Question from Roger:
I’m writing on behalf of my mother who reads your column in the Post Gazette and always uses it to beat me up. Here’s some background. She’s soon to be 86 and has a limited income of around $2,300 per month. My Dad was a public-school bus driver and after he retired qualified for HOP Benefits. Mom does not qualify for the $100 premium assistance, so she pays $267 per month for HOP Medical and their Basic Rx prescription plan. She also carries a dental policy for $37 per month. She has no assets such as a house, car, or savings account. She consistently complains about the costs and that she could do better. She does realize the plan is good with lower co-pays. She’s also concerned about her doctors. My understanding is they are all in network except for one. She would like to save some money on premiums but has trepidation concerning her doctors. Your thoughts would be appreciated.
Answer
I really got a good laugh when Roger sent me this email. I was very apologetic that his mom is “beating him up,” but I’m glad she’s paying attention and questioning why her insurance is expensive and wants to explore if she can get better value, which she absolutely can. Too many people who’ve been on a plan for years, like Roger’s mom, often don’t, which can be a very expensive mistake.
A couple pieces of general advice before I get into the heart of the column. First, it’s always good to get a family member involved when considering changing plans. It’s also nice to have an extra set of eyes and ears as well as someone to give assurance to mom or dad, aunt or uncle that the choice they’re making is sound. Secondly, these columns are not meant to be a substitution for making an appointment to sit down with myself or another agent. I don’t have enough space in the columns to go over every single pro and con of Roger’s mom’s or other scenarios. I might give five people in the same situation five different recommendations based on their health, access to VA or retiree benefits, how much they travel, what meds they’re on, income, and other factors.
Here’s my initial thoughts for Roger’s mom. The HOP Medical Plan is excellent in terms of coverage. There are just a few small co-pays and zero exposure to bills of more than $100 for Medicare covered services. However, without the premium assistance, it’s also quite expensive. The prescription plan is wildly overpriced for Roger’s mom because due to her income, she qualifies for PACENET, which is a state program to help lower prescription costs for Pennsylvanians 65 and older. By enrolling in PACENET, we could reduce her Part D premiums by $56 per month and significantly lower her drug co-pays as well. That combination may be enough that she could afford to remain on the HOP Medical Plan, which if she had some significant health issues, I would encourage her to do if at all possible.
I would also see how much value she’s getting out of the dental plan and might advise her to drop it if it’s not at least paying for itself, which dental insurance rarely does.
If money was still going to be tight, then a low-cost Advantage Plan HMO or PPO could be an excellent choice. We never want any of our clients to be insurance poor. In the inflationary economy we find ourselves in, more and more seniors on fixed incomes are making this move from Supplements that have gotten expensive over the years. Roger’s mom could save up to $3,600 a year in premiums alone and pick up some valuable benefits such as a prepaid debit card that could supply her $150 a quarter to purchase food at participating grocery stores, and a quarterly allowance to order vitamins and other over the counter products she uses regularly at no cost. Any Advantage Plan that we recommended would have more comprehensive dental coverage than what she currently has and ensure network access to all her doctors.
However, it’s so important before we advise this move and process an application that she understands the differences in Advantage Plans compared to what she has gotten used to with HOP. The biggest change would be additional and larger co-pays that could be hundreds, even thousands of dollars higher than HOP. Also, the HOP Medical Plan doesn’t require prior authorizations for CT scans, MRIs, surgeries, Physical Therapy, and a few other services. All those need approval from Advantage Plan Insurance companies before they can be administered to those with HMOs and PPOs. This often goes unexplained by other agents when all that’s on their minds is a generous commission. Not here at The Health Insurance Store. Our only concern is that the person we’re working with has the best possible plan for their situation and understands the pros and cons of changing. If that means advising someone to remain on their current plan and forgoing a commission, so be it. It’s the right thing to do and a recommendation we make quite often.
If you have any questions regarding this topic or any others, would like to make an appointment for a no cost consultation, give us a call or email me personally at aarongetyourbestplan.com.
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