Ask The Medicare Specialist
QUESTION:
Question from Brie: I’ll be 65 and going on Medicare in July. I worked for North Allegheny School District. My husband is retired and applied for Medicare but is currently on my school health benefits. I have researched the many plans and talked to a lot of people. It’s my plan to have my husband choose an Advantage Plan. He has no serious health issues and takes just two maintenance drugs. I was planning on also signing up for an Advantage plan because they seem to be good. However, I’m eligible for HOP Medicare retirement benefits and saw in your last column that you advise for a people to always go with HOP even though it’s more expensive than the best Advantage plans. I take no medications and also in good health. I’d like your opinion and advice on how to proceed.
ANSWER:
I consider this to be one of the most important columns I’ve ever written and it’s the longest I’ve ever done. I’m so glad Brie emailed me because I’ve been concerned with how many people are choosing Advantage Plans without understanding the possible consequences and risks. I’m shocked at the number of HOP recipients who are opting out of what I consider to be the best value in all of Medicare; The Hop Medical Plan for those who get the $100 per month premium assistance. I don’t stand to make any commission by making that statement or advising someone to choose the HOP plan.
Let’s get into answering the question and discussing my issues with the mentioned trend.
First of all, never ever choose a plan based on what a friend has or says. Period. I don’t give friends medical or financial planning advice and they shouldn’t be giving you advice on health insurance. As far as choosing a plan based on one’s current health, it’s simply not wise. It’s akin to not taking out homeowner’s insurance or choosing a policy that would put one of your biggest assets at risk because you’ve never had a fire. We buy insurance for the “what if’s” in life. The biggest what if when it comes to choosing a Medicare plan should be what if I’m diagnosed with Cancer, especially those that never, or may never, go away such as Chronic Leukemia, Lymphoma, Breast or Ovarian Cancer. What if I’m diagnosed with a rare disease or form of Cancer that can only be treated at the Mayo Clinic, MD Anderson, or another world class facility outside of Pennsylvania.
After 15 years dealing with people on Medicare, I can give example after example of the healthiest of 65-year-olds becoming very sick within a month to a year of going on Part B. Life is fragile and cancer doesn’t discriminate. That I know. Please also need to understand that almost everyone who goes on Medicare for the first time gets one shot and one shot only to enroll in a Supplement without having their medical conditions considered. Supplements do a few very important things that Advantage Plans don’t. a) Eliminate almost all medical bills. b) Provide access to every full-service non-VA hospital in the country and virtually every doctor at no additional costs. No Advantage plan provides all of these. c) Eliminate the need for Prior Authorizations. In other words, if you have a Supplement, your course of treatment is decided by you and your doctor. There is no outside interference from an insurance company. Those with Supplements will never be told they need to get physical or injection therapy before being allowed to have a CT scan, MRI, Stress Test, surgery etc. They also won’t ever be informed their insurance company is refusing to pay for any more days in the hospital. This is the number one reason people choose Supplements.
“I’m healthy so if I want to go back to a Supplement later, I can,” Brie may be thinking as many others do. Everyone loves Advantage Plans when they’re healthy and I completely understand why. The best plans cost $0 to under $40 per month, much less than Supplements. They come with extremely valuable dental, vision, hearing, OTC, gym membership benefits and more! But when people get sick, start getting thousands of dollars in bills, and/or have to fight with their insurance company to get services approved, they don’t like them so much. That’s when they call us wanting to get on a plan that eliminates those issues. Well, guess what? Supplement companies aren’t going to accept sick people into their plans for up to five years, maybe ever, after certain diagnoses.
I’d like to make this message very clear; I’m not anti-Advantage Plan. Not at all. We enroll clients in them every day and I approximate that 35 to 40 percent of our Medicare clients are on HMOs and PPOs. However, what I’m seeing in today’s market is too much misleading information and advertising that is steering people who really need to be on Supplements away. We’re meeting so many seniors who have been lied to or given false information and been sold on $0 or low premiums, dental, vision, and free stuff. But these brokers aren’t explaining any of the risks or disclosing they aren’t Supplements and not secondary to Medicare.
They’re leading people to believe they’re the same only less expensive while including extra benefits. They’re not explaining that CT scans, MRI’s, hospitalizations, outpatient surgeries will cost hundreds to thousands of dollars. They aren’t asking what types of ongoing medical issues people have that could cost them thousands of dollars per year such as injection or infusion therapy which are becoming more common. We’re talking to far too many people who didn’t know until they got big bills. And weren’t told that once they chose and Advantage Plan, most likely there’s no going back to a Supplement. The number of agents on the prowl looking to switch people off their Supplements and HOP plans is deeply disturbing. I’m shocked how ugly and out of control the industry has become. I’ve seen nothing like it in my 15 years in the field. And unfortunately, the Feds don’t have the resources for proper oversight. I’m afraid they may overcorrect and make enrolling in a new plan very difficult for everyone like they did with the mortgage industry after the housing collapse of 2008.
