Ask the Medicare Specialist

QUESTION:

In previous articles you’ve said for those who have HOP, it’s usually the best option.

I’ve noticed Advantage Plans have started offering benefits that HOP does not. Of interest to us is the $2,000 in annual comprehensive dental.

I can buy a Dental Plan for $480/year but have been wondering if I should stay with HOP or if there’s anything better? I’m 71 and healthy and wife is 69 and just had major cancer surgery and will start treatments next month. Your professional thoughts would be greatly appreciated.

ANSWER:

I want this column to be as much about dental insurance/ benefits as it is about HOP, which stands for Health Options Program. It’s Pennsylvania School Retiree Health and Medicare coverage that is sponsored by the Public School Employees’ Retirement System (PSERS).

Is there something better than the HOP Medical Plan option? If the retiree gets the $100/month premium assistance that most Pennsylvania public school retirees do, my answer is no. If it helps people understand just how strongly I feel about this, we’ve advised and helped enroll well over 1,000 people who are 65 or older in the HOP Medical Plan knowing we won’t make a dime in commission by doing so.

That being said, 95% of HOP recipients are better off buying a Part D prescription plan on their own, which we can help with. As great of a value as the HOP Medical Plan is, the HOP prescription plans are just as bad at monthly premiums of $69 to $128/month and higher co-pays than plans that can be purchased on the open market. In addition, neither HOP’s Basic or Enhanced Rx plan eliminate the Doughnut Hole. Although not Federally regulated like Medigap, The HOP Medical Plan is a Supplement designed to cover the Part A hospital deductible of $1,484 and the 20% Part B doesn’t pick up. Those who choose HOP Medical pay only a few small co-pays for services like physician’s visits, MRI’s/CT Scans, or a trip to the ER. Everything else is covered at 100%. And like Federally regulated Supplements, it offers access to every doctor and hospital in the country that accepts Medicare Assignment.

The best aspects of HOP may be the price and that premiums rarely increase like other Supplement do. Those who go on the HOP Medical Plan at age 65 pay less than $70/month after a 15% discount and the premium assistance. The only rate increases one normally sees are those as the discount gradually reduces to zero at age 71. Otherwise, premiums have remained almost unchanged in the 13 years I’ve been in business. In that same time period, some Federally regulated Supplements, namely Plans C and F, have doubled in price. Many Advantage Plan premiums have gone up 400% to 500%, MOOP’s have doubled from $3,400 to $7,550, and hospital co-pays have increased by $1,000 or more per 5-day. As I advised the gentleman who sent me the question, under no circumstance should he leave the HOP plan, especially with his wife undergoing treatments for Cancer. If they would have left HOP this past Annual Election Period and moved to one of the most popular HMO’s or PPO’s just for dental benefits, there would have been two very serious ramifications. First, there’s a chance they would never be to return to HOP. His wife certainly wouldn’t have been able to get back in to into another Supplement for at least two years, possibly in her lifetime. In addition, if she were going to be getting just an average amount of Chemo and Radiation therapy in 2021, she almost certainly would be billed the Maximum Out of Pocket (MOOP) on the plan she chose, up to $7,550.

Let’s just say in 2021 she would have used her dental benefits to the tune of two teeth cleanings and one set of bite wing X-Rays paid at 100%, two fillings that paid at 50% to 80%, and one root canal at 50%. She would have received around $800 total benefit in what I would consider a bad year for one’s dental health. However, depending on plan, she would have likely paid out between $5,000 and $7,500 in medical bills as opposed to around $100 had she stayed with HOP. I want to once again dispel the myth that dental insurance is a necessity. It absolutely is not! People have become more obsessed than ever about dental, especially those who take good care of their teeth. I’m guessing it’s due to the inundation of TV commercials which tout the “free” stuff that HMO’s and PPO’s provide without warning of the potential of paying out thousands of dollars in medical bills. We have insurance to protect our assets. It’s why we purchase homeowners and auto insurance, not only to replace those investments, but to protect us in the event of a lawsuit. I’ve said this 1,000 times when people fret over buying a Supplement that doesn’t come with dental or vision; you aren’t going to go bankrupt because you didn’t have insurance to help pay 50% of an $900 root canal, a $1,000 crown, or you don’t have vision coverage that provides $150 towards the purchase of a pair of glasses every two years. We don’t buy insurance to cover oil changes for our vehicles or to replace worn out tires. We just know these are inevitable expenses. I want people to think the same way about their teeth. You don’t need to spend $500 per year or more on dental insurance. You’re rarely going to get more in benefits paid out than you spent in premiums. If that were the case, dental insurance companies wouldn’t be in business.

We also advise potential clients not to choose an Advantage Plan over a Supplement for dental alone. Comprehensive dental is certainly a great benefit that more and more Medicare Advantage Plans have started to offer in the last couple of years. It’s especially nice when provided on plans that are less than $50/month, the highest premium we ever recommend someone pay for an HMO or PPO. But people need to understand I have no idea how long these comprehensive dental benefits will last. Companies currently offering them do not have to do so every year. They can be removed. I believe we’re in the heyday of ancillary benefits such as dental, Over the Counter and vision allowances, among others. I don’t see them being as generous in two to three years. If profits go down, I predict Advantage Plan companies will take one of three actions; remove and or reduce dental benefits, raise co-pays and other out of pocket costs including the MOOP, or both.

Just because the Annual Election Period has passed and won’t return until October, doesn’t mean people can’t explore their options. There’s never a bad time to educate yourself by calling and speaking to one of our licensed agents or making an appointment for a no-cost consultation. And many people are still able to make changes outside of the Annual Election Period. And if you’re turning 65, retiring after age 65 and going on Medicare for the first time, or need to bridge the gap until you reach Medicare age, we can certainly help.