don’t take, “that’s just the way it is” as an answer.
Our clients don’t have to stress about making those calls, being transferred back and forth, or given conflicting explanations from different people within the same company. They simply hand the task of researching questionable bills over to their agent or our dedicated support staff to resolve. I wish we would have kept track of the dollar amount of bills we discovered to be erroneous since The Health Insurance Store opened in 2007.
Watching and keeping track of your prescription drug costs is also something that needs to be done from the first day of the year. Be proactive about avoiding the “Doughnut Hole.” With the average brand name drug now retailing for $500, it won’t take long to get there, especially if you are taking multiple brand name drugs or more costly generics. See about getting samples of your more expensive drugs from your doctor, investigate Canadian pharmacies who often sell medication for less than your co-pays or costs in the Doughnut Hole, and check if your generics may be less expensive without using insurance. Good Rx is a great tool for that. There are also foundations and assistance programs available that can help offset costs for those who reach the Doughnut Hole. These programs have higher income limits, as much as $51,000 for a single person and $69,000 for a married couple. If you would like some tips or advice regarding prescription drugs, feel free to reach out to us.
Lastly, educate yourself. There’s never a bad time to do that. You can contact any of our agents or myself with questions or concerns. You can also make an appointment for a no-cost consultation at any time during the year. Even if you aren’t able to make a change, we welcome you to sit down with us and learn about the intricacies of Medicare, including the difference between Advantage Plans and Supplements.
As 2020 comes to an end, I would like to thank those who faithfully read the columns and/or patronized my agency. I wish everyone a healthy and happy holiday season!