Question from Judith:
I know you try really hard, but I still get confused by the information in some of your columns. I suppose that shouldn’t matter to me because I am well over 65 and also on HOP, which means I should always stay a HOP person.
The only change I made this year was I switched from the Enhanced Prescription plan to the Basic. I don’t understand how or when my deductible will be assessed. I have had many prescriptions filled and I see no evidence of being charged even though the information they sent said I would.
I still think I pay a lot of money in copays, and that there may be better options for me, but I have no interest in switching at this point.
Answer
There is no question today because once again I feel the need to address the concerns I have about the number of local seniors being misled, ill-advised, and even lied to about Original Medicare, Advantage Plans, Supplements, and Part D. Practically every day we’re meeting people who chose a plan or were advised to do so without understanding the differences between, as well as the pros and cons of Advantage Plans and Supplements, the two options that help lower medical and prescription costs. It’s often not explained at all, or in a one-sided manner to encourage enrollment in a plan that pays an agent the most commission. As the Medicare insurance field becomes more crowded with new agents and because their incomes are almost always 100% commissioned based and there isn’t enough oversight, I will continue to warn our community and encourage them to utilize my agency’s no cost services and resources.
Not only are agents completely dependent on selling a policy to receive a paycheck, but they can often be untrained, not understanding Original Medicare and the differences between Advantage Plans and Supplements themselves. I distinctly remember being thrown into the fire 16 years ago, encouraged by my boss to go into seniors’ homes with practically no knowledge of Medicare and armed only with why the product they were pushing, a Medicare Advantage Plan with no prescription coverage, was right for everyone. That wasn’t true at all, and it motivated me to become a broker of all competitive Medicare Advantage, Supplement, and Part D companies. But this is still how the business is done at many agencies; recruit an army of people to sell policies with the bottom line being the amount of commission generated, what’s best for the senior be damned. The Medicare industry has turned increasingly ugly in the last two years. There’s never been more misleading advertising and unscrupulous sales tactics which include cold calls to seniors impersonating their current insurance company, encouraging those on Supplements to leave for an Advantage Plan by falsely telling them they work the same only are less expensive with extra benefits, enrolling people in plans without their knowledge or consent, and more.
This column was motivated by two separate emails I received just this past week from people who didn’t get their Medicare plans from The Health Insurance Store. During my conversations with them, it became clear almost nothing was explained properly, they had no support or contact from whoever sold them their policies, and were basically misguided at every step.
The first email was from Joan, who is 82. She had Supplement Plan G with a premium of $182/month. Her husband, John, had an Advantage Plan that cost just under $200. I’m quite certain neither understood how their plans differed and Joan was concerned paying less for a plan would mean fewer benefits and subpar care from physicians, which isn’t the case. Another red flag was the cost of John’s Advantage Plan that had an annual exposure to $5,000 in medical bills despite being more expensive than Joan’s Supplement, which only exposed her to $226 in bills per year. He got bad advice somewhere along the line because he was paying $2,000 a year more for an Advantage Plan with higher co-pays and fewer extra benefits than plans we recommend. As Joan told me, they were “convinced” by the agent there was no need to be paying so much. The agent was correct as far as John was concerned because he got enrolled in a better overall Advantage Plan with a premium almost $175/month less. Joan was talked into enrolling in the same PPO, despite her explaining to me the importance of having better medical coverage, which her Supplement provided, even if she had to pay more to get it. Therefore, what that agent should have done, what my agents and I would have done, was recommend both go on Supplement Plan N with one of our trusted carriers for $126 and $163 per month, respectively. It would have given them an annual premium savings of over $1,000 and lowered John’s yearly exposure to medical bills by almost $5,000. We listen to our potential and current clients’ wants and needs before making a recommendation, which always includes advising them to stay with their current plan when that’s the better choice, even if it means we won’t get a commission. That’s obviously not every agent’s policy.
The second email I got was from Frank, who went on Medicare B last August. For some reason, he and his wife were put with two different companies. He was under the impression that the total costs (approximately 700/month for the two of them) for Parts B, D, and his IRMAA which is a tax on Parts B and D that married couples with income over $184,000 year must pay, was all part of their plan premiums. He also wasn’t aware they were sold Advantage Plans. I can’t wait to meet with Frank, who requested an appointment so I can clear things up for him. I’m almost positive he and his wife should not have to pay the extra $4,500 for Parts B and D in 2023. If my hunch is correct, I’ll help him fill out and submit the proper documentation to Social Security, so he won’t have to. I haven’t asked him how he ended up with two separate companies for him and his wife, why he didn’t know what type of plan he was in, and why whoever enrolled him thought Advantage Plans were the best fit. I can only speculate. I do know that agents, including myself, get paid double commission to enroll those new to Medicare in an HMO or PPO. Signing up a married couple can generate as much as $1,500 in first year commissions and $750 every year they renew. Compare that to a Supplement that pays us around $400 in first year commissions for the same married couple, but for only five to six years, when it’s reduced to almost zero. This kind of difference in agent compensation can absolutely play a role how agents advise Medicare beneficiaries unfortunately.
Let me make this clear. I really like Advantage Plans and the value they offer. They play a vital role and are a great option for a number of reasons which I’ve written about often. We have thousands of active Advantage Plan clients. However, as well they work for many, they make little or no sense for others. To not explain the differences or not present the Supplement option, to only explain the pros of Advantage Plans without also going over the risks of enrolling in an HMO or PPO, is akin to taking away someone’s choice, one that may be irreversible.
If you would like to get an unbiased second opinion on your Medicare plan, you don’t have to wait until the Annual Election Period to do so. Give us a call to set up a no cost consultation. Feel free to email me personally with questions as well. Aaron@getyourbest plan.com.
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.
Introducing New Facebook Group
Don’t forget to join our new Facebook group, “Ask the Medicare Specialist”, which has the same name as the column, where we post exclusive content and information. Go to our website, getyourbestplan.com, and click on the banner on the homepage to become a member. Thanks for reading everyone!
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.
Erie County Area
1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276
Fayette/Westmoreland County Area
121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402
Pittsburgh Area
21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149
Albuquerque/Santa Fe, New Mexico Area
821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073
Serving These Areas
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
We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico
Not affiliated with the U. S. government or federal Medicare program.
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.