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10 Terms to Beef Up Your Medicare Literacy

In this day and age, you have a vast pool of knowledge available to you. But none of that matters if you can’t understand any of it. If you’ve done any researching on the Internet about Medicare, you know what I mean. To help you out, I compiled a list of important terms that often catch retirees unaware.

 

  1. Annual Enrollment Period (AEP)

The AEP is the busy time of year for Insurance companies such as ours. You can think of it as the black Friday of Medicare. It is the time of year (October 15—December 7) when Medicare beneficiaries can switch plans, drop plans, and join new ones. It is an open market, a bustling time for anyone involved with the Medicare industry.

 

  1. Open Enrollment Period

The day you turn 65 and are signed up for Medicare Part B is the first day of your open enrollment. This 6-month long time frame is the window in which you can get on ANY Medicare Supplement plan, regardless of health! You will want to take advantage of this…your options narrow significantly outside of open enrollment.

 

  1. Deductible

A deductible is the money you have to pay upfront before the benefits of a plan begin. For example, Part A of Medicare has a $1340 deductible. They will not cover anything until you reach it.

 

  1. Copayments

Copays are a set dollar amount you pay in addition to the payment made by the insurer (whether it be Medicare or a private insurance company). Think of the $10-50 fees when you visit the doctor’s office or buy a certain prescription drug.

 

  1. Coinsurance

This is very similar to copayments, but it is a set percentage instead of a dollar amount. For example, the Medicare Part B coinsurance is 20%. This means you pay 20% of the total bill, not a set dollar amount.

 

  1. Out-of-pocket Costs

All three of the previous terms (deductibles, copays, and coinsurance) are all a part of a much larger concept of out-of-pocket costs. In other words, your out-of-pocket costs are everything you pay for your healthcare beyond your premium. One warning you will receive a lot is this: With only traditional Medicare (parts A and B), there is no limit to your out-of-pocket spending. Yes, I am low-key warning you again, but hopefully you fully understand it now.

 

  1. Donut Hole

Speaking of out-of-pocket costs, for a Part D drug plan, they are highest in the donut hole, a gap in prescription drug coverage. You enter the donut hole when you reach $3750 in total costs and exit it once you reach $5000 in out-of-pocket costs.

 

  1. Drug Tiers

Drug plan companies often organize the medications they cover into levels. They call these levels—you guessed it—tiers. Drugs on a lower tier (often generic brands) have lower copays and coinsurance. Drug on a higher tier (such as brand name or specialty drugs) often have higher associated costs.

 

  1. PPO

PPO stands for Preferred Provider Organization. So a PPO is a health plan that has a network of “preferred” doctors and hospitals. If you use those doctors and hospitals, they reward you will lower out-of-pocket costs.

 

  1. HMO

HMOs (Health Maintenance Plans) are a little bit more intense than PPOs. It is the same idea, but HMO plans won’t cover you at all if you don’t use their network of hospitals and doctors.

 

That brings this list to close. If you are still confused about a term on this list, ask us for help in the comments section. Have you come across another difficult word on your Medicare planning journey that you think we should add? Let us know. We want to hear from you!

 

Annual Enrollment is the only time of year you can switch your Medicare Advantage Plan or Part D Drug Plan! Looking to review your plans with a Certified Senior Advisor this open enrollment season? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

Can I Really Get a Medicare Advantage Plan For Free?

Yes, for quite a few Medicare Advantage plans, you will not have to pay a dime in premiums. And to sweeten the deal, you can even get extra benefits like gym memberships or a built in drug coverage with some plans. But I’m very stingy with my use of the word “free.”

 

From my experience, an Advantage Plan is free in the same way the newborn puppies of your best friend’s dog are “free.” You may not have to pay for the puppy, but how many know having man’s best friend around the house isn’t exactly a recipe for super savings (especially if you’ve got furniture and footwear that look especially appetizing in black and white)?

