This week’s questions from Mary
- I’m signing up for Medicare for the first time and looking for advice. I’m on Medicaid now, but don’t believe I’ll be eligible when I turn 65 since I have significant assets. They are considered after 65, correct?
- I’m a big fan of my current insurance company and have had them for decades.
- I have high blood pressure and take Lisinopril and HCTZ. I’m a former smoker and get an annual low dose CT scan of the lungs.
- I have a bad knee that may need attention in the future, but I’d prefer not to get surgery if possible.
- I wear prescription glasses for reading but don’t replace them very often. I wouldn’t mind dental coverage for my annual checkup and anticipate the need for crowns at some point. Are they covered by the “comprehensive dental” at 50%?
- Is there a plan with the company I’m currently with that you’d recommend above the others? I was thinking about the one that’s around $80 per month. A plan where I might have to pay a little out of pocket is fine, but I can’t be surprised with any huge bills. Please help!
Answer
I’m signing up for Medicare for the first time and looking for advice. I’m on Medicaid now, but don’t believe I’ll be eligible when I turn 65 since I have significant assets. They are considered after 65, correct?
That is correct. You will not qualify for Medicaid, also known as Medical Assistance (MA) when you turn 65. Prior to going on Medicare, the qualifications for MA are different. The income limit is 138% of the Federal Poverty Level instead of 100% and assets are not taken into consideration. Once on Medicare, the asset limit is $2,000 not counting a home or an automobile. Because assets do not determine eligibility, you will qualify for PACE however, which is prescription assistance for PA residents 65 or older. PACE and PACENET are very valuable programs and don’t cost anything. In fact, it makes you a candidate to enroll in an Advantage Plan that not only has a $0 premium, but rebates $50 of your Medicare Part B cost each month. It also has the best ancillary benefits and lowest Maximum Out of Pocket (MOOP) of any plan in our market.
I’m a big fan of my current insurance company and have had them for decades.
You should never choose a Medicare plan based solely on what health insurance company you currently have or how long you’ve been a member. These are two of the biggest and most common mistakes people make. The company you referred to, which I’m not able to name, has some very competitive plans that will be getting even better in 2023. They also have the best member services department in the industry, which is something
to be considered in a final decision. It’s not the most important aspect, however, especially for clients of The Health Insurance Store because we get involved in helping if there are ever any issues, questions, or concerns regarding their plan, bills, claim denials, etc. The plan you mentioned is an Advantage Plan, not a Supplement and the most critical element to any decision of what Medicare plan you initially choose is understanding the differences between both prior to enrolling. The decision you make when going on Part B for the first time can have a lifetime of consequences.
I have high blood pressure and take Lisinopril and HCTZ. I’m a former smoker and get an annual low dose CT scan of the lungs.
You are taking two very inexpensive Tier 1 generic medications that are $0 with almost all Advantage Plans. However, a CT scan, industry wide, has an average co-pay of around $200.
I have a bad knee that may need attention in the future, but I’d prefer not to get surgery if possible
If your knee gets to the point where a replacement is necessary, the out-of-pocket costs with the best Advantage Plans would be between $800 to $1,100 when adding up co-pays for a CT scan, the inpatient hospitalization required for that surgery, and six weeks of physical therapy. The out of pocket for those same services with Supplement plans we recommend would be $0.
I wear prescription glasses for reading but don’t replace them very often. I wouldn’t mind dental coverage for my annual checkup and anticipate the need for crowns at some point. Are they covered by the “comprehensive dental” at 50%?
One of the reasons why Advantage Plans are so popular is the ancillary benefits the most popular provide. They are highlighted by a free eye exam and up to $400 for a pair of glasses, comprehensive dental benefits, and much more. On plans that supply comprehensive dental; cleanings and X-rays are covered at 100% while “major services” such as root canals, crowns, and dentures are paid for at 50%. However, the plan you qualify for since you will have PACE pays for all dental services, including those I just listed and others, at 100%. Supplements don’t offer any ancillary benefits meaning dental, vision, and hearing costs generally must be paid completely out of pocket.
Is there a plan with the company I’m currently with that you’d recommend above the others? I was thinking about the one that’s around $80 per month. A plan where I might have to pay a little out of pocket is fine, but I can’t be surprised with any huge bills. Please help!
The company that currently supplies your health insurance is indeed one we recommend often to those who prefer Advantage Plans. However, the specific plan you mentioned is overpriced and we no longer advise our clients to consider it. If you have any Advantage Plan, no matter the cost and need chemo, lots of radiation treatments, other infused or injected medications, have an extended stay in a Skilled Nursing Facility, among a couple other less likely scenarios, you will likely be billed to your MOOP, which is currently $4,000 on the low end to as much as $7,550 on many
plans. If you’re worried about the possibility of getting hit with bills of this size, you may want to consider a Supplement that limits out of pocket costs to a bare minimum. You can actually buy Plan N, which we recommend almost exclusively to our clients who prefer Supplements, for around the same monthly cost as the Advantage Plan you were considering.
AEP is right around the corner!
I’d like to remind readers that the Annual Election Period (AEP) is right around the corner. Pre AEP, when plan details are made public, starts October 1st and AEP, when changes to your plan lineup can be made and applications submitted, begins October 15th and runs through December 7th.
If you enjoy the columns, please consider using our no cost services when going on Medicare for the first time or looking at possibly making a change in plans as well as referring friends or family who are. Enrolling new clients in plans, which cost the same whether you use our free services or go directly through a company, helps us cover the expense of the articles so we can continue to run them every week. As brokers, we are appointed to provide plans from every competitive Advantage Plan and Supplement company in Western PA and West Virginia.
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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