I’m a retired public-school teacher and get my Medicare plan through HOP. Is there anything I need to do during Annual Election Period? How do you normally advise those like me?
Let me first say HOP doesn’t call it Annual Election Period (AEP), rather the Health Option Selection Period. In the past it has run October 1st to November 15th. AEP runs October 15th through December 7th. Look for your HOP packet to arrive early October. Also, please note neither myself nor the other agents who represent The Health Insurance Store are compensated to help anyone enroll in HOP plans.
Nearly all those eligible for HOP who reach out to us get the same advice, although there are different groups to consider. Let’s start with those turning 65 or going on a HOP Medicare plan for the first time. We advise everyone who gets the $100 premium credit to choose the HOP Medical Plan, which has a net cost of $94/ month after the credit is applied. We also advise the purchase of a private Part D prescription plan though our agency because HOP prescription coverage is very expensive, and the co-pays are generally higher than industry standard. The HOP Basic Rx monthly premium is $67 in 2019, compared to the $14.50-$17.20 most of our clients are currently paying. Generic co-pays on the HOP Basic Rx are $8. Most of our clients have Tier 1 and 2 Generic co-pays between $0 and $6. Co-pays on the HOP Basic Plan for Preferred Brands are 30% of the retail cost, with a cap of $100. Brand name drugs now average around $400, so a $100 co-pay for a 30-day supply will be quite normal. Average co-pays for brand name drugs on plans our clients currently have range from $35-$47. The only real advantage with the HOP Basic Rx is the deductible for brand name drugs. With HOP it’s $100. Our clients generally have deductibles from $285 -$415. However, when considering the HOP plan costs $600 or more per year in premium, the net savings is still quite significant, especially considering generic drugs are not subject to a deductible on most plans.
The second group of people are spouses of retirees who don’t get the $100 credit. We advise them to choose a Supplement or Advantage Plan with a private company though our agency, with the exception of those older than 75 and others who can’t pass medical underwriting. A Supplement through a private company costs $70 to $100 less per month for those ages 65 to 67. The savings can be as much as $150/ month when considering prescription plan premiums. It’s also my professional opinion this coverage is as good or better than what HOP provides. Those who choose a $0 Advantage Plan can save as much as $250/ month in premiums. However, keep in mind private Advantage Plans potentially expose those who have them from $3,400 to $6,700 in out of pocket medical bills, compared to very minimal expenses with either the HOP Medical plan, HOP Advantage Plans, or a Supplement from a private company.
The third group of people we encounter are those who didn’t work for the school system long enough to get the $100 credit. If you have questions about your eligibility, call HOP. Their representatives are extremely helpful. I had a gentleman in the office last week who told me he didn’t qualify. We reached out to HOP and found out he was mistaken. With few exceptions, we advise this group the same as we do spouses of retirees; If 75 or younger, go with a private Supplement or Advantage Plan if you can pass underwriting.
Some other items to consider. Those who opt out may never be able to get back into the HOP program. That’s not a huge issue for those who are closer to 65 and aren’t getting the $100 credit. However, unless you want to take an Advantage Plan at age 76 or older, you’re not going to save as much money as those in their 60’s and early 70’s. In the past, HOP has opened enrollment up to those who have opted out. But that was a courtesy and may never happen again.
Also, we never advise choosing an HMO or PPO Advantage Plan through HOP. They’re generally more expensive than the HOP Medical Plan and have network restrictions. The HOP Medical Plan is a Supplement, which means if a provider accepts Medicare Assignment (virtually everyone), you’re covered anywhere in the country with no additional out of pocket costs. And, there are no pre-existing conditions considered when changing from one HOP plan to another, including moving out of an HMO or PPO.
You DO NOT need the HOP Enhanced Rx Plan! I personally have advised over 500 HOP beneficiaries. On only one occasion have I found someone whom it made even the slightest bit of financial sense. It’s costs $700 more per year than the Basic Rx and $1,300 more than the plans we enroll most of our clients in.
One thing everyone on the HOP Medical Plan should do is have The Health Insurance Store evaluate your Part D prescription coverage. We can show you exactly how much money you will save with a private Part D plan in 2020. And unlike the Medical portion of HOP, you can always opt back into HOP prescription coverage every year during the Health Options Selection Period. Call one of our offices if you would like us to provide you with this no-cost service.
I would also like to remind readers that starting in October, “Ask the Medicare Specialist” will be moving to Fridays. And don’t forget to tune into KDKA Radio this Saturday at 7am for my live show, Medicare A to Z.
No-cost, unbiased Medicare plan review and consultation with local, licensed agents
Email your question to: firstname.lastname@example.org