 

You see, a Medicare Advantage Plan might not cost anything in premiums, but it may eat up your money in the end. I’m not saying they aren’t right for some people, in fact; I’ve placed people in $0 Advantage Plans to their long-term satisfaction. For the cost-conscious retiree who is romping into retirement, healthy as a horse, it may be the best option. But before you purchase one, make sure you understand the hassles and extra costs that come along with the decision. I’ve outlined a few of the most important ones:

 

Networks

Advantage Plans have networks of health care providers that they have contracted with, usually within a fairly tight geographic area. If you do not receive care at one of their pre-picked providers, it can mean much higher co pays and coinsurance amounts. If you are in an HMO plan, they may not even cover you at all while receiving care out of network. This can work just fine for a person who stays local most of the year, but it does put the burden on you to ensure that your health care provider is in-network. Making mistakes could cost you heavily.

 

Inconsistency

With a Medicare Supplement, the benefits are stable, but with an Advantage Plan, this is hardly ever the case.

 

Since the private insurance companies that offer Advantage Plans re-file their contract with Medicare every year, the benefits always change—sometimes dramatically. One of your preferred doctors could go out of network. Co payments, coinsurance, and deductibles can all shoot up. This is why you must review your plan every year so you won’t be caught unaware. If you set your plan to the side and forget about it for even one year, it can be quite upsetting financially.

 

Potentially High Out-of-pocket Costs

I always like to remind people that Advantage Plans have more of a “pay as you go” approach. You pay less in premiums, yes.  But you may make up for it in deductibles, co payments, and coinsurance. For example, almost all Advantage Plans still keep you on the hook for the 20% coinsurance on Part B. That’s fine for an x-ray, but not as much for an outpatient surgery that may be $20,000 or more.

So be aware, Advantage plans do limit your annual out-of-pocket spending, but these caps are generally pretty high. If you have a period of extended illness, you could spend anywhere from $3500-6000 per year or more!

 

That doesn’t sound like free to me.

 

That is why you need to be wary of salespeople who may just be trying to convince you to switch to a Medicare Advantage Plan this Annual Enrollment Season. It may be right for you, but—then again—it may cost you a lot more in the long run.

 

Looking to review your plans with a Certified Senior Advisor this Annual enrollment season? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

 

Don’t “Set It and Forget It” This Annual Enrollment Season!

Does anyone remember Ron Popeil?  If you don’t, allow me to rephrase the question.  Does anyone remember the “set it and forget it” infomercial king?

 

I bet it’s ringing a bell now.

 

I, for one, can still see him in his green apron, armed with nothing but some well-seasoned meats and a fancy rotisserie cooker, taking the cheesy and overly scripted infomercial world by storm: “All you have to do is…”  The unrealistically enthused audience chants, “SET IT AND FORGET IT!”

 

He was like the Billy Mays of the 70s, but with food instead of cleaning products.

 

But I digress…back to the topic at hand.  The reason I retrieved this slogan from memory lane is to make a point: Many people have the “set it and forget it” mindset with their Medicare Health Insurance Plans.  They think that once they undergo the process of enrolling in Medicare, enrolling in supplemental coverage or an Advantage plan, and signing up for a drug plan that they never have to change anything again.  Happily ever after.

 

But this just isn’t true.  Yes, most of the work is done.  And you’ve definitely done the minimum to get by.  But there’s a good chance your situation will change over time.  And, even if your situation doesn’t change, there is a very good chance your health care plans will, oftentimes drastically.  This leaves you in an ill-fitting plan that doesn’t meet your needs or your budget.  You may need to switch!

 

When it comes to Medicare Annual Enrollment, there is a reason for the season.  From October 15—December 7, you have the opportunity to make strategic changes to your health care plans.

 

Here are 3 reasons you might need to make changes this year!

 

The Medicare Supplement Creep

Medicare Supplements are typically consistent from year to year.  The benefits are guaranteed to stay the same, and the premiums rarely increase drastically.  But the premium cost almost always creeps up, dollar by dollar, slowly but surely.

 

If you stay on that ride for too long, you could end up paying $100+ more a month than you should.  In fact, if you have been in the same Medicare Supplement Plan for 4-5 years, there’s a good chance you’re paying too much for it.  Shopping around for a better deal this year could save you hundreds…and all without reducing your coverage.

 

REMINDER:  You can change your Medicare Supplement any time of year (click here for related info), not just annual enrollment.

 

The Advantage Plan Leap

There are so many aspects of an Advantage Plan that can frog around over time.  The deductible may go up.  The premium may go down.  You might have higher copays.  Your coinsurance might drop.  And beyond benefits and price, doctors and hospitals may go in and out of your plan’s network.  A doctor available to you this year, may not be available the next.

