Ask The Medicare Specialist

QUESTION:

Question from Beverly: After reading your last few columns, I’m questioning my enrollment in an Advantage Plan and am very upset that the agent I worked with didn’t explain Supplements at all. I’m even starting to wonder why anyone would choose an Advantage Plan. I have one of the pre-existing conditions, which according to you, make it almost impossible to get a Supplement in the future. Is there anything I can do? Or am I just stuck with my plan?

ANSWER:

We have over 4,000 active clients on HMOs and PPOs and there are plenty of good reasons to choose them. The top two are the lower premiums and extra benefits they provide. I estimate that on average, the most popular Advantage Plans cost $75 to $250 per month less than Supplements depending on one’s age. The plans we recommend come with valuable ancillary benefits not available with Supplements. Those who maximize their eyeglasses and Over the Counter allowances, get just their two free teeth cleanings and set of bite wing X-rays, and utilize their gym membership receive over $1,000 in real value of goods and services. Some plans also provide prepaid debit cards that can be used to pay certain copays and buy “healthy foods,” which would increase that dollar amount. And I didn’t even calculate those who get help paying for more expensive dental care like crowns and root canals.

That being said, it angers me that Beverly and so many others aren’t being given all their options and some agents and other representatives often aren’t taking into account medical conditions that might result in expensive bills as well as their ability to enroll in a Supplement down the road. We have over 7,000 active clients on Supplements and despite having more expensive premiums, they can often save people thousands of dollars when considering out of pocket medical costs. Take for example someone on Remicade, an infused medication that treats several forms of arthritis, bowel diseases, and chronic plaque psoriasis which is a severe skin disease. It’s administered every four to eight weeks and billable at $2,000 or more per treatment. Every Advantage Plan member is responsible for 20% coinsurance for Part B drugs such as Remicade and others including chemo, dialysis, insulin used in a pump, and others injected as an outpatient treatment. In the case of Remicade, the cost to the patient is $400 or more per infusion. Someone who needs it every eight weeks pays $2,400 or more each year while those who require it every four weeks $5,200 and up. Compare that to $0 for people who have Supplements.

There are people who simply should not choose an Advantage Plan when they turn 65 or go on Medicare for the first time, especially considering how affordable Supplements are for those 65 to 75 years old. Plan N, our favorite, starts from $75-$78 for a 65-year-old married female and $82-$89 for a married male. Keep in mind most people need to add Part D prescription coverage that most of our clients pay an additional $11 to $12 per month for. However, there is no cost for chemo and other Part B drugs, blood work, MRIs, CT scans, outpatient surgeries, hospitalizations, physical therapy, skilled nursing, durable medical equipment, and virtually every Medicare covered service for those on Supplement Plan N. I pretty much insist that those who have a medical condition like Beverly choose a Supplement.

As far as what your options are Beverly, you may be able to move to a Supplement and I’d recommend that you do that if you can afford to and qualify. If both your Part A and B effective date are the same, you have 12 months from that date to enroll in a Supplement without answering any medical questions using what is known as Guarantee Issue (GI). Per regulation, all Supplement companies must accept those with GI rights at their “preferred” rate. If the A and B dates are different, you have six months from the Part B effective date. If you meet neither of those criteria, we have one last resort; filing for a Special Election Period that provides GI based on an agent or other representative using misleading information or sales tactics. It’s quite common that those on Medicare are led to believe an Advantage Plan works the same as a Supplement and meant to fill in the gaps of what Medicare doesn’t pay, namely the 20% of Part B services and the $1,600 hospital deductible. That’s false. If you were told that, led to believe it, and/or possibly never given the Supplement option like Beverly, it’s quite possible you can be awarded GI rights. We’ve helped many do this, especially those who were talked into giving up their Supplement to enroll in an Advantage Plan. If none of these are options, although you won’t be able to get a Supplement barring some sort of future amnesty or change in laws, you aren’t stuck in the Advantage Plan you first enrolled in. You can change to another HMO or PPO plan every Annual Election Period and other times during the year because all Advantage Plans must accept anyone who has Medicare A and B and applies during a valid enrollment period.

In contrast, when Supplement premiums reach $250 to $300 or more, we feel that the value of those plans becomes diminished and moving to an HMO or PPO makes financial sense for many, although I advise a conversation with a trusted professional like us.

If you have an Advantage Plan and want to make sure you understand all the pros, cons, and facts, are considering choosing one, or moving from a Supplement to an Advantage Plan, I encourage you to schedule a no cost appointment with one of our licensed and experienced agents to get the proper education needed to make what is one of the most important decisions of your life.