Ask The Medicare Specialist

By: Aaron Zolbrod

QUESTION:

Re: Sunday, March 10th, Question from Maryann:

2024, Post-Gazette article that discussed moving from a Supplement to an Advantage Plan. I’m a retired public-school teacher on the HOP Medical Supplement plus their Basic Rx prescription coverage. My husband is also on the same combination. In 2023 our premium was $534 and it’s $554 this year. I do receive the $100 premium assistance, so my net cost is $454. I would like your opinion as to whether I should consider a change to an Advantage Plan.

ANSWER:

This was an email I got the other day. I want to use Maryann and I’s correspondence as part of the column and then discuss it.

Good morning, Maryann. A large part of your premium is the HOP Part D prescription benefit. It’s very expensive with HOP and represents $134/month, 30 % of your total premium. Your husband’s portion for the Supplement is also $100 higher than yours because he doesn’t get the premium assistance. Only you, the retiree, is entitled to that benefit.

I absolutely would not recommend you personally going on an Advantage Plan. With the $100 premium assistance, the HOP Medical Supplement is one of the best values in all of Medicare! If you opted out, you may never be able to get back into the program. And with what I expect to take place with Advantage Plans; reductions in ancillary benefits like dental and OTC allowances among others, increased co-pays and MOOP, that should be a consideration of anyone thinking of leaving a Supplement. What I love about the HOP Supplement is the premiums don’t go up much, at a much slower pace than other Supplements you could buy on your own in fact. There are two things you might want to consider, however. Moving both you and your husband to a Part D prescription plan outside of HOP. I estimate we have at least 500 clients who have kept their HOP Supplement but moved to a Part D plan at 50 cents to $20 per month instead of the $67 HOP Basic Rx costs. And coverage is similar if not better. You could also move your husband off HOP to a Medicare Supplement or Advantage Plan. My advice on the latter, however, would really depend on his age, health, and your finances.

As far as moving to another Part D plan outside of HOP, we’d have to wait until the Annual Election Period in October to do that. And I’m not sure if there’s going to be much value because of what is occurring next year, a limit of $2,000 that anyone on Part D can pay out of pocket for medications. The burden of covering 80% of those costs after that $2,000 has been met is being put on the Part D and Advantage Plan companies so I’m anticipating the days of Part D premiums under $20 to be a thing of the past unfortunately. It’s also one of the reasons I anticipate Advantage Plans also becoming less of a value. For years and years, it was better for probably 75% of HOP recipients to get Part D on their own. If the HOP Basic Rx plan benefits stay unchanged and the premium similar to what they are in 2024, that may not be the case moving forward. I’m very eager to see what will happen. Good morning, Aaron. I appreciate your speedy and helpful response. Regarding the status of my husband. He is soon to be 82 and has cardiac and orthopedic issues. Since there are anticipated changes coming and a wait till the Annual Election Period, it seems like there is ample time to maul things over. Any additional comments/advice would be appreciated. Again, thank you for your expertise and time. Maryann, unfortunately your husband would not benefit from a move to another Supplement on the open market due to his age. It wouldn’t take long for the monthly premium to become significantly higher than what his cost is now and a return to HOP might not be possible. It’s my professional opinion that you absolutely don’t want to move him to an Advantage Plan unless you simply can’t afford the HOP Supplement. The peace of mind with HOP is he can get his care as his doctors order them and never wait for an approval from an insurance company. With an Advantage Plan, that’s not the case and treatments, tests, and services can be denied or delayed. Again, that can never happen with HOP. I’m also worried that some of the money he might save on premiums could be eaten up by additional out of pocket co-pays or coinsurance on an HMO or PPO that he doesn’t currently have with HOP. Keep reading the columns. I will get a better idea closer to October what the new Part D plans are going to look like versus HOP and will certainly be writing about that. Unfortunately, I won’t know until probably September at the earliest. Feel free to reach out in the meantime. ( This was basically the end of our email).

I’m almost certain that if Maryann would have reached out to another agent it would have been very likely that person would have seen the potential for very large commission by moving her and/or her husband to an Advantage Plan and been eager to discuss how they could save close to $5,000 per year in premium and get them generous benefits not offered by HOP, or any Supplement for that matter. It sounds like an excellent opportunity and is for many. I completely understand why people move from Supplements to Advantage Plans as I wrote last week. I just don’t believe with Maryann’s husband’s health and the value the HOP Medical Plan offers her, it’s a wise decision for them personally. Unfortunately, many agents will “sell” just the short-term savings and extra benefits that would be realized, but don’t ever mention the long term affects and risks involved. They too often go unexplained to people like Maryann and her husband. We’ve met countless people who were talked out of their HOP and Supplements despite it not being in their best interests and with no understanding of the possible consequences. That never happens when people choose to get advice from The Health Insurance Store. I estimate that we tell at least 25% of those who seek us out they are best to remain on the plan they currently have or choose one from a source we get no commission.

The moral of the column is to be careful who you listen to and what agent you use to enroll in a Medicare plan. Allowing the Health Insurance Store to help you is the only way to guarantee sound and ethical counsel.