This week’s question from Gina
I get very few of the ancillary benefits you listed in your last column with my Advantage Plan. Why is that? How can one plan offer $3,000 a year in dental and another little or none? I’ve been with this company for a very long time and don’t really want to leave them. But it appears I’m missing out on quite a bit.
Answer
Not Every Advantage Plan is The Same
Welcome to the wild world of Advantage Plans where paying more and getting less isn’t uncommon at all. One of the reasons for it lies in your question. You stated you’ve been with the company for a long time and don’t want to make a change. I’ve written about the unnecessary fear of transitioning from one Advantage Plan or company to another so many times I’m sure people are tired of reading about it. However, it continues to be one the most common mistakes made by those on Medicare; staying on a plan year after year that costs more, has higher hospital co-pays, and less ancillary benefits. This pseudo comfort zone costs people thousands of dollars per year in excessive premiums, out of pocket costs, and lack of valuable ancillary benefits, as much as $1,800 worth or more per year. I’m quite confident Gina has one of two plans that have been around almost since the inception of Advantage Plans in 2004.
Why does your plan supply very little ancillary benefits and others much more? Because Advantage Plan companies are not regulated to include them. They’re voluntary and plans within the same company can offer the bare minimum to the absolute most. And often, more expensive plans come with the least, which goes against all logic. Why would a company offer a plan with almost no dental and zero Over the Counter (OTC) allowances while charging $35 to $50 more per month while exposing members to a five day or longer hospital co-pay that’s about $1,000 higher? Because they can. They also don’t want to eliminate them completely out of fear those who still have them might choose to go with another company. After speaking with a knowledgeable colleague when doing some research for this column, we estimated between 10,000 and 40,000 people in Western PA are still on one of the two non-competitive plans I’m referring to.
Get Your Best Plan
The good news for Gina and the other people who still haven’t changed, the same company introduced excellent plans with some of the most competitive and generous ancillary benefits on the market a couple of years ago. In fact, the new plans have a nationwide network, which no other Advantage Plan company in our market can claim. So not only does this open up in network access to world class facilities like the Mayo Clinic and MD Anderson Cancer Center as well as virtually any hospital when traveling, those who are fearful of changing companies don’t have to move to another to get one of the best plans available.
I want to point out that there are now seven Advantage Plan companies doing business in Southwestern PA and around 100 plans to choose from, an overwhelming number for someone to try and review on their own. However, only three companies are worthy of consideration, and everyone would recognize them. Two are regional and one national. I wish I could state names of companies and in this case specific plans, but regulations don’t allow me to do that in a public forum like social media or in any advertisement. I understand why, but I wish I could just tell people what plans specifically aren’t competitive when it comes to premiums, co-pays, and the amount of ancillary benefits offered. The bottom line is out of those 100 plans, there are literally less than 10 we recommend to our clients. I will repeat this again. If your plan costs more than $30/month, has the potential for a hospital co-pay of more than $350, doesn’t come with at least $2,000 of comprehensive dental as well as OTC benefits, you aren’t on one we feel is competitive. And if that’s the case, you can switch right now because several of our favorite HMOs and PPOs are rated Five-Star and can be enrolled in all year round.
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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