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Question: I’m getting so many ads in the mail from Medicare companies. It’s all so confusing. What should I be looking at so I make the right decision when choosing a Medicare plan?

Answer: The easiest move you can make to take the confusion out of the process is let my agency help guide you to the best plan for your individual health care needs and budget.

That being said, let’s answer your question. Medicare Open Enrollment starts October 15th and ends December 7th. All these companies you’re getting mail from want to convince you their plan is the best by offering what they are calling dental and vision coverage and bragging about a $0 primary doctor co-pay or a free gym membership. Let me give you what I believe to be the most important items to consider when choosing a plan and why.

1) Make sure you have access to as many doctors and hospitals as possible. With the news that it won’t be plausible for most people who have Highmark Medicare Advantage Plan HMO’s and PPO’s to utilize UPMC next year, this moves to the top of my list. Be careful. I’m being told that Highmark representatives are telling current Highmark members there won’t be an issue if they want to go to UPMC. That’s simply not true. You will be required to pay hundreds or thousands of dollars up front if you want to get medical services from UPMC doctors and hospitals when the contract between the two healthcare giants ends.

2) Know the difference between Medicare Advantage Plans and Supplements. Advantage Plans are not designed to pay the 20% that Medicare doesn’t pick up and have co pays for virtually every Medical service. Some can be in the thousands of dollars. Supplements, also known as Medigap policies, are secondary to Medicare. Those who insure themselves this way
have little or no out of pocket costs. In addition, they have access to every medical hospital in the country, including both UPMC and AHN.

3) How much is your monthly premium? Paying more rarely means the plan has the best benefits, less out of pocket costs, or overall value. In fact, when it comes to Advantage Plans HMO’s and PPO’s, many of the higher priced plans can expose you to almost $3,000 more in medical bills than some of the lower priced plans. It’s my opinion no one should be paying more than $95 for an HMO or PPO in 2019. When it comes to Supplements, often you can get the exact same coverage for hundreds or even thousands less per year just by switching companies.

4) What is the most you can be billed for medical services in a calendar year, known as the Maximum Out of Pocket or MOOP? With the many HMO and PPO plans, that figure is $6,700 while others are much lower at $3,400. Obviously, if you can get a plan with similar or lower premiums, while also lowering exposure to expensive bills, you should do that. Supplements,
again, have little or no out of pocket costs.

5) What will I pay if I have a 5-day or longer hospital stay? Many plans charge by the day, as much as $300 or more, resulting in a total bill of close to $2,000. We never advise people to choose those plans.

6) How much will it cost for Chemotherapy or other drugs administered by a doctor in an outpatient setting (known as Part B drugs), or a lengthy stay in a Skilled Nursing Facility? You can bet you are going to be billed the amount of your MOOP, between $3,400 and $6,700 if any of the above occur. Once again, if you needed any of those same services and you had a
Supplement, your bill would be $0.

7) Is there access to doctors and hospitals throughout the country when traveling or spending time away from home for the winter or visiting family? In the event of a rare disease or Cancer, is there access to facilities like, Mayo Clinic, Cleveland Clinic, or M.D. Anderson Cancer Center outside of Pittsburgh? PPO’s allow you to access most medical providers nationwide, but you can literally be billed $10,000 or more if you chose to have a surgery or an inpatient procedure done out of network. People on Supplements have access to virtually every doctor or facility in the country and won’t pay any additional costs away from home.

I want people to notice items I didn’t list as most important; limited dental or vision coverage that only provide discounts on cleanings and X-rays, $100 towards a pair of glasses every two years, paying $5 or $10 less for doctor visits, or a gym membership. Far too often people pay more attention to these items rather than looking at the big picture. If you paid $500 to $2000 more in premiums or got medical bills of $3,000 more in 2019 than someone who didn’t get dental, vision, or a gym membership, who did better? HMO and PPO companies want you to fall in love with “free stuff.” Don’t get caught in that trap.

If you have questions or would like to set up an appointment for a no cost consultation, please give us a call. You can also find us online or follow us on Facebook where you can find previous columns as well as other important announcements and news regarding Medicare.


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