One thing I’ve been researching that I’ve not seen you comment on, except in passing, are the differences between Part D prescription plans and MAPD (Medicare Advantage Plans that have Part D embedded in them). The more I investigate this, the more complicated it looks, with the obvious danger being the top tier drugs and what they cost in the various coverage stages.
Does the Medicare Donut Hole start at the same dollar amount regardless of which Part D prescription insurance you are enrolled in? Also, I thought it was scheduled to go away in 2020. Was I mistaken?
From Julie: In your last column you mentioned “total cost of ownership,” which I had never heard before. Can you explain that a bit more as it pertains to Medicare plans?
I recently went on Medicare for the first time and chose a $0 premium HMO Advantage Plan. Did I make the right choice?
Question from Greg: My wife has Multiple Sclerosis. She’s having mobility issues and is likely going to require some in-home care in the future. One of her primary needs is somebody to assist with bathing. I didn’t know if Medicare helps pay for a home care worker coming in once or twice a week to assist with personal hygiene. Can you advise please?
Question from Sylvia: I just found out that I need to get the updated Shingles (Shingrix) shot, and in an online chat with the provider to inquire if it’s covered, I found out that my deductible for Tier 3 – 5 drugs is $435. The Shingrix shot is considered a Tier 3 drug and therefore subject to the deductible at a cost to me of $175. That deductible seems a little high and isn’t something I anticipated.
I and thousands of other US Steel Retirees are confused. We are provided an Advantage Plan. Calls to US Steel, Aetna, and the United Steelworkers Union all end up with the same response. “If you drop, change, or enhance the plan, you can never get it back”. We have no dental or eye protection that retired seniors drastically need. Is there any plan or supplement available that won’t break the bank?
My husband and I are investigating making a switch from an Advantage plan to a Supplement, if we qualify, and have several questions which we’ve not yet seen addressed in your columns:
Should I move from an Advantage plan that has a premium in the $70 per month range, to a true Medicare Supplement and Part D prescription plan at a cost of $150? Taking into consideration what someone may pay for medical services, in addition to Advantage Plan HMO or PPO premiums, a Supplement could be a much better value. Let’s take a look. #thehealthinsurancestore, #getyourbestplan
In last week’s column you recommended that people who have Medicare Supplements G or F change to N. I’m afraid to do that because N has Excess Charges. Is my fear founded? Can you fully explain what Excess Charges are and how they work?
You don’t need to be afraid to switch to N due to Excess Charges for several reasons.
1) It’s illegal to bill Excess Charges in Pennsylvania as well as seven other states.
2) Only Doctors who don’t accept “Medicare Assignment” can bill Excess Charges. It’s estimated that only 7% of doctors do not and they generally fall into two categories: Primary or family doctors who’ve decided they just don’t want to deal with taking insurance. They work for cash only and aren’t interested in making claims to Medicare or private insurers. The others are doctors who treat the Uber rich such as movie stars, Wall Street CEO’s, foreign dignitaries, etc. They work out of places like Manhattan, Miami Beach, Los Angeles, and Palm Springs. Even after charging the maximum Excess Charges, 15%, these doctors would be working for pennies on the dollar compared to what their clients pay. They aren’t interested in giving that kind of discount to people like you or me.
3) There isn’t a full-service medical hospital in the country that doesn’t accept Medicare Assignment. As the population continues to age and people live longer, they don’t have a choice. It wouldn’t take long for a hospital to become wildly unpopular if they decided to bill people more than their competitors, which would lead to treating fewer patients. I imagine it also would cause billing nightmares. By the time they had to hire more people to work in billing and pay agencies to collect unpaid bills, the Excess Charges probably wouldn’t generate any extra profit. You might now ask “Even if the hospital accepts Medicare Assignment, what if the surgeon or anesthesiologist doesn’t?” That would be extremely, extremely rare. First, the majority of physicians are employees of a hospital system in today’s healthcare environment.
There are very few independent doctors left, especially surgeons who need to perform procedures in hospitals and outside of their own facilities. Secondly, doctors must meet certain criteria to get hospital privileges. I assume taking Medicare Assignment would be one.
4) Never. Not one single time, have we gotten a call from a client who has been billed Excess Charges. Plan N was introduced in 2010. I recognized the value immediately, and it has been the most popular plan among our clients since. We have sold over 3,000 Plan N policies. We make sure our clients understand the bills they are responsible for no matter what plan letter they choose. With N, it’s three bills and three bills only; the Medicare Part B deductible ($198 in 2020), a $20 co-pay at a primary care doctor or specialist, and $50 at the Emergency Room. They are well aware they pay $0 after their deductible has been met for services such as blood tests, X-Rays, MRI’s, CT Scans, hospitalizations, surgical procedures, durable medical equipment, diabetic supplies, Chemo, radiation, outpatient rehab, Skilled Nursing, etc. We instruct them to contact us right away if they get a bill for any of these services or one in excess of $20 for an office visit or $50 at the Emergency Room. We would know if billing Excess Charges were even a rare occurrence.
Today’s topic is regarding Supplements. However, I want everyone to understand that Advantage Plan HMO’s and PPO’s work very differently in regards to what bills one is responsible for, what doctors and hospitals one can access, how medical services are approved or authorized, how they are regulated, and what they cost. It’s vital to understand the pros and cons of both types of plans when making a choice. This is especially important for those going on Medicare Part B for
the first time, as this is generally the one and only chance people have to get a Supplement without their medical history being considered. That’s not the case with Advantage Plans. They must accept everyone who has both Medicare Parts A and B, regardless of past or present health issues, with only one exception.
If you are turning 65 soon or thinking about retiring, give us a call to set up a no cost consultation. Our agents are brokers, appointed with virtually every competitive Advantage Plan, Supplement, and Part D plan available on the market. Do not make the common mistake of simply calling the company you currently have your insurance with and buying a plan. Many companies won’t explain Supplements or even mention them as an option.
And if you already have Medicare, feel free to contact us to get a second opinion on what plan you may have enrolled or renewed in during the Annual Election Period which ended December7th. I’d also like to remind those readers who don’t live within a convenient drive to one of our three Western PA locations in Forest Hills, Connellsville, or Erie, we can consult over the phone or via virtual appointment, which is almost like sitting across the desk from an agent. You can also call with any questions or email me personally at firstname.lastname@example.org. And don’t forget to follow us on Facebook for information on the latest news regarding Medicare and prescription drugs, which is going to be a hot topic as the House of Representatives debate and introduce bills that will supposedly attempt to reduce the costs of brand name medications.
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