Ask the Medicare Specialist

QUESTION:

I get so confused about drug costs and medical bills I receive. I’m not a client of yours but can you still help me?

ANSWER:

You’re not alone. If Medicare was simple, The Health Insurance Store wouldn’t be in business. There are Parts A, B, C, and D, HMO’s PPO’s, POS’s, Supplements, and on and on and on. Good grief. Right?

Plus, seniors get overwhelming stacks of advertisements and literature in the mail when they turn 65. It all starts getting delivered again every September before that the Annual Election Period (AEP) begins and doesn’t stop coming until December. Some of the ads can be very misleading too.

Then there are all the correspondences from the company you have your plan with. Every time there’s a claim submitted on your behalf, they are required to send what is called an Explanation of Benefits (EOB). It states what the provider billed, what Medicare paid, what your plan paid, and what you might be on the hook for. Almost no one can understand them. I’ve been in the business since 2008 and at times they don’t make sense to me. For many seniors they often cause stress and anxiety. And to answer your question. Yes, we’ll help anyway we can. If you’re paying a lot of money for prescriptions, if you go into the Doughnut Hole, have bills you don’t understand or think might be in error, have a claim denied, or just have questions about your current plan and benefits, we don’t mind taking a look and doing our best to answer those questions and solve problems. We are very familiar with programs for seniors, as well as some tricks that can help save money and limit confusion. Moving from an Advantage Plan to a Supplement is one way to reduce uncertainty because there are virtually no medical bills involved. Our clients who have Supplements are instructed that after they pay their small deductible of $185, they should never get another bill. If one is received, they know to just pick up the phone and dial us so we can get it straightened out. For those who get erroneous bills, more often than not, a simple call to a provider or billing department is all that’s needed. On other occasions a referral to a foundation or non-profit can be extremely helpful.

There are well known programs like PACE and PACENET, as well as others that have been kept somewhat of a secret we’ve come across over the years while assisting clients.

On the topic of PACENET, I want to remind everyone that the income limits were recently increased. A single person making less than $29,108, and a married couple earning less than $38,716 now qualify. It’s a fantastic program that’s paid for with PA lottery proceeds. It can save seniors thousands of dollars annually in drug costs. Any of our agents can help see if you qualify and even make the application.

Many people don’t realize the only determining factor is the dollar figures from your prior year’s tax return. Assets such as checking or savings accounts, stocks, bonds, other investments, property, etc., are not considered when your application is being reviewed.

Also, don’t assume because you were denied in the past, you won’t qualify today. We’ve helped over 1,000 people enroll in PACENET, many who were told they didn’t qualify in prior years.

PACENET provides another benefit in addition to prescription savings. It gives those who are currently enrolled, or new to the program, what is known as a Special Election Period (SEP). SEP’s allow you to enroll in a Medicare Advantage Plan, Part D, or a Supplement all year round, not just during AEP. There are several situations in which people can utilize an SEP to change plans. We can help determine if you qualify for one and advise you if we feel the plan you have offers the best value or moving to another might make more sense.

As I’ve written in so many columns, mistakes those on Medicare commonly make are overpaying premiums out of fear of changing plans and exposing themselves to thousands of dollars in unnecessary out of pocket medical bills. But the error made most often is not understanding the differences between Medicare Advantage Plan HMO’s and PPO’s vs Supplements.

Even if you don’t qualify for an SEP to change plans now, you’re welcome to come and sit down with myself or another licensed agent to get an education, review your plan, or get some advice any time during the year. We never charge for consultations in our office or over the phone.

If you have any questions, please feel free to call one of our offices. You can also email me directly at aaron@getyourbestplan.com.