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What is most important to consider when choosing an Advantage Plan? Which plans and companies are the best?
This is Part V of my “Medicare Reset” series designed to prepare those on Medicare for the Annual Election Period (AEP) that runs October 15th to December 7th. You can find and read the previous four on our website as well as recently recorded podcast and webcast versions as well.
My experience with Medicare Advantage Plans is they’re always evolving as health care regulations, trends, and markets change. 2021 is a year that I believe will be memorable due to two significant developments that just recently came to light.
In the past ten years the first things I’ve always looked at and I believed to be most important in deciding what Advantage Plans to recommend to clients for the following year were premiums, co-pays for a four to six-day or longer hospitalization, and Maximum Out of Pocket (MOOP) limits. In 2021, there will be another vital piece of the puzzle, companies that are participating in the Center for Medicare and Medicaid’s new, voluntary “Part D Senior Savings Model.” According to the American Diabetes Association website, “This model …is designed to help 3.3 million Americans affordably access insulin by capping the cost of a 30-day supply for most insulins to a maximum of $35. For enrollees who choose a model participating plan, their insulin prescription will not be subject to a deductible or any coverage gap cost increases. (Whether it’s January or December, their monthly out-of-pocket cost for insulin will be $35 or less.)”
This is huge for those who take insulin and means those who enroll in participating plans will not pay higher prices for insulin in the Doughnut Hole when co- pays can increase up to $100/ month. With the retail cost of insulin at as much as $500 for a 30-day supply, the savings in 2021 should range from $1,000 to $2,500, depending on how many different kinds one may use.
But here’s what people need to be aware of, not all Advantage Plans are participating. In fact, less than half of the most popular Advantage Plans in our region are. Therefore, those on insulin who I likely would have advised to choose another company or plan for 2021 prior to this discovery, will now get a different recommendation. The availability of this program
may trump the MOOP limit in importance and it’s quite likely I will advise many people who use insulin to enroll in plans with a higher MOOP than I normally would.
For those who aren’t taking insulin, the Part D Savings Model will have no bearing on my recommendation for the benefit year 2021. I estimate that myself and the other licensed agents at The Health Insurance Store will recommend the following to 90% of those people who seek our advice and opinions regarding which Advantage Plan(s) to choose for the benefit year 2021: It should be an HMO or PPO that has a MOOP less than the maximum allowed by CMS, a per-stay hospital co-pay less than $400, and a premium under $50/month. In the past I actually advised people not to fall in love with dental and what I called the “sizzle” of it and other ancillary benefits when making a decision. That was three years ago when so called “dental” equated to free or discounted teeth cleanings and a single set of bite wing X-rays annually. However, in today’s market, true comprehensive dental as well as Over the Counter allowances are provided by multiple companies and plans. So, I’ve added a new criterion of what we feel are the best Advantage Plan. In addition to the three others I just listed is the inclusion of at least $2,000 in comprehensive dental that covers not only preventative services, but others such as fillings, crowns, root canals, extractions, and dentures.
Be advised, when going on Medicare Part B for the first time and making the initial choice between an Advantage Plan and Supplements, ancillary benefits are not something I want people to weigh as heavily as they might when deciding betweenAdvantagePlans.There are a couple of reasons. Number one, the inclusion of ancillary benefits is not mandated, and may be removed in future years.
After all, there was a nine-year period between the comeback of comprehensive dental in 2019 and the last time it had been available to everyone on Medicare Parts A and B. Number two, remember that acceptance into a Supplement is only guaranteed up to one year after going on Medicare PartB for the first time. After that, companies can deny one’s application based on current or previous health issues. I wouldn’t want someone to base their decision on getting comprehensive dental only to see that disappear a year or two down the road.
As far as who are the best companies? I would like to remind everyone that Advantage Plans are regulated and must be approved by CMS to offer them. All companies and plans, regardless of premium, must cover the same categories of benefits. They all must cover the same medical services as Medicare, and as good or better than Medicare. Plans and companies differ in the following ways: Premiums, which in 2020 range from $0 to close to $300/month. What co-pays or co-insurance is for the same medical service. MOOP limit, which range from $3,400 to $6,700 in 2020. The network of doctors and hospitals. And lastly, what ancillary benefits are offered and the dollar amount of those.
As far as the quality of customer service, reputation for approving claims in a timely fashion, the pre-approval process, and who denies the least amount of claims, my staff and I have our opinions on which companies do that best. However, I am not permitted to name specific companies in my columns. And those may not be the same as the companies that we feel offer the best value as far as a combination of premiums and overall benefits and co-pays.
If you would like to make an appointment for a no cost consultation during AEP to inquire if you currently have an Advantage Plan, Supplement, or Part D we believe offers the best possible value for the benefit year 2021, give one of our offices a call or reach out to me directly at aaron@GetYourBestPlan.com.
The column runs every Tuesday on page A7 in the Tribune Review.
This is a guide to prepare for the up coming Medicare Annual Election Period. Click on articles, videos and podcasts dedicated to helping those soon to be new to Medicare and just as importantly those who are already on Medicare.
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