Navigating Your Medicare Choices
Health Insurance counseling can help make Medicare choices easier
There’s some good news emerging on the health care front for beneficiaries using Medicare Advantage.
Recently, the Centers for Medicare & Medicaid Services (CMS) announced that, on average, Medicare Advantage premiums in 2020 are expected to decline 23 percent from 2018 while plan choices, benefits and enrollment continue to increase. The Medicare Advantage average monthly premium will be the lowest in the last thirteen years for the more than 24 million people with Medicare who are projected to enroll in a Medicare Advantage plan for 2020.
According to medicare. gov:
“Medicare Advantage Plans, sometimes called ‘Part C’ or ‘MA Plans,’ are an ‘all in one’ alternative to Original Medicare. They are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These ‘bundled’ plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D).”
The Medicare Advantage average monthly plan premium is expected to decrease 14 percent to $23 (estimated) in 2020 from an average of $26.87 in 2019. Since 2017, the average monthly Medicare Advantage premium has decreased by an estimated 27.9 percent.
Specifically in Pennsylvania, the average monthly Medicare Advantage premium changed from $52.61 in 2019 to $44.58 in 2020.
As it stands, 95 percent of people with a stand-alone Medicare prescription drug plan have access to a plan with a lower premium than what they paid in 2019.
But the bigger picture for many beneficiaries is learning how to navigate the Medicare system. According to The Centers for Medicare & Medicaid Services, 2,725,101 beneficiaries in Pennsylvania are enrolled in Medicare. When asked about their plans, many local beneficiaries in the Pottstown area had additional questions about what their plans mean and expressed frustration with understanding the multifaceted process of enrolling in Medicare or Medicare Advantage.
That’s where Apprise Health Insurance Counseling comes in.
Apprise is a free health insurance counseling program from the Pennsylvania Department of Aging designed to help older Pennsylvanians with Medicare. Counselors are specially trained volunteers who can answer questions about Medicare and provide objective, easy-to-understand information about Medicare, Medicare Supplemental Insurance, Medical Assistance and Long-Term Care Insurance.
Ed Savitsky, an Apprise counselor for the area agreed that the biggest obstacle for individuals looking to enroll in one of these plans is getting the knowledge they need to choose.
“Finding out what’s going on and what’s happening is probably the biggest obstacle. It’s why we do what we do. We make these presentations so that even people who know what they’re doing get a look at what’s new for next year. The biggest problem is knowledge. A lot of people either start with something their parents had or their neighbor across the fence said, ‘I had this and I don’t have to pay anything.’ It all sounds good until someone goes to the hospital,” said Savitsky. “The other big thing is it’s complicated so people give up.”
Understanding the difference between Medicare with a supplemental plan and Medicare Advantage can be key to helping beneficiaries choose. The only issue, according to Savitsky, is that the needs of each individual can be what dictate the best option.
“If there was a real advantage to one or the other, one of them wouldn’t exist. So the situation is it’s different for different people,” explained Savitsky.
“If you are not squeezing the dollars, if you have enough money, with the regular Medicare, insurance companies take all the risk if you have a supplemental plan which is also called a Medigap plan. You don’t take any risk you just pay a higher premium every month,” said Savitsky.
Medigap is extra health insurance that can be bought to help cover costs that original Medicare doesn’t cover such as copays and deductibles.
“With Medicare Advantage Plan, you have a significantly lower premium every month but you take part of the risk. The biggest risk being, if you go into the hospital, it’s between $200 and $350 a day for the first six days. But that’s a chunk of money for people. But many of them [Medicare Advantage] now have a zero-cost plan so you’re not paying any monthly premiums, whereas if you have a supplemental plan, a 65 year-old female is paying anywhere from a little less than $150 a month,” explained Savitsky.
Savitsky summarized the difference between the plans by explaining that if an individual is content with paying the monthly premiums, supplemental plans can reduce an individual’s risk considerably. Alternatively, those pressed for cash or who are just like having more options in plans may choose Medicare Advantage.
“It’s not black and white unfortunately. People still have decisions to make and there are probably at least 20 Medicare Advantage plans to choose from. Even more disconcerting is the fact that doctors choose which of these plans to be in. So you have the responsibility of finding out whether your doctor, hospital or specialist all accept that Medicare Advantage plan’s program and that’s the biggest decision for people to make. The big ones — the Aetnas and the Blue Cross Blue Shield, they pretty much have all the doctors signed up for their programs but the rest of them you have to check,” said Savitsky.
Savitsky will be giving presentations in October and November to inform area residents about their Medicare options. Savitsky comes to the TriCounty Active Adult Center on the first Tuesday of every month. Individuals can also schedule appointments with him or Craig Soloff by calling 610323-5009 ext. 105.
There are several important dates this month that Medicare beneficiaries should remember:
• Beneficiaries can begin shopping and comparing plans on Medicare.gov starting Oct. 1, 2019.
• Beneficiaries should watch their mail for notices from Medicare with information about changes in 2020.
• Medicare health and drug plan 2020 Star Ratings will be available on Medicare.gov on or around Oct. 9, 2019.
• Medicare Open Enrollment begins Oct. 15, 2019.
Open enrollment ends on Dec. 7, 2019 and Medicare health and drug plan coverage for 2020 begins on Jan. 1, 2020.