Ask the Medicare Specialist
QUESTION:
From Laurie: Would you please answer the following questions on Medicare Supplemental and Advantage plans: 1. Supplemental Plan N: Besides the monthly premiums (as well as the monthly premiums for original Medicare), would the cost to my husband and me include anything other than the following: a. $203 annual deductible for each of us, b. All Part B Excess Charges only for health care providers
who don’t accept Medicare assignment, c. 20% of Foreign Travel Emergency Care up to a $50k
lifetime ceiling, and d. Insurance premiums for other types of care excluded
from the basic Plan-N, such as dental, vision, drug, etc. 2. Advantage Plans (which include Dental, Vision, Drug coverage): Besides the monthly premiums (as well as the monthly premiums for original Medicare), would the cost to my husband and me include anything other than the following: e. Specified annual deductible for the Health and Drug
plan for each of us, f. Copay as listed for each type of visit or procedure, g. Coinsurance as listed for each type of visit or procedure,
and h. Maximum out-of-pocket costs (MOOP) of $7,550 for each of us per year, but this maximum level would be unusual for relatively healthy people.
3. On a transfer from an Advantage plan to a Supplemental plan, after the first 12 months of the Medicare subscriber’s participation in any Medicare plan, I understand that medical underwriting is required. Is that also true for a transfer from one Supplemental plan to another Supplemental plan?
4. If the results of medical underwriting are not good (i.e., serious health issues), is a patient denied coverage under a specific plan or is the patient accepted in the plan, but at higher premium rates?
ANSWER:
Now that’s a question!!!! I’m a huge fan of Plan N and recommend it to probably 90% of people I meet who choose to go the Supplement route. That being said, let’s get started. 1a) The Part B deductible on Plan N must be met first. Even a physician’s office visit is subject to it and co-pays don’t go into effect until the $203 has been satisfied. 1b) The key phrase here is “those who don’t accept Medicare Assignment.” The fear of being billed Excess Charges is overblown and need not be a concern at all. I’ve had multiple questions regarding this since the last two of columns ran. Again, only doctors who don’t accept Medicare Assignment can bill Excess Charges. First of all, there isn’t a full-service medical hospital in the country that doesn’t accept Medicare. Secondly, the only doctors who don’t accept Medicare are generally the rare PCP who doesn’t take any insurance at all and those who treat the ultra-rich: Wall Street CEO’s, movie stars, Arab Oil Emirates, etc. The maximum allowable Excess Charge is only 15% so, even after adding that on, these doctors would be working for pennies on the dollar compared to what their private clients pay. In 13 years, we have insured thousands of people on Plan N. Not once have we had a client who was billed Excess Charges. It need not be considered when making a decision on what plan to choose or moving from F, C, or G to N. 1c) Foreign Travel benefits are included in all Supplement plans, including N. Be advised when traveling, you won’t simply hand over your Medicare and Supplement cards to a provider like you do at home. If you’re in a less developed country such as Mexico, Belize, Costa Rica, etc., be prepared to pay up front for services before they’re provided. I tell this joke with clients who ask about care when traveling abroad; if your right arm is dangling out of socket when you show up to a hospital while in one of these countries, you’ll need to reach in your pocket or purse with your left arm to pull out a credit card. When traveling outside of the United States, make sure you have enough cash or credit limit for these situations. Your claim(s) for services received in a foreign country will need to be filed manually upon your return home. 1d) The majority of those who choose a Supplement also need to purchase a Part D prescription drug plan. Most of our clients pay between $7 to $18 per month for those and the majority of plans have a $445 deductible for Tier 3, 4, and 5 drugs. As far as buying a vision and dental insurance, don’t do it! Plans for sale on the open market will never pay off for the user because over any three-to-five-year period. One will always spend more in premiums than get back in paid claims. I’ve said this many times. We buy insurance to protect our assets. You’re not going bankrupt because you didn’t have a dental plan to cover 50% of a $1,000 root canal, or vision benefits that pay $150 towards a pair of glasses every two years. I could make a small fortune selling dental and vision, but I don’t. We refuse to sell products that are not a benefit or value to our clients for the sake of a commission. 2e) As far as Advantage Plans, there are none in Western PA as of now that have a deductible for prescriptions. There is one plan that’s been quite popular over the years that has a medical deductible, but it’s the exception, not the norm. I estimate 95% our Advantage Plan HMO and PPO clients do not have any deductibles. 2f) Advantage Plans have co-pays or coinsurance for virtually every medical service one could possibly have except for those considered “preventative,” as well as PCP visits, and possibly blood work on select plans. Co-pays can be as low as $5 and as high as $1,800 for a hospitalization, depending on the plan. 2g) Coinsurance is also a cost associated with Advantage Plans. It’s a percentage of the billable amount one must pay, generally 20%. Services such as Chemo, as well as injection and infusion therapy fall into this category and can be extremely expensive. Those who need them usually meet their Maximum Out of Pocket (MOOP) which range from $4,000 to $7,550 for the plan year 2021. 2h) Those who stay just relatively healthy are not likely to meet their MOOP. However, your current health should not be the reasoning one uses when deciding between an Advantage Plan or a Supplement in my opinion. Cancer does not discriminate. I’ve learned that life is very fragile in my 13 years in the Medicare insurance business. Remember, after being diagnosed with a number of conditions, one may never be able to go back to a Supplement again. Something as common as A-Fib is now an automatic denial for every Supplement company! 3) Yes. It is. Even when moving from one plan to another within the same company, underwriting will occur. 4) There is a company that will accept those who can’t pass underwriting for their “preferred” rate. However, the costs are extremely high, around $300/month, making it very unappealing for most. Please keep the great questions coming! If you have one of a more personal nature or would like to make an appointment for a no cost consultation, please give us a call, visit our website, or feel free to email me personally. We are once again seeing people for in person appointments if that is your preference. For those who are still not comfortable with that, we will continue to offer phone and Zoom meetings.