 

This is why it is important to review your plan.  Is your family doctor still within the plan’s network?  Is it still the best value for you?  If you simply set it, forget it and let it skate by another year, you’ll never know.

 

The Drug Plan Drop

A drug plan may vary in cost from year to year, but what you really need to check is the list of medications the policy covers, also known as the formulary.

 

Over the years, a drug plan may discontinue or reduce coverage on certain medications.  Imagine if the drug it discontinued was your most expensive one, and you didn’t realize it.  Yeah…it could be a financial disaster.

 

Review Your Plan This Year!

So make sure to take control of your health insurance options.  Review your plans, and take careful note of all the changes.  The “set it and forget it” philosophy might work well for cooking chickens, but it doesn’t work for this.

 

For your health insurance, I offer another slogan:  If you set it and forget it, you might regret it.

 

Maybe that will catch on…

 

Yeah…probably not.

 

Looking to review your plans with a Certified Senior Advisor? Call Seniormark at 937-492-8800 for a free consultation.

Think Poor Health Will Stop You From Getting Medicare Supplement Insurance? Think Again.

Insurance companies can’t refuse you coverage for having cancer or being on an expensive chemo-treatment. They can’t deny you a policy for having diabetes or (Burger King-induced) sky-scraping cholesterol or any other pre-existing condition for that matter. These companies are federally mandated to grant you coverage as long as you enroll within the Medicare Supplement Open Enrollment Period. This is good news for you!

 

The Open Enrollment Period

The Medicare Supplement Open Enrollment Period is a 6-month window beginning the day you both turn 65 and are enrolled in Part B of Medicare. During this time frame, you have all the privileges of someone who doesn’t have poor health, including:

  • Access to all 11 Supplement plans (A, B, C, D, F, HDF, G, K, L, M, and N)
  • No premium hikes due to health conditions
  • No medical underwriting

 

You’ve Got Another Shot.

And then there’s guaranteed issue. Although this is based on very specific circumstances (such as coming off of employer insurance or your current plan discontinuing service), it still offers many people with pre-existing conditions another shot at getting on a plan. It is important to note, though, that some plans may not be available under guaranteed issue. It isn’t an all-access pass like the Open Enrollment Period, but it does give you the assurance to know you will not be denied.

 

 

It’s Not the End of the World!

But don’t sweat if you are no longer within the Open Enrollment Period. This definitely does not mean you won’t be able to get Medicare Supplement Insurance. It just means you will have to answer questions about your health, where they might look at your whopper addiction with a more critical eye.  You may have to pay more, but (depending on your specific conditions) they won’t automatically deny you coverage.

 

Of course, this doesn’t mean that there aren’t still circumstances where you will be unable to receive coverage. But—because of open enrollment and guaranteed issue—this doesn’t happen nearly as much. The government is making strides to ensure that health coverage is available to those who need it most: those who are unhealthy.

 

Need help picking out one of the 11 Medicare Supplement Plans? Want somewhere to start? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

Sample Medicare Card

Is Signing Up For Medicare Automatic?

It might be. A lot of things are nowadays. You can now set up your bank account to automatically pay for your bills. And do you remember the last time you turned on your computer, and it took 20 min doing automatic updates?

 

But Medicare enrollment? Most of the time—no. You usually have to call or go online or visit your local security office to enroll…unless…

 

Did you sign up for social security prior to age 65?

If you did, signing up for Medicare is, in fact, automatic. You will receive your Medicare card in the mail 3 months before you turn 65. As pictured above, it will have the dates your Medicare Part A and B will go into effect and your Medicare number (which you should protect very carefully). As long as you can’t think of a reason why you should delay Part B of Medicare, you are finished with this phase of the Medicare planning process.

 

But before you exit this window, I do have some bad news: you’re not done yet. You still have some major decisions to make. Do you want a Medicare Advantage Plan? Or a Medicare Supplement? What about Drug plans?

 

And—quite unfortunately—these decisions are not automatic.  But, the good news is that we can help you make those decisions.  Just call our office at 937-492-8800 to set up your free, no obligation consultation and we will put your mind at ease.

 

Turning 65 soon and not sure what to do? Click here to sign up for our free Medicare workshop. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!

