Ask the Medicare Specialist
QUESTION:
Question from Cheryl: I read in your last column that Advantage Plans have very good dental and vision benefits. My plan doesn’t cover much dental at all, just cleanings and X-Rays, and I don’t get $400 a year for glasses like you mentioned. I don’t even get half of that every two years. Why do plans have such different benefits? Can I still change, and would you suggest that I do?
ANSWER:
This is going to be the shortest column I’ve ever written because the answer is so simple. Let me be blunt. You’re on the wrong plan Cheryl, as are tens of thousands of Western Pennsylvanians. Yes, you should change, and you can still do that. You’re able to move to any Advantage Plan up until March 31st, and to those that have been awarded 5-Star ratings all year round.
The plans we recommend to our clients who prefer or must choose Advantage Plan HMO’s or PPO’s meet the following criteria: Premiums of $35 per month or less with no deductibles. Those who qualify for PACENET or VA benefits are often best on $0 plans that also refund as much as $50 of the Medicare Part B premium; A per stay hospital co-pay of no more than $300 regardless of how many days one is admitted; At least $2,000 in comprehensive dental benefits that cover not only cleanings and X-rays, but also fillings, extractions, periodontal, crowns, root canals, and with some plans, partials and dentures; Over the Counter (OTC) benefits that provide an allowance to order health and hygiene products out of a catalog such as vitamins, pain relievers, cough, cold and flu remedies, and pretty much anything you could walk into a pharmacy and buy off the shelf.
Cheryl, if you have one of the plans I suspect you do, not only does your plan not meet any of my benchmarks, you’re also being charged double or more of what you should be. Some on these companies’ plans are paying over $100 to almost $300 per month!! That’s a flat out rip off. Yours is what I call a “legacy plan” and has been around since the inception of Advantage Plans in 2004. Why do companies and plans vary so much? Because they can and are for profit entities. They also don’t want to eliminate their legacy plans because I estimate there are as many as 50,000 people or more enrolled. Getting rid of them would create a shopping frenzy that could result in many of their members moving to competing companies.
You have to be a smart consumer and honestly, when it comes to Medicare, far too many people shop with emotion and remain on legacy Advantage Plans or outdated Supplements out of fear. For those of you who are afraid to move from the company you’ve been with for decades, there’s an alternative to overpaying and not getting the benefits you should be. The company I’m betting Cheryl is with created a new set of plans last year and a couple meet all our criteria and are part of the handful we recommend. In addition, they supply what no other Medicare Advantage Plan company does, access to a nationwide network. So, you can stay with the company you’re comfortable with, save between $500 and $3,000 per year in premiums, lower your hospital co-pay, pick up comprehensive dental and OTC benefits, and possibly expand your network of doctors and hospitals.
Making this move is a slam dunk, a no brainer, or whatever other cliché you want to use for a decision that should be one of the easiest ever. Not making the move is unwise and those who continue to remain on more expensive plans with fewer benefits are throwing money away. It never ceases to amaze me how many people do just that. Sorry if that offends anyone, but I take it very personally when seniors on fixed incomes are being taken advantage of, especially in a time when costs for everyday needs have risen so dramatically.
If you have any questions or would like clarification on any of the information in today’s column or want to make an appointment for a no cost consultation to compare benefits side by side, please give one of our offices a call or email me personally at aaron@getyourbestplan.com.