Question from Nora:
My friend Jess turned 65 in January and signed up for Medicare A &B along with Supplement plan N but didn’t enroll in Part D prescription coverage. At the same time, she continued to pay her ACA insurance through Pennie. Then effective 6/30/22, the ACA plan company cancelled her saying she couldn’t have both it and Medicare. Do you think she can pursue getting a refund of her premiums that were paid January through June? I’m trying to convince her to get Part D through Medicare, but she’s reluctant since she uses GoodRx for the only generic medicine she takes. Does she really need a Part D plan? I tried to get her to call you, but she’s one who needs an extra push, and everything overwhelms her.
Answer
Changing Plans on Supplements
Answer: We understand the initial process of choosing a Medicare plan and the constant solicitations by mail, phone, radio, and TV during the Medicare Annual Election Period (AEP) can be overwhelming. It doesn’t have to be, however. We make sure our clients know exactly what plan(s) they should be on each and every year. The mistakes Jess made are what happens when people use inexperienced or poorly trained agents and those who aren’t willing to put in the extra work clients deserve in return for getting paid very generous commissions. I’m sorry if this offends anyone, but we’re seeing more and more of this kind of incompetence and laziness along with some very unethical behavior the last couple of years as the field becomes more crowded and competitive. We would have explained to Jess that she couldn’t have both and made sure her ACA plan was cancelled the same day her Supplement went into effect.
The ACA company should refund those premiums. Here’s why. There were no claims submitted to them during the six months after Jess turned 65. They were all paid for by Medicare and her Supplement. Because one can’t have both an ACA plan and Medicare, I’m quite sure if claims had been made to the ACA plan, they would have been denied. Therefore, for them not to issue a refund would be 100% wrong in my opinion. That being said, I would put it at less than 50/50 they will. I’m also concerned if she was getting a subsidy after turning 65, she may be forced to pay that all back since those eligible for Medicare are not able to get ACA subsidies. This could wind up being thousands of dollars in addition to what was already paid for insurance Jess didn’t need. The sad part about all of this is it should have been avoided.
As far as Jess not taking a Part D plan? That’s extremely unwise. I can’t fathom an agent not explaining this to her. GoodRx is not insurance! It’s a useful tool and can help save money on certain generic drugs, but it’s not meant to be a substitute for Part D. GoodRx is no help for those who take expensive brand name medications. Only Part D from a Stand-Alone plan or that supplied by an Advantage Plan HMO or PPO can reduce those costs. Jess needs to understand that her good health is not guaranteed. Cancer doesn’t discriminate. I don’t care how healthy she eats or how much she exercises. It doesn’t make her immune to a bad accident or bad luck either. I once had a client who was served a salad with tainted romaine lettuce. She wound up with a rare parasitic infection, spent 120 days at the Cleveland Clinic, and more than a year driving back and forth for follow up. Let’s say Jess decided not to take Rita’s and I’s advice and went without Part D for 2023. If she were diagnosed with cancer or another illness or disease that required a medication that had a retail of $10,000 or more, which is more common than you might think, she would not be able to get Part D until 2024 and would be on her own to pay for her drugs. The most popular Part D plan for 2023 is going to cost a bit over $10 per month. I know money is tight right now. But it’s simply not smart for anyone to put themselves in a situation that could result in prescription costs of tens of thousands of dollars to save what amounts to the price of a trip through a McDonald’s or Wendy’s drive thru.
Helping our clients avoid pitfalls and trapdoors as well as finding that sweet spot for their healthcare needs and budgets are what my agents and I have been doing since 2008. We work for our clients, not insurance companies, and always fight to ensure everyone is getting the benefits and care they are entitled to, not overpaying in premiums, or being charged for bills they shouldn’t have received. Being a good Medicare insurance broker is about much more than initially enrolling people in the right plan.
AEP is here and if you didn’t get your current policy from The Health Insurance Store, I recommend reaching out with a quick phone call to one of our offices or an email to me, aaron@getyourbestplan.com, to check if you’re on one of the handful of Advantage Plan HMOs or PPOs we will be recommending for 2023, make sure you’re not overpaying for your Supplement, and/or have the best Stand-Alone Part D plan. Consultations in person, over the phone, or via a virtual internet meeting are always no cost, as is every service we provide after becoming a client.
If you can, check out my live radio show, Medicare A to Z, on WMBS Uniontown 590am this Monday from 1:15 to 3. You can listen from their website wmbs590.com and even watch it live from their Facebook page.
Get Your Part D Reviewed
Another mistake those on Supplements make is remaining on their Part D prescription plan without having it reviewed professionally, which should be done every year. Two of the most popular plans are almost doubling their premiums while not offering better coverage. It’s also common for drug tiers on plans to be moved from 1 to 2, 2 to 3, and so on. Failure to change Part D plans can be extremely costly. Even if you didn’t buy your Supplement from The Health Insurance Store, we can review and recommend a plan for 2023, just like we do for all our active clients. If you’re interested, please contact us as soon as possible so we can get you the necessary form.
There aren’t many significant changes to Advantage Plans, but indeed some items worth mentioning. Probably the biggest news is the reduction of the MOOP by one of our three major companies. In 2021 they raised it significantly across the board on all their plans to the maximum allowable by Medicare. It stayed the same in 2022 and many members chose other carriers due to the increase. However, on a select number of plans, including what we feel is their best for 2023, it has been reduced by $3,000 and is now the lowest in the market for those that supply prescription coverage.
If you weren’t aware, there are no preexisting condition clauses with Advantage Plans. Anyone who has Medicare Parts A and B can change plans or companies regardless of their current or prior health, even those who have End Stage Renal Disease. All Advantage Plan companies must accept you and begin to pay claims the 1st day the policy goes into effect. In addition, all Advantage Plans must cover the same categories of benefits. As I’ve written on so many occasions, paying more in premium doesn’t get you any additional coverage for medical services! In fact, we will not be advising our current or potential clients to choose any Advantage Plan that will have a premium above $40 per month in 2023. If you are paying over $40 for your HMO or PPO, you should call or email us to set up an appointment and see side by side why paying more doesn’t equal more.
How will Inflation Affect AEP?
Lastly, due to inflation, we’re expecting this AEP, which begins on October 15th, to be the busiest we’ve ever had in terms of moving people from Supplements to Advantage Plans out of financial necessity. If there was ever a good time to do that, now is it because the most competitive plans have never been better in the 15 years I’ve been in the Medicare industry. For those who don’t like the thought of leaving a Supplement, there is some good news. You may not have to as it appears one of the biggest increases in the Social Security Cost of Living Adjustment (COLA) is going to be announced soon. It’s estimated to be from 8.5% to almost 10%. And for once, the raise will not be eaten up by a large Part B premium increase. In fact, many people believe it’s going to remain $170.10.
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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