I’m also afraid that people are falling too much in love with dental, vision, and all the free stuff while ignoring more important aspects of Advantage Plans vs Supplements. I’m worried that we may be in a bubble. Advantage Plan companies are being reimbursed by the Feds much more than they did three and four years ago. It’s what’s prompted all the extra benefits. And in case you didn’t know, Medicare is not in a good place financially.
The following is a quote from a June 2022 press release by the Committee for a Responsible Federal Budget, a non-partisan and non-profit agency. “The Social Security and Medicare Trustees released their annual reports on the state of the trust funds today. The Trustees find that Medicare’s Hospital Insurance trust fund will be insolvent by 2028. Upon insolvency, Medicare Hospital Insurance payments will be reduced by 10 percent.”
HAVANA — In the Telegram group chat, the messages roll in like waves.
“I need liquid ibuprofen and acetaminophen, please,” wrote one user. “It’s urgent, it’s for my 10month-old baby.”
Others offer medicine brought from outside of Cuba, adding, “Write to me in a direct message.” Emoji-speckled lists offer antibiotics, pregnancy tests, vitamins, rash creams and more.
The group message, which includes 170,000 people, is just one of many that have flourished in recent years in Cuba alongside an exponential increase in internet usage onthe communist-governed island.
The informal sale of everything from eggs to car parts — the country’s so-called black market — is a time-honored practice in crisisstricken Cuba, where access to the most basic items such as milk, chicken, medicine and cleaning products has always been limited. The market is technically illegal, but the extent of illegality, in official eyes, can vary by the sort of items sold and how they were obtained.
Before the internet, such exchanges took place “through your contacts, your neighbors, your local
community,” said Ricardo Torres, a Cuban and economics fellow at American University in Washington. “But now, through the internet, you get to reach out to an entire province.”
With shortages and economic turmoil at the worst they’ve been in years, the online marketplace “has exploded,” Mr. Torres said.
Bustling WhatsApp groups discuss the informal exchange rate, which provides more pesos per dollar
or euro than the official bank rate.
Meanwhile, Cuba’s versions of Craigslist — sites such as Revolico, the island’s first digital buyingand-selling tool — advertise everything from electric bicycles brought in from other countries to “capitalist apartments” in Havana’s wealthy districts.
Many products are sold in pesos, but higher-priced items are often listed in dollars, with payments either handled in cash or through bank transfers outside the country.
While wealthier Cubans — or those with families sending money from abroad — can afford more lavish items, many basic items remain unaffordable for people like Leonardo, a state-employed engineer who asked that his real name not be used because he fears retribution from the government.
Three months ago, Leonardo began buying items such as inhalers, antibiotics and rash creams from friends arriving from other countries, then reselling them for a small profit online. Government authorities are harshly critical of such “revendedores,” or resellers, especially those who buy products in Cuban stores then sell them at a higher price.
In late October, President Miguel Díaz-Canel called for a crackdown on the practice, referring to the revendedores as “criminals, swindlers, riffraff, the lazy and the corrupt.”
“What we can’t allow is that those who don’t work, don’t contribute and break the law earn more and have more opportunities to live well than those who actually contribute,” he said during a meeting with government officials. “If we did that … we’d be breaking the concepts of socialism.”
But Leonardo said he and others like him are just trying to get by.
“This medicine goes to the people who need it, people who have respiratory issues,” he said. “Those who use them are people who really need them. ... More than anything else, we sell antibiotics.”
With the money he’s earned from his sales, Leonardo has been able to buy soap and food, as well as antibiotics and vitamins for his elderly parents.
The rise of the new digital marketplaces speaks to a specific brand of creative resilience that Cubans have developed during decades of economic turmoil. Much of the crisis is a result of the U.S. government’s six-decade trade embargo on the island, but critics say it’s also due to government mismanagement of the economy and reluctance to embrace the private sector.
So people on the island tend to be highly resourceful, working with whatever they have available to them — think old cars from the 1950s that still roll through the streets, thanks to mechanics using ingenuity and spare parts to address a shortage of new vehicles.
Entrepreneurs have used the same creativity to deal with what was initially very limited internet access.