Before I get into the question, I want to say how happy I am to be once again running Ask the Medicare Specialist in the Trib. It will appear every Sunday on Page C2.
The columns are designed to help educate those already or soon to be on Medicare. Unfortunately, with all the television advertising, phone calls, solicitations in the mail, choosing a plan that meets one’s needs as far as coverage, cost, access to doctors and care, can be overwhelming. Medicare plan advertising and sales tactics have also become extremely deceptive, especially in the past two or three years.
The goal of Ask the Medicare Specialist is to enlighten people on all the facets and intricacies of Medicare, to help clear up the confusion and make sure seniors don’t fall victim to bad advice or misleading information.
Question from Lou:
I just turned 65 in February, went on Medicare and chose my plan to help pay for what Medicare doesn’t cover. I had a knee replacement in April. I’ve gotten bills for an MRI, hospitalization, and now physical therapy. They’re approaching almost $1,000. I thought Medicare Supplements were supposed to pay what Medicare didn’t pick up. Can you help me understand what’s going on?
Answer
I sure can. You don’t have a Supplement Jenny. Supplements, aka Medigap, are secondary insurance and do what that name implies; fill in the gaps of Original Medicare, namely the $1,600 Part A Hosptial Deductible and the 20% for Part B outpatient services. Those who buy Medigap policies pay little or no bills for Medicare covered services.
You chose an Advantage Plan, aka Part C, that works very differently than Supplements. Instead of being secondary, Advantage Plan HMOs and PPOs pay in place of Medicare, not in addition. When one chooses an Advantage plan Medicare stops paying all but $1,600 for a hospitalization and 80% of Part B services. What they do instead is pay the private insurance company about $12,000 a year to take over and become your one and only insurance provider. That’s why you don’t show your red, white, and blue Medicare card when you go to the doctor, the physical therapist, or the hospital. Those on Advantage Plans have co-pays for almost all services. They can be as little as $10 for blood work; $25 for X-rays; hundreds of dollars for MRIs, outpatient surgeries, and hospitalizations; to thousands for chemotherapy, other infusion or injection therapy, Skilled Nursing, and other services.
Often, when I explain the differences in what people can pay in bills between Supplements and Advantage Plans, many ask me why anyone would choose an HMO or PPO. The answer is twofold: First, they can be much less expensive, as little as $0 per month compared to $80 and up for Supplements. Secondly, the best plans, and the ones we advise our clients who prefer Advantage Plans to choose, supply outstanding ancillary benefits such as comprehensive dental coverage; no cost routine vision and hearing exams; allowances for eyeglasses, hearing aids, and over the counter products; a free gym membership and more. Some plans also give their members pre-loaded debit cards that can be used to pay certain co-pays and even buy groceries. All these extra benefits can be very valuable and don’t come with Supplements.
It’s obvious that whoever originally worked with Jenny didn’t explain how her plan was going to work or the differences between Supplements and Advantage Plans very well or at all, which is common. I’ve just scratched the surface of those in this first column. Understanding the two types of Medicare plans, the pros and cons, the risks and rewards, is absolutely vital and the most important part of the equation. Not choosing a Supplement when first going on Medicare or while in relatively good health can have a lifetime of consequences. This is because once someone is 6 to 12 months past their original Part B effective date, Supplement companies can discriminate in who they accept based on current and past health conditions.
The first thing we do when we meet prospective clients is to go over Original Medicare, Supplements, and Advantage Plans in great detail and explain how they work and differ in a way that’s easy to understand. There is no one size fits all approach, and several factors must be considered when choosing a plan or deciding whether to remain on a current plan. The following are just a small sample of the questions we ask to help determine what plan or plans might be best: Do you have any ongoing health issues? What meds are being taken? Do you travel much? Do you have access to VA or retirement benefits?
The agents and I at The Health Insurance Store are brokers, able to provide Supplements, Advantage, and Part D prescription insurance plans from every competitive company on the market. This ensures each person we work with gets unbiased advice.
If you have any questions about this column as well as any other Medicare topic or would like to set up an appointment for a no-cost consultation, please give one of our offices a call or email me personally. Aaron@getyourbestplan.com. I hope you enjoy the columns!
Make An Appointment
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 aaron@getyourbestplan.com. And keep the great column questions coming! Also, I am now licensed in over 20 states and able to help people choose and enroll in Advantage, Supplement, and Part D plans throughout the country.
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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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