Ask the Medicare Specialist
QUESTION:
From Sue: I didn’t realize Medicare Advantage Plans don’t have a deductible for prescription drugs like my Stand-Alone Part D plan has. I meet it every year because I take a brand name medication. Many of my friends have HMO’s or PPO’s with zero or low premiums, and tell me they really like them because they pay $0 at their PCP, get really good dental coverage, and a catalog that they can order vitamins and over the counter medicine from for free. I’m really thinking about changing from a Supplement to an Advantage Plan for next year. Do you think that’s a good idea?
ANSWER:
I can’t answer that for you, or anyone else for that matter, until I’ve taken the time to explain how Advantage Plans and Supplements work, ensure the differences between the two are well understood, and I get a good idea of what’s most important for each individual client who’s on the phone, having an internet appointment, or sitting across the desk from me. There’s no one size fits all approach when it comes to choosing a Medicare Advantage Plan or Supplement. The other licensed agents and I at The Health Insurance Store need to ask and answer lots of questions as well as guide you through the ins and outs, the fine print, the pros, cons, and what I sometimes refer to as “trap doors” of Medicare. After we’ve done that, we can then give advice on what we feel is/are the best option(s).
What I will tell you is we’re now in what I’m calling the “Golden Age of Advantage Plans.” From what I’ve seen thus far, it’s my opinion that the top HMO and PPO plans for 2022 will be the best I’ve ever seen in the 14 years I’ve been in the Medicare field. They’re providing excellent value in terms of the combination of really affordable premiums, low hospital and other co-pays, no deductibles for Part D as Sue mentioned, and all the ancillary benefits that are now being offered, which just keep getting more and more generous. Not only are the plans that we’ll be renewing or enrolling most of our clients in offering comprehensive dental, free eye exams and up to $400 for glasses or contacts, Over the Counter (OTC) products and hearing aid allowances, and a no cost gym membership, some are going to be providing a pre-paid debit card that can be used to pay for as much as $400 a year in co-pays. It doesn’t stop there either. The list of no cost benefits keeps getting longer and longer.
In 2022, those on select Advantage Plans who use all their OTC allowance, max out the eyeglasses benefit, take advantage of the gym membership, spend all co pay assistance money, and utilize dental coverage for just routine cleanings and X-Rays will literally receive as much as $1,800 worth of goods and services at no cost! For someone like Sue, who meets her Part D deductible each year, increase that figure to just under $2,200. Add even more to that total for those who would get comprehensive dental services performed such as crowns, root canals, or dentures.
It’s easy to see why there’s a very high interest in Advantage Plans and they continue to become more popular. I bet we’ll help close to 1,000 or more new clients enroll in one between October 15th, the start of the Annual Election Period (AEP) until the same time next year, with many moving from a Supplements like Sue is considering. Let’s discuss a few items of importance for those who are interested in Advantage Plans. Most importantly, people who make that move need to understand although you may see ads promoting $0 co-pays for Primary Care Doctor (PCP) visits and Tier 1 generic drugs, if you need an MRI or CT scan, an outpatient surgery, take and ambulance, or are hospitalized, those services can cost from $150 to $2,000 depending on plan and company. Chemotherapy and other drugs infused or injected in an outpatient setting come with a 20% coinsurance of the allowable billable amount. Chances are you know someone who is receiving Remicade infusion or shots for Macular Degeneration every four to six weeks. Those who have Advantage Plan HMO’s or PPO’s pay around $400 every time those services are rendered. The $0 co-pays are nice, but shouldn’t be what prompts one to enroll in any plan in my opinion. Those are small ticket items that don’t result in much savings. I’m never worried if one plan offers a $0 co-pay compared to $5 or $10 on another. My biggest concerns are monthly premiums, hospital copays for a six-day stay or longer, the Maximum Out of Pocket (MOOP), network access to all the medical providers the client wants and needs, the number and amount of ancillary benefits, as well as the quality of customer service the company provides.
Which leads to another important detail. Not all Advantage Plans are created equal. Not even close! Even within the same company plans can have a $500 or more larger hospital co-pay, a $3,500 difference in MOOP, not offer nearly the same amount of dental benefits or OTC and eyeglass allowances (if any), as well as not having both our major health care systems in network, which is important for many. There’s one company in particular who is now offering plans from a total of four different entities/names. Only one has plans we feel are competitive. What I know happens far too often is a Medicare beneficiary hearing from a friend or family member that they have XYZ insurance and love it. Meanwhile, there might be 15 or more plans offered by that company with only one or two being those the agents of The Health Insurance Store and myself will be recommending for consideration in 2022. Dealing with a company directly over the phone or via the internet, calling an 800 number advertised on TV, or using an inexperienced agent or broker could very easily lead to being enrolled in a non-competitive plan which could result in higher premiums and/or co-pays, and more out of pocket costs that can add up to thousands of dollars.
Lastly, it’s imperative that people who are going on an Advantage Plan when they initially get Part B or those leaving a Supplement to move to an HMO or PPO understand it’s possible they may never be able to enroll in a Supplement again due to those companies’ ability to utilize medical underwriting, which allows them to deny applications based on current or previous health conditions. We encourage everyone who’s going to be new to Medicare Part B, currently has an Advantage Plan and wants to ensure they will be enrolled in one of the plans we consider to be the best value for 2022, as well as those who would like to inquire about moving from a Supplement to an HMO or PPO to make an appointment for a no cost consultation. Those can be done over the phone or internet as well as in person, whichever is more convenient and comfortable. We are currently scheduling for AEP, which begins October 15th and runs through December 7th.
If you would like to have an initial conversation with myself or one of our licensed agents prior to making an appointment, feel free to give us a call or email me personally at aaron@getyourbestplan.com.