Question from Sherry
You stated in your last column that people on Advantage Plans need to be prepared to switch plans or companies every year. Why would I need to do that if my premium is going down for 2022?
Answer
Answer: For those who aren’t aware, HOP benefits are available to those who retired from any Pennsylvania Public School District. We give the same advice to every single HOP recipient we meet; If you get the $100 premium credit, choose the HOP Medical plan which is a Supplement to Medicare. We also advise everyone to allow us to enroll them in a Medicare Stand Alone Part D plan because as great of value as the HOP Medical plan is, the prescription plans offered are as bad for probably 85 to 90% of those who are eligible. The Basic plan is $66/month compared to the $11 to $13 most of our clients will be paying in 2023. Co-pays on drugs, especially brand names are much more expensive on the HOP plans vs Part D as well. If you’re currently on the HOP Medical Plan, you can contact us to review your prescriptions. We can tell you how much money you will save by moving to Part D and then help with the application. Those who take this step then become clients of The Health Insurance Store with all the benefits that come with it and there are never any charges for our services.
HMO and PPO Advantage Plan options are available for HOP members, however, they’re more expensive. And as I’ve gone over in numerous columns, those who have an HMO or PPO need prior authorizations for services such as MRI’s, CT scans, home health care, and Skilled Nursing. Supplements, including the HOP Medical plan do not. In other words, if your doctor wants you to have an MRI the same day and surgery tomorrow after reading that image, it happens with no questions asked or interference from an insurance company. If I had to name the number one disadvantage of HMO’s and PPO’s, it’s that the insurance company can make their members get physical or injection therapy before they get approved to receive an MRI, CT scan or outpatient surgery. They can also limit the number of days one can stay in a hospital or skilled nursing facility.
I like the overall benefit package Shelly’s husband’s plan supplies, and it meets our criteria for choosing an Advantage Plan: a premium less than $40 per month, a per stay hospital co-pay, an Out of Pocket Maximum (MOOP) under $7,000, and at least $2,000 in comprehensive dental coverage. However, it excludes network access to Western Pennsylvania’s largest hospital system. The same company offers another $0 premium plan as well and a low-cost plan that has a national network, including every Western PA hospital. If Sherry’s husband wants to remain on an Advantage Plan, I would recommend one with a better network.
I also like to encourage people who have been on Advantage Plans for a few years and saved a ton of money in premiums to consider a Supplement. Advantage plans with drug coverage have MOOPs of $4,500 to $7,500. Maybe think about cashing in your chips so to speak, ensuring some or all those savings are secured by moving to a Supplement that eliminates the possibility of any large bills for care such as chemo, radiation, skilled nursing, and injection or infusion therapy. Supplements are very reasonably priced right now too. A 70-year-old female can get Plan N for $79/month and the same age male $89. Prices are $2-$3 more for every year older than 70.
That being said, Advantage Plans have never been a better value in the 15 years I’ve been in the Medicare business. We have more clients than ever choosing to enroll in them. Premiums and co-pays are lower than ever and the amount of ancillary benefits such as comprehensive dental, over the counter allowances, vision, hearing, money for food as well as copays, and other goodies that are supplied are so generous, it’s hard to believe. I’m concerned it may not be sustainable, however. If Advantage Plan companies fall below a four-star rating or the federal government decides to lower the subsidies they pay to the insurance companies, premiums and co-pays could go up and/or most of the ancillary benefits may be reduced or eliminated. I sure hope it doesn’t happen because 30 million Americans are now utilizing them. However, if it were to occur many or most who wanted to return to Supplements won’t be able because those with certain current or pre-existing conditions could be denied acceptance by the Supplement companies, even during the Annual Election Period (AEP).
As for dental and vision, you absolutely don’t need it. There isn’t a dental or vision plan on the open market worth buying, including the one offered by HOP at $40 per month in my opinion. The amount in claims paid will never be greater than the premiums you shelled out to the insurance provider over any three-to-five-year period. And remember that all medical conditions of the eye, ear, or mouth are covered by Advantage Plans or Medicare and a Supplement: Glaucoma, cataract, macular degeneration, an eye or ear infection, broken jaw, etc.
AEP is going on now and runs through December 7th. I encourage anyone who didn’t buy their Medicare plan from us to call and get a quick review if what you currently have is one of the five or six Advantage Plans we’re recommending for 2023 or if you can save money on your Supplement without giving up coverage or benefits. You can also email me personally at aaron@getyourbestplan.com
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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