Ask The Medicare Specialist

QUESTION:

I’m 75 years old and have Question from Claudia: been on a Medicare Advantage plan for many years. Currently, my husband and I are each paying monthly premiums in the mid $30 dollar range for an HMO which covers us when we are in FL for the winter. We don’t have any serious health issues, but I still wonder if this is the best choice. What do you think?

ANSWER:

Claudia, like so many others, got bad advice and misleading information. Despite her plan being one of our “10 Best” as I’ve referred to our most commonly recommended Advantage Plans, it’s not the best choice due to the fact she spends her winters in Florida.

Unfortunately, there are no adequate training requirements for those who want to sell health and Medicare plans. Anyone who takes a state certified course, can pass the official state exam and background check, completes Medicare’s Fraud, Waste, and Abuse Training known as AHIP is given their license and can start selling products as soon as they get appointed with Medicare companies. None of the requirements train agents nearly well enough or provide the most important knowledge needed to best educate and provide sound advice to Medicare beneficiaries. At the Health Insurance Store, we pay our new agents a salary and don’t let them talk to a potential client by themselves for at least six months and after they have sat in countless appointments with our most experienced staff. That rarely happens at other agencies because most agents work on commission only and are self-employed, meaning the agency really can’t dictate to them where they work, when they work, or that they even ever show up at an office. Most agencies provide their new agents little or no additional training and send agents out into the field selling products they don’t understand.

Let me explain on why I feel Claudia got bad and misleading advice. First of all, when in Florida she’s still out of network and can’t just get care the same way she can from an in-network provider in Pennsylvania. I doubt that was explained to her by the broker. Since she’s in good health, she’s probably never experienced trying to get anything more than a routine doctor visit while in Florida. If she needed to get an MRI, CT-scan, or a surgery, she would understand quickly things aren’t nearly as simple as they were made to sound.

Another common and egregious error made by agents is telling someone choosing a PPO automatically means they can see any doctor or hospital they want regardless of if they’re in not in network. It’s simply not true. An out of network provider must agree to take the insurance, and many won’t. Even if a provider agrees to take the plan, with some PPOs the cost of getting care out of network can be unaffordable. There’s only one Advantage Plan company in our market that offers PPOs where the majority of doctors and hospitals in Florida and other states are in-network and accessible the same way and the same cost they are in PA. Claudia’s broker didn’t suggest that company for some reason. I also doubt the broker ever went over what I recommend for Claudia, a Medicare Supplement, the only plan that guarantees access to virtually every doctor and hospital in the country at no additional cost. For those who have homes in different states, it really is the best choice in my professional opinion because there will never be any issues of getting care when away from home.

Again, my guess is this option wasn’t provided or the broker went over the best parts of Advantage Plans without explaining any of the risks, either because he or she didn’t understand them or guides clients to HMOs and PPOs because they pay a much higher commission.

As always, I don’t want anyone to think we don’t like Advantage Plans. We have thousands of clients on them and they’re vital for millions of Medicare Beneficiaries, especially those who can’t afford Supplements and rely on the valuable extra benefits HMOs and PPOs provide such as comprehensive dental, OTC allowances, and debit cards that provide up to $600 a year for groceries.

I’m assuming that affordability of a Supplement at $100 per month vs thirty something and not having the extra benefits wouldn’t be a financial burden for Claudia and her husband. If Advantage Plans versus Supplements would have been explained properly and in an unbiased manner, I’m almost positive the latter would have been what they chose as snowbirds. There are many other individual situations where a Supplement can be the better option as well. For those with certain medical conditions, it should be the only option.

For those like Claudia, there is an opportunity right now to still make a change to a Supplement or Advantage Plan that might be a better fit. If you would like to make an appointment for a no cost consultation, give us a call or email me personally. Aaron@getyourbestplan.com