Don’t “Set It and Forget It” This Annual Enrollment Season!

 

Does anyone remember Ron Popeil? If you don’t, allow me to rephrase the question. Does anyone remember the “set it and forget it” infomercial king?

 

I bet it’s ringing a bell now.

 

I, for one, can still see him in his green apron, armed with nothing but some well-seasoned meats and a fancy rotisserie cooker, taking the cheesy and overly scripted infomercial world by storm: “All you have to do is…” The unrealistically enthused audience chants, “SET IT AND FORGET IT!”

 

He was like the Billy Mays of the 70s, but with food instead of cleaning products.

 

But I digress…back to the topic at hand. The reason I retrieved this slogan from memory lane is to make a point: Many people have the “set it and forget it” mindset with their Medicare Health Insurance Plans. They think that once they undergo the process of enrolling in Medicare, enrolling in supplemental coverage or an Advantage plan, and signing up for a drug plan that they never have to change anything again. Happily ever after.

 

But this just isn’t true. Yes, most of the work is done. And you’ve definitely done the minimum to get by. But there’s a good chance your situation will change over time. And, even if your situation doesn’t change, there is a very good chance your health care plans will, oftentimes drastically. This leaves you in an ill-fitting plan that doesn’t meet your needs or your budget. You may need to switch!

 

When it comes to Medicare Annual Enrollment, there is a reason for the season. From October 15—December 7, you have the opportunity to make strategic changes to your health care plans.

 

Here are 3 reasons you might need to make changes this year!

 

1.  The Medicare Supplement Creep

Medicare Supplements are typically consistent from year to year. The benefits are guaranteed to stay the same, and the premiums rarely increase drastically. But the premium cost almost always creeps up, dollar by dollar, slowly but surely.

 

If you stay on that ride for too long, you could end up paying $100+ more a month than you should. In fact, if you have been in the same Medicare Supplement Plan for 4-5 years, there’s a good chance you’re paying too much for it. Shopping around for a better deal this year could save you hundreds…and all without reducing your coverage.

 

REMINDER: You can change your Medicare Supplement any time of year, not just annual enrollment.

 

2.  The Advantage Plan Leap

There are so many aspects of an Advantage Plan that can frog around over time. The deductible may go up. The premium may go down. You might have higher copays. Your coinsurance might drop. And beyond benefits and price, doctors and hospitals may go in and out of your plan’s network. A doctor available to you this year, may not be available the next.

 

This is why it is important to review your plan. Is your family doctor still within the plan’s network? Is it still the best value for you? If you simply set it, forget it and let it skate by another year, you’ll never know.

 

3.  The Drug Plan Drop

A drug plan may vary in cost from year to year, but what you really need to check is the list of medications the policy covers, also known as the formulary.

 

Over the years, a drug plan may discontinue or reduce coverage on certain medications. Imagine if the drug it discontinued was your most expensive one, and you didn’t realize it. Yeah…it could be a financial disaster.

 

Review Your Plan This Year!

So make sure to take control of your health insurance options. Review your plans, and take careful note of all the changes. The “set it and forget it” philosophy might work well for cooking chickens, but it doesn’t work for this.

 

For your health insurance, I offer another slogan: If you set it and forget it, you might regret it.

 

Maybe that will catch on…

 

Yeah…probably not.

 

If you haven’t already downloaded our Annual Enrollment Checklist, there is no time like the present!  Make sure you have completed it — and then you can forget it — until next year this time!  Download it here:  https://seniormark.com/annual-enrollment-period-checklist/.

 

Looking to review your plans with a Certified Senior Advisor? Call Seniormark at 937-492-8800 for a free consultation.

 

Hate Your Medicare Insurance Plan? Here’s a Quick and Easy Guide to Switching!

You thought the Medicare mess was all tidied up when you first enrolled and purchased proper Medicare insurance (whether it be Medicare Advantage or Medigap), but then you discover a sad fact of life: Costs change. Benefits change. Your needs change. Or, perhaps you’ve quickly come to realize that a plan you thought was all sunshine, rainbows, and good value is a terrible fit for you. Regardless of the reason, it’s time to switch to an option that is more suited to you needs.

