Question from Lou:
You mentioned in a recent column that there are co-pay cards with some Advantage Plans that can be used to pay for certain expenses and even food. I have an Advantage Plan that doesn’t provide that. Obviously, I’m not getting the same ancillary benefits. Why is that? You also wrote that more expensive plans could have higher co-pays and MOOPs than others with a lower premium? How can companies charge more and give less? And what other benefits am I not getting?
Answer
Welcome to the wild world of Medicare Advantage, where spending more than $40 in monthly premiums is a waste of money and proves the old saying, “you get what you pay for” doesn’t apply. That can also be said for many Part D prescription and Supplement plans. It’s hard to believe that an HMO plan with premiums over $2,000 per year more than another, with the same company, would have higher co-pays for specialist visits, physical therapy, and hospitalizations. The more expensive plan I’m using as an example offers zero comprehensive dental or Over the Counter (OTC) benefits compared to $3,000 and almost $600 annually on the less expensive one. To boot, the network is smaller on the more expensive plan! This is yet another example of the lack of oversight on the part of the Centers for Medicare and Medicaid (CMS), who are tasked with that important job. I don’t understand why they don’t regulate companies to stop selling overpriced plans and/or move their members to those with better value. Our older senior population is one of our most vulnerable demographics. Their fear of change and that vulnerability are preyed upon by companies and agents who care only about profit or a paycheck. We run into it literally every business day and it angers me.
As far as not getting the same ancillary benefit Lou, the major players in the Western PA Advantage Plan market, “The Big Three” let’s call them, all offer a little something that the other two don’t. This is why it’s great to be a broker and offer all competitive plans to make sure we can match clients up to what fits them best.
For example, as Lou mentioned, there’s a company that offers some plans that provide a pre-loaded debit card that can be used to pay for out-of-pocket costs such as specialist visits, X-rays, Physical therapy, MRIs, CT scans and more. The same company also has a couple plans that supply an additional pre-loaded debit card that can be used to purchase “healthy food” at participating grocery stores. The value of those cards can be as much as $700 per year.
Another of The Big Three has a plan with the lowest Maximum Out of Pocket (MOOP) of any plan that comes with prescription drug coverage. It’s $1,400 to $2,000 less than the other HMOs or PPOs we also recommend to our clients who prefer Advantage Plans. That same company is also the sole provider of emergency foreign travel assistance, a valuable benefit for those who vacation outside the states and one that could be lifesaving.
The other of The Big Three boasts a couple plans we recommend that have a true national network and one in particular that has the lowest overall co-pays of any HMO or PPO in plan in the market.
I’ve written the last three columns about how prevalent selfish, untrained, and unethical agents are in the Medicare insurance sales industry. They will put you in the plan they want or pay them the most commission, not what you might have wanted if given all the facts. I just had an appointment with a married couple the morning this column was written who were victims of that. Now the wife is going to spend almost $2,000 a year on injection therapy and can’t move back to a plan where that cost would be eliminated. They weren’t even given this plan option when they met with the agent.
Choosing The Health Insurance Store to help guide you through the Medicare process guarantees this will never happen. We educate potential clients on the two types of Medicare plan options, ask numerous questions so we can determine what their wants and needs are, listen, and break down the options in a way that is easy to follow and understand. And after the policy goes into effect, our staff is always available to help in any confusing circumstance. Just today I helped the same married couple save over $4,000 in Medicare B and D IRMAA premiums and assisted in filling out the form. This is just one example of the many ways we advocate for our clients and senior citizens.
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