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Question from Patricia:
How do I know I’m on the right Advantage Plan? Which are best and what makes them the best? You also said that starting in January, there’s a limited opportunity to change plans. I thought that ended in December?
As I stated in the last couple of columns, starting in January everyone on Medicare can make a change from one Advantage Plan to another or move from an Advantage Plan back to Original Medicare and a Supplement.
I’d also like to point out that switching from one Supplement company or letter plan to another can be done anytime during the year. There are no enrollment period limitations for that. However, to successfully move Supplements, one must pass medical underwriting. Don’t assume you won’t even if you’ve had some more serious health issues in the past. We write our Supplement business with five companies, and they all have different criteria for approval. Even if you’ve been denied previously or think you can’t pass underwriting, let us look into it. Just last week I got three people approved for Supplements who had recently been denied with another company. I got them all approved, and they each lowered their premiums by $90 to $150 per month!
The easiest way to know if you’re on the right Advantage Plan is to simply call us, ask to speak to an agent and let him or her know what company you have your HMO or PPO with and what the premium is. In less than two minutes we can tell you if you have one of the “10 Best” plans we feel are worthy of consideration. With over 100 to choose from in Western PA, there’s a pretty good chance you aren’t on one of those 10. In fact, I estimate that well over 50% of people we meet who didn’t come to The Health Insurance Store when they first went on Medicare are on the wrong plan and either paying too much premium, not getting enough ancillary benefits like dental, OTC, etc., have too high of a Maximum Out of Pocket (MOOP), or one or all of these issues with their Advantage, Supplement, or Part D plan.
Let me share what gets an Advantage Plan into our “10 Best list.” First, it needs to be a plan from one of what I call the “Big Three” companies. Unfortunately, I’m not able to name them per Medicare regulations, but all three are household names with two being regional companies who also own hospital systems. I estimate the Big Three hold about 85 to 90 percent of the Advantage Plan market in Western PA. There are another five companies who also offer HMOs and PPOs in our area, but I don’t consider any of them competitive at this time due to smaller networks that don’t include both of the Pittsburgh areas largest healthcare systems and/or some smaller hospitals in more rural areas, have higher co-pays or MOOP, or a bad reputation for denying claims.
When we are creating our list of best plans for the year the three most important aspects we consider are the following. 1) Premium cost. In 2024 the most expensive plan of our 10 Best is less than $50 per month. Also included are plans that are $0, in the teens, $20 and $30 ranges. 2) Cost of a hospital stay. We generally prefer plans that have a “per stay” hospital co-pay. In other words, regardless of the length of stay, there is one set cost of $200 to $400. We do have two plans in our 10 Best that have a per day co-pay, but they are still reasonable and only billed to a maximum of three or four days. We absolutely avoid plans where a 5-day stay could result in bills of $1,000 to $2,000. 3) The MOOP. The highest allowable MOOP in 2024 is $8,850. All of our 10 Best have a MOOP that’s as much as $4,900 less than that figure! 4) Network. One of the Big Three doesn’t have both of Pittsburgh’s largest hospitals in network. That can be a non-starter for some folks. Another of the Big Three has a national network. 5) Amount and generosity of ancillary benefits. There about an equal number of plans from Big Three in our 10 Best and all of them have very similar co-pays across the board. So much so that for some people the determining factor can be what extras and how much are provided. For example, there’s one plan that provides $150 per quarter to purchase “healthy food.” For our clients who are on fixed incomes with very little or no disposable income, this is a really big deal, especially with the cost of groceries being what they are today.
Each of the Big Three has a niche. One provides the best package of ancillary benefits with the healthy food allowance, a co-pay card, and a fitness reimbursement that together total over $1,000 a year in real value of goods and services. This is in addition to the standard vision, dental, hearing, and OTC benefits that the others in our 10 Best provide.
Another of the Big Three has a national network as I just mentioned and overall lower co-pays. Those who prefer Advantage Plans and spend time outside of Pennsylvania such as those who winter down south almost have to choose this company.
The third offers hands down the best member services in my opinion. The representatives are some of the most patient and kind people I’ve ever dealt with in the 16 years I’ve been in the health and Medicare business. You can call and have them make doctor appointments and get all kinds of help and advice. They also provide an ancillary benefit that is flexible and can be used to cover a choice of several costs.
If your Advantage Plan doesn’t meet any of the five criteria mentioned above, if you read something today you think may make another company or plan more valuable than what you currently have, or if your Supplement has gotten expensive, reach out to speak with an agent or set up an appointment for a no cost consultation. And feel free to email me with questions. Aaron@getyourbestplan.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 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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