 

That is why I want to offer you a simple guide, answering some questions you may have about switching. Is it possible for you to switch? If so, when? And how should you go about it? I will also cover some of my best tips all of us at Seniormark have learned after helping thousands of retirees through this process—tips to save you time and needless hassle.

 

This post is organized into section based on the type of switch you are planning to make:

  1. From a Medicare Supplement to another Medicare Supplement
  2. From a Medicare Supplement to a Medicare Advantage Plan
  3. From a Medicare Advantage Plan to a Medicare Supplement
  4. From a Medicare Advantage Plan to another Medicare Advantage Plan
  5. From a Part D Drug Plan to another Part D Drug Plan

 

Feel free to skip to the section that is most pertinent to you, and don’t forget to call us at 937-492-8800 if you have any additional questions!

From Medicare Supplement to another Medicare Supplement

Can I Switch?

Most people can, except people with very serious, chronic health conditions. You will have to undergo medical questioning and get approved, but don’t lose hope too fast: in many cases, even those with poor health can find a company who will accept them (click here for an blog to answer some questions about this)!

 

When Can I Switch?

Anytime of year. However, I recommend avoiding switching during the Annual Enrollment Period (October 15- December 7). That is a really busy time of year for insurance agencies, so the process might not be as smooth.

 

How Do I Switch?

 (1) Find the best plan for you by doing private research or shopping with an independent insurance agency like Seniormark. (2) Call the company and follow their application process. (3) If you are approved, cancel your previous supplement.

 

Best Tip

This type of switch is not just for those who hate their plans, but is also for those who like to save money (which I assume includes most of us). If you have been in the same Medicare Supplement for 3-5 years, you could save hundreds a year or more by switching without changing your benefits (click here for some help on shopping around).

 

From a Medicare Supplement to a Medicare Advantage Plan

Can I Switch?

Yes, in the vast majority of cases. As long as you don’t have End Stage Renal Disease (kidney failure), you can switch!

 

When Can I Switch?

You can switch during the Annual Enrollment Period (October 15- December 7).

 

How Can I Switch?

(1) Find the best plan for you by doing private research or by shopping with an independent agency like Seniormark. (2) Call the company and follow their application process. (3) Cancel your previous coverage effective January 1st and wait for your new coverage to go into effect for the New Year.

 

Best Tip

Before switching to an Advantage Plan, realize that you are giving up benefits for the lower premium. Advantage Plans are more cost effective when it comes to premium, but even the ones that cost $0 aren’t really free (click here for our blog on “free” Advantage plans), so make sure you understand what you are getting into.

 

And as you are shopping plans, remember to consider more than just the premium. For instance, are your doctors in the plan’s network? If your plan has a built-in drug plan, does it cover your medications? We’ve had unfortunate retirees call in for help after they found out they couldn’t see their own doctor without losing all coverage. And the worst part? They were locked into their plan for the whole year! Advantage Plans can be an excellent fit, but only if you find the right one for you.

 

From a Medicare Advantage Plan to a Medicare Supplement

Can I Switch?

Most people can, except people with very serious, chronic health conditions. Anytime you switch to a Medicare Supplement, this will be the case: You will have to undergo medical questioning and get approved. But don’t lose hope too fast: in many cases, even those with poor health can find a company who will accept them (see link above)!

 

When Can I Switch?

You can only switch during the Annual Enrollment Period (October 15-December 7).

 

How Can I Switch?

(1) Find a plan that’s right for you by doing private research or by shopping it with an independent, local insurance agency like Seniormark. (2) Call the company and follow their application process. (3) If approved, ensure that your policy gets cancelled effective January 1st and then simply wait for your coverage to go into effect in the New Year.

 

Best Tip

Don’t wait until the last minute to switch. Since Annual Enrollment is such a busy time of year for Insurance companies, it may take 3-4 weeks for your application to get processed. So, put your application in early (in October or early November); you don’t want to be stuck in an Advantage Plan you hate for another whole year!

 

From a Medicare Advantage Plan to Another Medicare Advantage Plan

Can I Switch?

Yes, in the vast majority of cases. As long as you don’t have End Stage Renal Disease (kidney failure), you can switch!

When Can I Switch?

You can only switch during the Annual Enrollment Period (October 15-December 7).

 

How Can I Switch?

