Question from Darlene:
Question from Darlene: I just recently found out about The Health Insurance Store and have been reading the columns on your website. However, this was unfortunately after I already enrolled in a Medicare plan on my own. Is there any way I can still become a client of yours? I really like the services you offer.
Answer
Answer:
Yes Darlene, you can become a client, even if remaining on your current Advantage Plan or Supplement is the best option. I say if because it’s quite common that one’s initial was not made wisely. For example, many people opt for $0 premium Advantage Plans when those that have costs in the teens to around $35 offer better value in the form of lower across the board co-pays, including five-day hospitalizations that are $1,000 less. In addition, low-cost plans very often provide better dental, vision, and other ancillary benefits, including a co-pay card that supplies as much as $400 per year to use pay for services such as specialist visits, physical therapy, x-rays, MRIs, and CT scans. This in itself pays for the difference in premium. The Maximum Out of Pocket (MOOP) is almost always less on low premium plans compared to those that are no cost, which can be up to $4,300 more per year! I estimate we recommend $0 premium plans to less than 10% of our clients who prefer HMOs and PPOs. There are also many people who are overpaying for Advantage Plans. We want our clients on those that are less than $40 per month. And some Medicare beneficiaries should never choose an Advantage Plan because they have conditions that require treatments such as chemo or other infused drugs, injection therapy, or others that result in thousands of dollars in out-of-pocket costs. The same services are covered in full by Original Medicare and a Supplement, so even though premiums are higher, far less money is spent on medical care. The good news is anyone who wants to change from one Advantage Plan to another for 2023 can still do so and those new to Medicare whose first choice was an Advantage Plan have 12 months to move to a Supplement without their current or past health conditions considered. During this time, all Supplement companies are required to approve the application and issue a policy.
A common mistake for those who first go on Medicare and choose Supplements, aka Medigap, is opting for Plans F or G. Those plans get labeled as “the best” and as far as the value offered, it’s 100% false when it comes to F and isn’t true for probably 90% who choose or are currently on G. Aetna offered the lowest cost Plan G in Allegheny County and surrounding areas for several years until recently. Those who bought it at age 65, and are now only 69, may have premiums in the range of $175 to $185/month or more. Plan N for a 69-year-old married female is only $76/month, $86 for a male. That’s a savings of $1,200 per year and there’s no difference in what’s covered between G and N. The only other out of pocket expenses on N are a co-pay of $20 for a physician’s office visit and $50 at the Emergency Room. In this scenario, for G to be of equal value as N, one would have to go to the doctor 60 times in a year! Rates on G are going to continue to rise at a much faster pace than N. Again, some good news is those new to Medicare have six months to change Supplement plans without having medical conditions considered and can also move to a new plan or company anytime during the year. If you are on Plan G, I can’t make my recommendation clearer; move to Plan N while you can!
Darlene pointed out she called a company directly which leads me to believe she chose an Advantage Plan. There are a few reasons why enrolling in a plan with a company directly isn’t a good idea. First, premiums are the same whether the plan is purchased direct from an insurance company or The Health Insurance Store. Secondly, those who call Advantage Plan companies are likely not going to be given the Supplement option and definitely not going to have them compared and contrasted like we do with all potential clients. There’s nothing wrong with choosing an Advantage Plan and the best offer excellent value for the right people. But they can end up much more expensive for some in the form of co-pays, as I explained above. There are also others who may have conditions that will keep them from ever getting approved for a Supplement in their lifetime. It’s vital this is explained, but so often neglected when going directly through a company or dealing with many other agents or agencies. Lastly, you can’t have plans from different companies compared side by side when calling a company directly. As brokers, we are appointed to provide plans from all the competitive Advantage and Supplement providers. The three most popular all have good options, with each having their own strengths and weaknesses that need to be explained.
If Darlene or anyone else is on Supplement Plan N or one of the handful of Advantage Plans we recommend, you can become what we call a non-commission client. All you need to do is give us a call or email with your name, contact information, and your current plan. You will then be entered into our database and entitled to all the no-cost services we offer including: Our annual review and recommendation each and every Annual Election Period; help straightening out erroneous bills or filing appeals if claims are denied; finding relief for expensive medications including counseling from our Prescription Drug Case Worker, Tony Diroma; and assistance with any issue or question even remotely related to your insurance policies.
Thanks for reading everyone. Happy New Year! Keep the great questions coming to me. 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.
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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