Question:
There is no question today. Instead, I’m going use the latest publication of our weekly series “Truths, Tips, and Tricks” where we discuss regulations, trends, facts, and other nuances of Medicare. We also have another, “Feel Good Fridays,” in which we talk about real issues our clients brought to us and how we solved them. The two are only available on our Facebook Group that bears the same name as the columns. If you would like to join and read them, you can go to our website and click the banner at the top of the page. Here’s what Bonnie Bloom, our senior agent and office manager at the Forest Hills office, wrote this week.
Truth:
There’s an alarmingly high number of people who have no idea what out of pocket medical costs are associated with their Medicare Advantage Plan, the monthly premium, the name of the plan is, or even what company they have it with. I recently met with someone who started physical therapy (PT) and was shocked at the $40 co-pay per visit ($720 for the six weeks she was prescribed) because she had no clue what her co-pays were for any services other than her PCP. It’s what prompted her to make an appointment. By the end of our meeting, she discovered she was able to do much better. PT is now just $5 and she also lowered her specialist visit co-pay along with many others. HMO and PPO Advantage Plans are not created equal. In fact, they vary wildly! Premiums can be $0 to over $200 per month. Hosptial co-pays range from $200 to almost $2,000 per stay. Total annual out of pocket costs can be from $4,000 to $12,450! Some plans offer comprehensive dental and other valuable benefits while others don’t.
Tips and Tricks: If you’re unsure of the financial responsibilities for an MRI, surgery, hospitalization, chemo, other infusion or injection therapy, all of which can range from hundreds to thousands of dollars, don’t wait until you too are shocked by the bills that come in the mail after a service has already been performed. You can make an appointment for a no cost consultation, and we can sit with you and go over every detail of your plan. We’re appointed with every competitive Medicare Advantage and Supplement company on the market which ensures our clients unbiased advice. We ask questions and listen so we can learn about needs and expectations for a health care plan and then make sure you’re properly matched based on those.
Bonnie is spot on when she states there are many people who have no idea how their plan works or what the costs for medical services might be. I remember having a conversation with a relative who had a $0 premium HMO. She told me, “I love my plan, It’s great. I don’t pay a premium or a co-pay when I see my primary doctor.” I then asked her if she knew what it would cost if she were hospitalized or needed chemotherapy. “I don’t,” she said. I then replied with the question, “How do you know your plan is great then?” It turns out a 5-day or longer hospital stay on her plan was $1,250 and chemo would come with a bill equivalent to her annual Maximum Out of Pocket (MOOP), which was $6,700 at the time. Turns out, she also did better by moving to another plan.
There’s no reason anyone should be in the dark when it comes to their plan benefits and design. There are literally over 100 HMOs and PPOs to choose from in Westen PA, but only a handful that should be considered. Many people simply called the company they had their insurance with before they retired or went on Medicare and enrolled in whatever the representative they spoke with on the phone suggested. Others were talked into taking a plan from an agent who cares more about a commission than what is actually the best fit for their client. I’ll never forget having a conversation with another agent at an awards banquet. He bragged to me about only selling one company’s plans. The scary part was this company didn’t have any that were competitive in the market. Others get a plan and are afraid or intimidated to make a change, so they stick with it year after year after year. For example, I estimate that there are still 20,000 or more Western Pennsylvanians who are on antiquated plans from one of the most popular Medicare Advantage companies. These folks are paying triple or more in premiums and not getting comprehensive dental coverage or OTC benefits. They also have a 5-day hospital co-pay that’s almost $1,000 higher than other plans with the same exact company!
If you don’t know what your benefits are, if you haven’t had your plan looked at and compared to others side by side in the last three or four years, you need to make an appointment to talk with us. And you don’t have to wait until the Annual Election Period starts. We can have that conversation now if you would like to be prepared before AEP starts October 15th. If you have older parents, neighbors, aunts or uncles, please encourage them to make an appointment, and if possible, be available to attend as well. Those in their 80s, or 90s are much more susceptible to being talked into the wrong plan or hanging on to one that’s overpriced and or doesn’t provide as good of benefits as others. We don’t charge for consultations and often a simple phone call to one of our agents or an email to me is a great start. It’s likely you or your loved ones are on the right plan. However, I estimate that 50% are not!
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
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Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
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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
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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.