Ask the Medicare Specialist

QUESTION:

I’m a client of The Health Insurance Store. Not long ago we met with one of your agents, Bonnie, when my husband retired and first went on Medicare Part B. She recommended, and we agreed, that a Supplement was the best way to go. But it seems like almost everyone we talk to has a Medicare Advantage Plan that comes with benefits we don’t get. Did we make a mistake by taking a Supplement?

ANSWER:

The short answer is no. You did not. Here’s why. You can always leave a Supplement and go on an Advantage Plan HMO or PPO. The Centers for Medicare and Medicaid regulations mandate Advantage Plan companies accept everyone who has Medicare Parts A and B, regardless of prior or current health conditions. In addition, there are no pre-existing condition clauses and any covered medical service must be paid for the first day the policy goes into effect. I’ve helped people who were actively receiving Cancer treatments change from one Advantage Plan to another.

So, if you are now regretting your decision to enroll in a Supplement, and want to move to an Advantage Plan, you can do that, and without waiting until the next Medicare Annual Election Period. Five Star rated HMO’s and PPO’s, which there are many available from all three of the most popular companies in Western Pennsylvania can be enrolled in all year round. Almost all of the plans we recommend to our clients who prefer Advantage Plans are now Five Star.

However, some advice to Beth, her husband, and any other Medicare beneficiary who is wondering if Supplements are still the best option; Sit down with Bonnie again, myself, or any of our licensed agents. It’s so important to get educated, or in this case reeducated, on the many differences between Supplements and Advantage Plans. They vary in how claims are approved and paid, what doctors and hospitals can be used, and how much money one can be billed. Here’s the most important aspect to understand, however. As easy as it is to move from an Advantage Plan to a Supplement, going the other way can actually be impossible for many, if not the majority of Medicare beneficiaries. Supplements can discriminate in who they accept into their plans based on past or current heatlh and there are several conditions, some quite common in fact, that result in an automatic application denial. So, once you leave a Supplement or even decide not to initially enroll in one when going on Medicare Part B for the first time, there’s a good chance you’re never going back. Ever. It’s one of, if not the biggest risk of Advantage Plans in my opinion.

That being said, there are many reasons why Advantage Plans have become so popular in recent years with almost 30 million people now enrolled. We have thousands ourselves. The right plans, which in my estimation number under 10 out the 100 or so offered in Western PA, are extremely affordable with premiums from $0 t0 $40. They have low and very fair co-payments for the most common services, from $0 to $25 for blood work and X-Rays; under $100 at the ER; $150 to $250 for MRI’s, CT-Scans, outpatient surgeries, and ambulance rides; and $250 to $350 for a hospitalization of any length. And as you’ve seen on TV and heard from those who have them, they supply excellent comprehensive dental benefits that are better than practically every employer provided plan on the market, a $0 eye exam and as much as $400 for a pair of glasses or contacts every year, no cost gym access, almost $500 per year in Over-the-Counter allowances, and now even pre-loaded debit cards that can be used to pay certain co-pays and for healthy food. These are all new or newer benefits that were only introduced two or three years ago. Be advised if you already have a plan and are paying more than $40 a month, your co-pays are higher than those I listed, or if you’re plan isn’t providing most or all the above ancillary benefits, you’re not on one of the best available plans. However, you can enroll in a 5 Star plan that does, right now, or at any time during the year.

Please don’t think all this means I disagree with Bonnie’s recommendation for Beth and her husband, or their choice to enroll in a Supplement. While I understand the value Advantage Plans offer with the low premiums and all the extras that Supplements don’t, I also very often give the same advice, especially to those ages 65 to 75 when Supplements are inexpensive, starting at $75 to $85 per person for married couples ages 65-67, and not a whole lot more for those who are older. And although they don’t provide all the free stuff, what they give those who choose them is the piece of mind that there will never be any medical bills higher than the annual deductible of $233. They also provide access to virtually any doctor or hospital in the country at no additional cost. Someone who had an Advantage Plan on the other hand, was diagnosed with cancer and needed chemotherapy is almost certain to be billed what would literally amount to four to eight years’ worth of Supplement premiums. As you can see, there’s always a give and take.

What we’ve been doing at the Health Insurance Store going on 14 years is helping people take inventory of what is most important to them personally while ensuring they are educated on the nuances of Original Medicare, Supplements, and Advantage Plans and making sure they choose a plan or plans that offer the best value. And after that has been accomplished, we provide constant support and advocacy for our clients whenever any issue even remotely related to their insurance policies arises, which is inevitable.

Hope everyone had a Happy Hanukkah and a Merry Christmas. Here’s to a healthy and joyful 2022!