This week’s question from anonymous
I know that Annual Election Period is over, but is there anything people who are on Medicare need to be aware of during the rest of the year?
Answer
Don’t Just Sit Around
I think one of the biggest mistakes those on Medicare can make is to just sit back and wait for the bills to come. In today’s health care climate, we need to be proactive in several areas.
The first is ensuring you have the best value in plan in terms of benefits and premiums whether you have an Advantage Plan HMO/PPO or Supplement. This past AEP, we didn’t recommend any Advantage Plans that had a premium over $40/month, and the majority were in the mid $20’s. We also almost never advise clients to choose plans with a “per day” hospital co-pay that can result in bills between $1000 and $1,800 for a four to six-day admission. The most popular plans among our clients for 2022 all have hospital co-pays of no more than $375 per stay regardless of how long the admission is. They also include at least $2000 in comprehensive dental that covers not only cleanings and X-Rays, but extractions, root canals, crowns, periodontal, partials, and dentures. Make sure you’re getting and taking advantage of all the extras your plan offers including the dental, eyeglasses and OTC allowances, and the newest benefits, a $100 per quarter co-pay debit card and the $75 per quarter Healthy Food debit card that a limited number of plans are offering. You can verify co-pays and benefits in the document called the “Summary of Benefits.”
If you don’t have a plan that meets the criteria I just listed, you have some comparing to do. And you can still make a change for 2022 because those who have both Medicare Parts A and B can now enroll in 5-Star rated Advantage Plans all year round and the majority of the HMO’s and PPO’s we recommend our clients consider are 5 Star. You may also be able to move from an Advantage Plan to a Supplement as well.
As I mentioned last week, Supplements can also be changed year-round and are not restricted by Enrollment Periods. We’re recommending almost everyone who currently has Plans C, G, or F to move to Plan N if they can pass medical underwriting. We already know that C and F are going up in large chunks, $25 or more, every year. Increases on G are also starting to approach that number and we anticipate rates will keep rising much more every year than Plan N, which has had significantly lower increases over the past five years.
A horribly common mistake seniors make is paying erroneous bills. It’s so important for those on Advantage Plans to understand what their co-pays are for all medical services and prescriptions. I can’t even comprehend how much money is wasted paying bogus medical bills in the US. Always question any bill that has even the slightest appearance of being wrong. Call your insurance company first to see what they say prior to sending a check. And don’t take, “that’s just the way it is” as an answer.
We Reduce the Stress
Our clients don’t have to stress about making those calls, being transferred back and forth, or getting conflicting explanations from different people within the same company. They simply hand the task of researching questionable bills over to their agent or our dedicated support staff to resolve. I wish we would have kept track of the dollar amount of bills we discovered to be erroneous since The Health Insurance Store opened in 2008.
Watching prescription drug costs is also something that needs to be done from the first day of the year. Be proactive about avoiding the “Donut Hole.” With the average brand name drug now retailing between $500 to $800 for a month’s supply, it won’t take long to get there, especially if you’re taking multiple brand name drugs or more costly generics. Ask doctors for samples, investigate Canadian pharmacies who often sell medication for less than your co-pays or costs in the Doughnut Hole. Many people are even avoiding paying their Part B deductible by getting their brand name drugs from Canada. You would be shocked at how much less medications cost, up to 500%! There are also foundations and assistance programs available that can help offset costs for those who reach the Doughnut Hole. These programs have higher income limits, $51,000 for a single person and $69,000 for a married couple for many medications.
You can also check if your generics may be less expensive without using insurance. Good Rx is a great tool for that.
Stay Educated
Lastly, educate yourself. There’s never a bad time to do that. You can contact any of our agents or myself with questions or concerns. You can also make an appointment for a no-cost consultation at any time during the year. Even if you aren’t able to make a change, we welcome you to sit down with us and learn about the intricacies of Medicare, including the difference between Advantage Plans and Supplements.
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.
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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.