Ask The Health Insurance Specialist

QUESTION:

Question from Sherry: A few months ago, I asked about HOP benefits, and you suggested their Supplemental plan. However, I will also need prescription, vision, and dental coverage. How should I determine the best option, or should I purchase through HOP? My husband is on a $0 Advantage Plan. He is very happy with it although now we are wondering if he should consider adding some other options or a plan instead with less out of pocket exposure.

ANSWER:

For those who aren’t aware, HOP benefits are available to those who retired from any Pennsylvania Public School District. We give the same advice to every single HOP recipient we meet; If you get the $100 premium credit, choose the HOP Medical plan which is a Supplement to Medicare. We also advise everyone to allow us to enroll them in a Medicare Stand Alone Part D plan because as great of value as the HOP Medical plan is, the prescription plans offered are as bad for probably 85 to 90% of those who are eligible. The Basic plan is $66/month compared to the $11 to $13 most of our clients will be paying in 2023. Co-pays on drugs, especially brand names are much more expensive on the HOP plans vs Part D as well. If you’re currently on the HOP Medical Plan, you can contact us to review your prescriptions. We can tell you how much money you will save by moving to Part D and then help with the application. Those who take this step then become clients of The Health Insurance Store with all the benefits that come with it and there are never any charges for our services.

HMO and PPO Advantage Plan options are available for HOP members, however, they’re more expensive. And as I’ve gone over in numerous columns, those who have an HMO or PPO need prior authorizations for services such as MRI’s, CT scans, home health care, and Skilled Nursing. Supplements, including the HOP Medical plan do not. In other words, if your doctor wants you to have an MRI the same day and surgery tomorrow after reading that image, it happens with no questions asked or interference from an insurance company. If I had to name the number one disadvantage of HMO’s and PPO’s, it’s that the insurance company can make their members get physical or injection therapy before they get approved to receive an MRI, CT scan or outpatient surgery. They can also limit the number of days one can stay in a hospital or skilled nursing facility.

I like the overall benefit package Shelly’s husband’s plan supplies, and it meets our criteria for choosing an Advantage Plan: a premium less than $40 per month, a per stay hospital co-pay, an Out of Pocket Maximum (MOOP) under $7,000, and at least $2,000 in comprehensive dental coverage. However, it excludes network access to Western Pennsylvania’s largest hospital system. The same company offers another $0 premium plan as well and a low-cost plan that has a national network, including every Western PA hospital. If Sherry’s husband wants to remain on an Advantage Plan, I would recommend one with a better network.

I also like to encourage people who have been on Advantage Plans for a few years and saved a ton of money in premiums to consider a Supplement. Advantage plans with drug coverage have MOOPs of $4,500 to $7,500. Maybe think about cashing in your chips so to speak, ensuring some or all those savings are secured by moving to a Supplement that eliminates the possibility of any large bills for care such as chemo, radiation, skilled nursing, and injection or infusion therapy. Supplements are very reasonably priced right now too. A 70-year-old female can get Plan N for $79/month and the same age male $89. Prices are $2-$3 more for every year older than 70.

That being said, Advantage Plans have never been a better value in the 15 years I’ve been in the Medicare business. We have more clients than ever choosing to enroll in them. Premiums and co-pays are lower than ever and the amount of ancillary benefits such as comprehensive dental, over the counter allowances, vision, hearing, money for food as well as copays, and other goodies that are supplied are so generous, it’s hard to believe. I’m concerned it may not be sustainable, however. If Advantage Plan companies fall below a four-star rating or the federal government decides to lower the subsidies they pay to the insurance companies, premiums and copays could go up and/or most of the ancillary benefits may be reduced or eliminated. I sure hope it doesn’t happen because 30 million Americans are now utilizing them. However, if it were to occur many or most who wanted to return to Supplements won’t be able because those with certain current or pre-existing conditions could be denied acceptance by the Supplement companies, even during the Annual Election Period (AEP).

As for dental and vision, you absolutely don’t need it. There isn’t a dental or vision plan on the open market worth buying, including the one offered by HOP at $40 per month in my opinion. The amount in claims paid will never be greater than the premiums you shelled out to the insurance provider over any three-to-five-year period. And remember that all medical conditions of the eye, ear, or mouth are covered by Advantage Plans or Medicare and a Supplement: Glaucoma, cataract, macular degeneration, an eye or ear infection, broken jaw, etc.

AEP is going on now and runs through December 7th. I encourage anyone who didn’t buy their Medicare plan from us to call and get a quick review if what you currently have is one of the five or six Advantage Plans we’re recommending for 2023 or if you can save money on your Supplement without giving up coverage or benefits. You can also email me personally at aaron@getyourbestplan.com.