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Question from John:
Do all Advantage Plans offer the same ancillary benefits? I’m turning 65 soon and need some expensive dental work.
I want to remind readers that Advantage Plans aren’t Supplements or designed to pick up the portion of the bills Medicare doesn’t pay, the 20% of Part B outpatient services and the $1,600 Medicare Part A hospital deductible. This isn’t a bad thing at all, and Advantage Plans can offer excellent value. However, so often the differences between them and Supplements are not disclosed. It’s vital to have all the pros and cons of the two types of Medicare plans explained in detail because the choice you make when first going on Medicare or during the Annual Election Period can have a lifetime of consequences,
The reason Advantage Plans are so popular other than the low premiums are the ancillary benefits that John mentioned. These are the generous and valuable “extras” that Supplements don’t provide. The following are offered on many HMOs and PPOs: comprehensive dental that covers everything from teeth cleanings to root canals, crowns, and even dentures. Free routine eye and hearing exams as well as an allotment for eyeglasses and hearing aids. Over the Counter (OTC) benefits that supply an allowance to order everyday products such as vitamins, cold and flu remedies, pain relievers, and practically everything you can buy off the shelf at a pharmacy or grocery store. A free gym membership program known as Silver Sneakers, and more.
The answer to John’s question is no. Not all plans offer the same ancillary benefits. In fact, two of the historically most popular plans don’t offer any comprehensive dental or an OTC allowance. The handful of Advantage Plans we recommend to our clients run from $0 to just under $40 per month and provide the best overall combination of low co-pays and ancillary benefits. There is no reason to pay more than $40 for an Advantage Plan. None.
Among those plans, only a couple offer two preloaded debit cards. One supplies $100 per quarter and can be used to pay co-pays such as specialist visits, X-rays, physical therapy, CT scans, and MRIs. The other is a Healthy Foods benefit. This card provides $75 per quarter and can be used at Giant Eagle or Walmart. Groceries eligible for purchase using the card include meat, cheese, bread, fruits, vegetables, juice, milk, and much more.
When it comes to dental, most plans pay for cleanings and X-Rays at 100%, but only cover more expensive services at 50%. However, there are a couple of plans that pay all covered dental claims in full. One of those might be a very good choice for someone like John, who knows he needs quite a bit of dental care. All our licensed agents, including myself, make it a point to understand these types of intricacies in Advantage Plans, which is so important with over 100 total to choose from in Western PA.
John and everyone going on Medicare Part B for the first time for that matter, need to make an appointment to sit down with one of our experienced agents. Making a decision is nowhere near as simple as choosing a plan based on who has the lowest premiums or most ancillary benefits. Depending on his medical conditions and needs, an Advantage Plan may not be appropriate. For example, if John has an insulin pump, receives ongoing expensive infusion or injection therapy, needs multiple joint replacements, among other services, any money he may save by having dental claims paid would likely be negated and then some because the services I listed would be quite costly, in the thousands of dollars with virtually every Advantage Plan. There are other considerations as well. When meeting with new clients, we ask lots of questions and do a thorough evaluation to help them make the best choice for both the short and long term. We also know how clients can initially enroll in an HMO or PPO, take advantage of ancillary benefits, and then move into a Supplement without fear of being denied due to current or preexisting health issues. There is never a charge for consultations or the services we extend once a client.
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If you would like to make an appointment for a no cost consultation to go over Medicare options, individual ACA marketplace plans, you’re an employer and would like a second opinion on your group policy, or are interested in life insurance, give us a call or email me personally at firstname.lastname@example.org. And keep the great column questions coming!
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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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Fayette/Westmoreland County Area
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We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas: Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford, Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.