Ask the Medicare Specialist
QUESTION:
I got a Medicare Advantage HMO when I turned 65 this past November. I didn’t realize until I began reading your columns that I likely won’t be able to go on a Supplement down the road because I have a pre-existing condition. I’m very upset that wasn’t explained to me when I originally applied. Is there anything I can do?
ANSWER:
Yes. There is. But time is of the essence. Because you’ve had your Advantage Plan for less than 12 months, you can, one time, go back to a Supplement without answering medical questions. Per Federal Regulation, Supplement companies must accept you regardless of current or past health issues if you’ve had an Advantage Plan for less than a year and it was your first time on one of these HMO’s or PPO’s. However, there are a select few times or circumstances when you can make that change before your 12 months is up. Annual Election Period run from October 15th to December 7th every year. Other than that, you would need to qualify for what is known as a Special Election Period. The most common is if you qualify for PACENET, a state funded program that helps seniors with the cost of prescriptions. The income limits were just recently increased so tens of thousands more Pennsylvanians will now be accepted! Feel free to call one of our offices and an agent will determine if you qualify and even complete the application.
Remember, Advantage Plan HMO and PPO’s like you have ARE NOT designed as secondary insurance and don’t pick up the portion of the bill Medicare doesn’t. They pay in place of Medicare. That’s why you don’t show your Medicare card at a doctor or other provider. You also have co-pays for virtually every medical service. Those can be as little as $5 or $10 for a PCP visit or blood test, $200 to $300 for CT Scans, MRI’s, or Ambulance rides, to thousands for hospitalizations, Chemo, Skilled Nursing, and other more expensive treatments or services. Those with Supplements, pay virtually nothing out of pocket for all the above.
One other item of note. We do business with several different Supplement companies. They all ask different medical questions. Some want your history from as far back as the day you were born, others five years ago, and some only two. I recently had a client who was told by another agent he wouldn’t qualify due to his health. I found a company that approved him right away. On the flip side, one may be able to pass medical underwriting and get a Supplement policy easily because he or she is healthy today. Many in that situation often say, “I’ll stick with my less expensive HMO and just wait until next year to get a Supplement.” If you want to take that risk in order to save money on premiums, I completely understand. My agency has over 2,000 clients on HMO’s. However, be careful here. Can you can predict with 100% certainty that at age 65, 70, 75, etc., you won’t be diagnosed with a serious medical condition or have an accident? Not only could that unfortunate scenario result in up to $6,700 in medical bills every calendar year depending on your plan, more than likely you will not be able to get approved for a Supplement for at least two years, possibly ever, with certain conditions like some forms of Cancer, COPD, certain heart conditions, and others.
I would like to make one last point. Don’t ever assume anything when it comes to Medicare and your plan. Don’t assume you can’t change. Don’t assume your plan is “the best” simply because the name on the card or the length of time you have had it. Don’t assume your benefits are the same as they were five or six years ago when you paid very little for a hospitalization, Chemo, etc. HMO and PPO benefits have changed dramatically over the years, some more than others. The same medical service you paid $100 to $200 for a few years ago could now cost thousands!
There is never a bad time to get educated on what your benefits are, how much exposure you have in medical bills compared to other companies, or the differences between Medicare Advantage Plan HMO’s/PPO’s and true Medicare Supplements.
We invite all readers to call us with any questions or to set up an appointment for a no-cost consultation anytime during the year, not just during election periods.