This week’s question from Emma
Why does it seem like every year around this time we get more and more mail and see so many TV commercials regarding Medicare. I’m even getting phone calls now. It’s all so confusing and makes me anxious to be honest. I don’t know if I should keep the plan I have or look into something else. What do you suggest?
Answer
Annual Election Period
I find it ridiculous the number of solicitations every single US citizen 65 years or older will get in the mail and the amount of money that will be spent on TV, radio, billboard, and print advertising prior to and during the Annual Election Period (AEP), the 53 days when everyone on Medicare Parts A and B can make changes to their plan lineup. I wish there were some regulations that would limit how much soliciting each company could do, with some of the money saved passed on to Medicare beneficiaries in the form of lower co-pays and premiums. I’d also like to see more transparency in the commercials that have pro football players and actors as pitch men. If it were up to me, they would be forced to disclose that the plans they’re promoting expose insureds to as much as $7,550 in bills per calendar year. I find the advertising very frustrating on several levels: First, there are people like Emma who are so inundated with ads it becomes overwhelming and scary to make a change. Instead of researching plans, they often remain on one that is overpriced, has higher co-pays and a Maximum Out of Pocket, or doesn’t provide as generous amounts of ancillary benefits such as dental, vision, OTC allowances, and others. Secondly, we’ve met far too many people who called an 800# number and were talked into changing from a Supplement without being told the plans and benefits are much different and that it’s quite possible they won’t ever be able to enroll in a Supplement again. It’s also common for someone to be persuaded into enrolling in another Advantage Plan where all their doctors and hospitals aren’t in network, or one that has much higher out of pocket costs. Salespeople who aren’t local have been known to use unethical tactics to get seniors to move to a plan just so he or she can get a commission with no concern if it’s a better value or not. I had a longtime client just last week tell me they were called unsolicited, something that isn’t even legal when it comes to Advantage or Part D plans. When they explained to the guy on the other end of the phone that have an agent they’ve worked with for years and were going to see in a few days, according to my clients, he said, “I can do better than him. He’s going to rip you off,” without even knowing what plans I was going to be discussing with them. And lastly, when I send clients our annual recommendation letter, I’m not even allowed to mention their Advantage Plan or Part D company by name, even though our agency helped them enroll in it! The Centers for Medicare and Medicaid (CMS) have some very strict and what I feel are nonsensical regulations on agents, meanwhile, many outfits and companies can use misleading advertising to try and convince seniors to call them or switch plans with the promises of “free stuff,” refunds of the Part B premium most aren’t entitled to, or $0 co-pays for services or prescription that would cost $5 or less on another plan or without insurance.
Call Us for Information
The easy solution, if you feel the same as Emma, is to ignore all the ads and call us. As I wrote in the last column, it’s my estimation that probably 50% or more people on Medicare are either overpaying for their Supplement or Advantage Plan, or don’t have an HMO/PPO that aren’t in the handful of plans I feel are worthy of consideration. With a brief phone call to either of our offices or an email to me directly, we can let you know if you have one of the plans available in 2022 we will be recommending to our own clients or another that doesn’t fall in that category. If the former is the case, you have peace of mind. If the latter, we can set up a no cost consultation to compare plan costs and benefits side by side.
When Should You Make an Appointment?
Here are a few of the scenarios where those on Medicare will want to make an appointment and don’t even need to speak to myself or an agent: 1) Your Advantage Plan monthly premium will be more than $40 in 2022. 2) Your HMO or PPO will have a per day hospital stay co-pay. In other words, instead of it costing $250 to $350 for a visit regardless of how long that stay is, you pay $200 to $300 per day, up to five or six days, which can result in a co-pay as much as $1,000 to $1,800 for the same exact inpatient services. 3) Your plan will not supply at least $2,000 in comprehensive dental for services such as fillings, crowns, root canals, dentures, etc., OTC benefits, as well as $200 or more in eyeglasses or contact allowances and a free eye exam. There are several plans that will meet all three of these criteria in 2022.
Here are the people on Supplements who need to call us: 1) Anyone who has plans C or F. These letter plans provide zero value. Most, if not all, who still have them are paying $1,000 or more per year in premiums and only receiving a little over $200 in additional benefits vs Plan G or N. 2) Anyone who did not buy their Supplement from the Health Insurance Store. Every year we move people to our most popular and least expensive plans while keeping the client on the same letter plan, savings hundreds, even thousands of dollars in premiums without giving up anything. Remember, all Supplement companies offer the same medical benefits and access to the same doctors and hospitals nationwide. Plan G is G is G and N is N is N regardless of the company providing it. Cost is the only difference between companies selling the same letter plan. 3) Anyone who has not had their Part D evaluated in the last year or two. Part D companies count on Medicare beneficiaries renewing their plan without doing any research. We can evaluate all available 2022 Part D plans, ensuring the best value in the form of prescription costs and premiums. We do this each AEP for every single one of our Supplement clients who need to purchase a Stand-Alone Part D plan. Even those who have premiums that are going down, staying the same, or increasing just a few dollars a month, and/or taking drugs that haven’t changed from a year ago need to have their plan reviewed. Here’s why. Companies can remove drugs from their formulary or move a Tier 1 drugs to a Tier 2, a Tier 2 to a 3, 3 to a 4, etc., which can be costly.
We Support You
I’d like to remind those who are not yet a client of The Health Insurance Store, when you become one, we provide support services in the event there’s a premium payment error, a questionable bill, claim denials, or prescription issues. We will always get involved and advocate in situations such as the aforementioned and more. We’re also dialed into the pulse of the market so we can inform our clients of any important developments when they occur such as premium increases or decreases, opportunities to save money by enrolling in new or emerging companies or plans, as well as changes in benefits that could be impactful. In addition, Tony DiRoma, our in-house Prescription Drug Case Worker, is always available for counseling when clients’ prescription drug expenses become burdensome due to a diagnosis that requires a “Specialty Drug” or falling into the Donut Hole.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
Erie County Area
1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276
Fayette/Westmoreland County Area
121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402
Pittsburgh Area
21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149
Albuquerque/Santa Fe, New Mexico Area
821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073
Serving These Areas
We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas: Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford, Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania
We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico
Not affiliated with the U. S. government or federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.