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News From The Health Insurance Store

Question: From John in Moon: I already have a Supplement and I’m very happy with it. Is there anything I need to do during Medicare Annual Election?

Answer: Yes John. You will want to investigate a couple of things during Annual Election Period (AEP), which starts October 15th, and runs through December 7th. Frist let me briefly remind everyone that not all Medicare plans are Supplements. In fact, I estimate that at least 50% of seniors in our market have Medicare Advantage Plan HMO’s or PPO’s that are NOT secondary to Medicare. These plans are NOT designed to pick up the portion of the bill Medicare doesn’t pay, like the 20% for outpatient services. Very few people understand that.

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Question: From Joyce in the North Hills: Since my HMO will no longer provide access to UPMC hospitals and doctors next year, I am considering moving to a Supplement. But I don't want to lose Silver Sneakers or my dental and vision benefits. Can you comment on my concerns?

Answer: Absolutely Joyce. First, I want to remind everyone Advantage Plan HMO's and PPO's like Joyce has are NOT Supplements and are NOT designed to pick up the portion of the bill Medicare doesn't pay. Instead of paying 80%, when you have an Advantage Plan, Medicare instead pays the company you choose approximately $800 per month to become your one and only insurer. In return they provide your medical benefits and pays claims. You, the insured, are then responsible for a deductible (very few plans have one), coinsurance (a percentage of the bill you are responsible for, commonly 20%), and/or a co-pay for virtually every service you receive. Here's some examples of what your medical bills could be: $5 for a PCP visit. $40 for an X-Ray. $200 for an MRI, $300 to $2,000 for an inpatient hospitalization, up to $6,700 for Chemo or a lengthy Skilled Nursing stay.

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Question: Question from Don in Latrobe: I don't fully understand deductibles and what all is included in the Maximum Out of Pocket expense. Would you please explain?

Answer: You are not alone Don. If it were easy to understand, I wouldn't be in business. Let me clarify as it applies to Medicare plans, and explain what co-insurance and co-pays are
as well.

The deductible is the amount of money you must pay for certain medical services before the insurance company will pay any portion of the bill. Let me give you an example.

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Question from Mary in Monroeville: I have a Medicare Supplement Plan F and been told that it will be discontinued in 2020. What does that mean for me? Should I change my plan now. Am I going to lose my plan?

Answer: That's a great question. Indeed, Medicare Supplement Plans F and C will no longer be available for purchase after January 1st, 2020. However, you will be able to remain on the plan if you would like. Medicare Supplements, aka Medigap, are highly Federally regulated. One of the regulations states you cannot be forced off a discontinued plan, and benefits must stay the same so long as premium payments are made. I do have a couple of concerns about remaining on either plan F or ( however. Those plans have become quite expensive over the last few years.

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Question: From Jan in Pittsburgh: I got a Medicare Advantage HMO when I turned 65 last September. I didn't realize until I read your column last week that I couldn't go on a Supplement down the road because the preexisting condition I have. I am very upset that wasn't explained to me when I originally applied. Is there anything I can do?

Answer: Yes. There is. But time is of the essence. Because you have had your Advantage Plan for less than 12 months, you can, one time, go back to a Supplement without answering medical questions. Per Federal Regulation, Supplement companies have to accept you regardless of current or past health issues if you have had an Advantage Plan for less than a year
and it was your first time on one of these HMO's or PPO's.

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