Ask the Medicare Specialist

QUESTION:

What is your advice for those of us already on Medicare as the Annual Election Period is upon us?

This is the final part of my Medicare Reset series designed to prepare those on Medicare for the Annual Election Period ( AEP) that began yesterday. If you would like to read the entire series, it can be found on our website.

ANSWER:

There’s no cookie cutter approach to Medicare due to the two different types of Medicare plans and everyone’s individual circumstances, so it’s impossible to give one piece of blanket advice to all. But I’ll provide as much general advice as I can and break down our recommendations for those who prefer Advantage Plans as well as those who prefer or are considering Supplements. I will also address stand- alone Part D prescription plans.

Let me state this again. There is no cookie cutter approach. What might be right for your neighbor, friend, brother, or sister may not be right for you. Don’t take what I call, “over the fence advice” and never sign up for a plan because someone told you they “love it” or “it’s worked great for me.” The reason why it’s worked so well may very well be they’ve never used it when they had a more serious medical issue.

Don’t assume your plan is the best because you’ve had it for years. That means absolutely nothing. What’s most important is what your benefits are going to be in 2021. What is your Maximum Out of Pocket ( MOOP) limit? Are you aware of what your bills would be if you got cancer and needed chemo or radiation? How much does a fiveday or longer hospitalization cost? How about a six- week Skilled Nursing Home stay? Is your plan participating in the new “Part D Senior Savings Model” that caps Insulin copays at $ 35 all year long?

Never buy a plan directly from a representative or an agent who offers only one company’s plans. Remember, their job security and/ or income relies on them talking you into enrolling, regardless if it’s best for your individual health care needs. I can’t tell you how many times I’ve met someone who made a mistake in their initial choice because they simply called the company they had their insurance with when they retired and enrolled in a plan without doing any comparison shopping or having the Supplement option explained.

Which brings me to what I consider the most vital piece of information one needs to have, an understanding of the differences, as well as the pros and cons, of both Medicare Advantage Plans and Supplements. Failure to have this presented correctly and comprehending them can possibly affect you for a lifetime.

DON’T LET FEAR OF MOVING FROM A COMPANY YOU’VE BEEN WITH FOR YEARS KEEP YOU FROM MAKING A CHANGE! I put this in capital letters because no matter how many times I say or write it, a large percentage of seniors can’t get past it, which allow insurance companies to prey on that fear, overcharge for premiums, and inflate co- pays and out of pocket costs. It’s dishearteningly common.

Let’s get into my advice for those who favor Advantage Plans: Do not pay more than $ 50/ month for an HMO or PPO in 2021. With just a handful of exceptions, if you have a plan with a premium of over $ 50 next year, you are flat out overpaying in my professional opinion. Do not choose a plan with a per day hospital co- pay that can result in a bill of $ 1,000 to $ 1,800 for a five- day or longer stay. You should have a co- pay of no more than $ 350 for an admission of any length. Unless you are an insulin dependent diabetic, don’t choose a plan with the highest MOOP of $ 7,550. As many as 200,000 Western Pennsylvanians are currently enrolled in plans that have increased their MOOP to $ 7,550 for 2021, and it’s estimated that one out of twenty reach their MOOP each year. That means as many as 10,000 people in our region will end up with bills of over $ 7,000 unless they move to a plan with a lower MOOP. There are plans with a MOOP of as little as $ 4,000 who meet all my criteria for choosing an Advantage Plan. We will be enrolling the majority of our existing Advantage plan clients who have had their MOOP increased, as well as those we meet for the first time, in HMO’s and PPO’s that check all those boxes and in addition, provide at least $ 2,000 in comprehensive dental benefits.

For those on Supplements, my advice is as follows: Anyone who has Plans C or F needs to move to Plans G or N asap if medical underwriting can be passed. I’m meeting people in their early 70’ s who are paying as much as $ 1,200 per year in premiums for Plans C and F to get rid of just $ 200 in bills! It makes zero financial sense, and the cost of C and F will continue to skyrocket. Again, DON’T LET FEAR DRIVE YOUR CHOICES. Get the facts about how Supplements work. There’s zero risk of moving to a new plan letter or Supplement company due to Federal regulations. Anyone who has Plan G and didn’t buy it from The Health Insurance Store call or email us to get a quote for the same letter with a different company.

For those who have Supplements and must purchase Stand Alone Part D prescription plans need their plans reviewed! I’m amazed at how many of you overpay for premiums and medications because you haven’t had it a professionally analyzed. Most brokers don’t want to put in the work of reviewing them every year. We do because it’s a must. People often save hundreds and sometimes over a thousand dollars making the easy switch to a new Part D plan. We review every one of our clients Stand Alone Part D plans each AEP. We can do that for you as well, even if you didn’t purchase your Supplement from The Health Insurance Store.

Lastly, stop stressing about what plan to choose every year. Should I change to a new plan or company? Is my plan still the best? What actions should I be taking? Put that in our hands. Once you become a client, we’ll notify you of any upcoming changes and let you know if a move to another plan or renewing your current plan offers the best value. In addition, we have a dedicated staff to assist our clients if they have any issues with medical bills, claim denials, prescription coverage, etc. We advocate for our clients all year long.

Consultations in one of our office locations, over the phone, or via Zoom meeting are always no cost. If you would like to speak briefly to an agent and get an opinion if you’re already on a plan that’s going to be a good choice for 2021 or if yours is going to have significant changes, feel free to make that call as well or reach out to me directly via email, Aaron@ getyourbestplan. com.