Question from Rob:
In last week’s column you wrote that you and your agents would have recommended a married couple pay $126 and $163 per month for a Supplement. Why? My wife and I are healthy 68-year-olds. We both have $0 premium Advantage Plan HMOs that we’re extremely happy with. We get dental, Over the Counter (OTC) benefits, and a free gym membership as well.
There is no one size fits all recommendation, Rob. What we do here at The Health Insurance Store is educate potential and current clients about the differences between Advantage Plans and Supplements, which are many and stark. We also listen and find out what is most important to them in a Medicare plan. Is that getting lower premiums and/or ancillary benefits like you have such as dental, OTC allowances, and more? The ability to get care such as MRIs, surgeries, physical therapy, injection therapy, etc., without waiting for them to be approved, possibly denied or delayed? Having access to practically every doctor and all non-VA full-service hospitals in the country as well as world class facilities like the Mayo Clinic, Cleveland Clinic, Johns Hopkins, MD Anderson Cancer Center, and others with no restrictions or extra cost? Making sure there is no exposure to expensive bills in the hundreds or thousands of dollars?
Joan and her husband John were the couple you are referring to. She had been “convinced” as she put it, to move from a Supplement Plan G with a $182/month premium to a low-cost Advantage Plan. Her husband had not gotten good advice and was on an HMO that cost almost $200 per month, which I believe they thought was a Supplement. She told me they could afford to pay more premium and didn’t mind doing so to get coverage that would limit out of pocket costs for major services, which her husband just had, and she was scheduled for as well. That’s why I would have given her the advice to go with Supplement Plan N. It would have saved them over $1,000 in premiums annually and eliminated John’s exposure of up to $5,000 in medical bills.
Rob is happy with his and his wife’s plans, and it sounds like it’s working well for them, especially as healthy individuals. I completely understand why people choose $0 or low-cost Advantage Plans. We’ve helped approximately 10,000 clients enroll in them since the agency opened in 2008. Let’s break down the number one reason people choose HMOs and PPOs vs. Supplements. Monthly premiums for a married couple ages 65 to 68 on Plan N are $89 for a male and $79 for a female. Add in a Part D prescription plan that most people on Supplements must also buy, at a cost of $12 per month per person, and the total monthly expense is $192, or $2,300 per year. That’s what Rob and his wife are saving in premiums. If they have one of the $0 premium plans we recommend to our clients who want or are considering Advantage Plans, are going to the gym regularly, getting their two free or teeth cleanings and set of bitewing X-rays as well as maxing out their OTC benefits and co-pay debit cards, they’re getting as much as $2,400 in real value of goods and services. Add that figure to the premium savings and you come up with a huge number! When we think of it in these terms only, many may wonder why anyone would choose a Supplement. However, we have never once enrolled someone in an HMO or PPO without first explaining how they work in comparison to Supplements, some of the risks involved as well the benefits of Supplements that Advantage Plans don’t provide. There are also people who should never choose an HMO or PPO because the cost of their ongoing treatment or care could be as much as $4,500 to $8,300 annually. There are others who once enrolled in an Advantage Plan will never be able to move to a Supplement based on their current or previous health conditions, a fact that often goes unexplained by other agents. In addition, there’s no guarantee that the low premiums along with very generous ancillary benefits such as comprehensive dental, OTC, co-pay and healthy food debit cards will be offered down the road. I am concerned about that with the poor state of Medicare’s finances.
Still, Advantage Plans remain a smart choice for millions of Medicare beneficiaries. But please get all the facts first. We provide those and answer all questions and address any concerns prior to making that decision, one which can have a lifetime of consequences. And not all Advantage Plans offer the same value. Many are overpriced and/or don’t supply the same level of ancillary benefits. Others have much more expensive hospital co-pays and MOOP. There are over 100 HMOs and PPOs to choose from in Western PA and less than 10 worthy of consideration in my opinion. In addition to ensuring the best choice is initially made, our clients get support and help from the staff when issues arise such as erroneous bills, claim denials, expensive prescription costs, and anything even remotely related to their policies. These services and consultations are always no cost.
The bottom line is that the Medicare insurance sales industry has far too many scoundrels looking to prey on seniors. They will cold call despite regulations against it, impersonate insurance companies and Social Security, send mailings that look like official documents that once signed and returned result in the sale of one’s personal information to as many agents as possible, which is actually part of next week’s question. I’m determined to do what I can to make the public aware of the scams and tricks that are used until the Centers for Medicare and Medicaid enacts more regulation and oversight, something that is severely lacking presently.
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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! 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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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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