(1) Find a plan that’s right for you by doing private research or by shopping it with an independent, local insurance agency like Seniormark. (2) Call the company and follow their application process. (3) Wait for your previous plan to cancel by itself and wait for your new coverage to go into effect on January 1st.

 

Best Tip

As I’ve previously noted, make sure your new Advantage Plan has your doctor in its network, and—if your new plan has a built-in drug plan—that your medications are covered. It’s a real pain to kick off New Year off with an ill-fitting insurance plan!

 

From a Part D Drug Plan to Another Part D Drug Plan

Can I Switch?

Yes, there are no restrictions to changing coverage!

 

When Can I Switch?

You can only switch during the Annual Enrollment Period (October 15-December 7).

 

How Can I Switch?

(1) Find a plan that’s right for you by shopping it yourself on Medicare Plan Finder or call OSHIIP (Ohio Senior Health Insurance Information Program) at 1-800-686-1578 and they can help you re-shop your plan. (2) Enroll online at www.medicare.gov for a new plan. (3) Your new coverage will go into effect on January 1st and your old coverage will automatically end when you sign up for a new part D plan.

 

Best Tip

Do not make drug plan decisions with a tunnel vision focus on premiums. Make sure you find a plan that covers all of your medications and, if possible, has your desired pharmacy as one of its preferred pharmacies.

 

The Ultimate Best Tip: Get Expert Guidance When Making Your Switch This Annual Enrollment Season!

Annual Enrollment is the only time of year you can switch your Medicare Advantage and Prescription Drug plan.  Looking to review your plans with a Certified Senior Advisor this Annual enrollment season? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

One Priceless Secret to Help You Find a Trustworthy Retirement Advisor

You can’t choose retirement help based on an agent’s smile or friendliness or wrinkleless pants. And contrary to popular belief, the handshake shouldn’t make or break your decision either. The truth is, even if he or she is a nice guy or gal, that doesn’t make the person any more trustworthy.

 

Not that those things don’t matter at all. I hope the person you work with during this crucial transition isn’t a jerk. All I am asking is for you to consider this as well: Is he a captive or an independent agent? Because knowing the difference…well…it can make a world of difference.

 

Tied Hands

A captive agent works for one company. Their job is to sell that one company’s products. They can’t lead you to the best-valued plan for your unique needs because they are limited to the insurance plans that their company offers.

 

Here’s something you’ll never hear a car salesman say: “Yeah, you know what you need, sir? You need to go visit the dealer down the street. He’s got exactly what you are looking for…and at half the price! Here, let me get the directions for you.”

 

It’s the same thing with captive agents. Even if there’s a better deal with another company, they’re not going to tell you that! Just like a car salesman, they have to sell what’s on the lot if they want to make a commission. In other words, their hands are tied. And when their hands are tied behind their back, it’s a bit more tempting for them to cross their fingers.

 

Hands Free Help

On the other hand (I promise I didn’t try that), independent agents are on their own. Since they don’t work for any one specific company, they can instead work for you, shopping plans from all the companies they represent. By analyzing your situation, they can find the one health care plan that is best suited to you. Or—if there are several—they can talk to you honestly about the advantages and disadvantages of your different options. It’s that simple!

 

And that’s why the captive vs. independent agent dichotomy is so vital when you are deciding who to work with. Because—when compared side by side—the independent advisor is the obvious choice…

 

Hands down. (I’m deeply sorry…I had to.)

 

Are you interested in working with an independent advisor with a passion for helping retirees? Then call Seniormark at 937-492-8800 to set up a free consultation.

 

 

Photo:  https://www.mogicons.com/en/stickers/emoticons/secret-emoticon-265/

 

Is There an Advantage to Medicare Advantage?

According to Reader’s Digest, 1 in 4 retirees receive their health insurance coverage from a Medicare Advantage Plan. And I can certainly understand the attraction. Premiums as low as $0 a month. Prescription drug plans often included. What’s not to like?

 

But—as it goes for most purchases—you get what you pay for. And when it comes to Medicare Advantage Plans, they definitely have a dark side. Allow me to shed some light on the subject.

 

The Medicare (Dis)Advantage Plan

Networks

Medicare Advantage Plans contract with specific hospitals and doctors, usually within a relatively tight-knit geographic area. If you don’t receive care from the ones with whom they’ve “networked”, you may be subject to higher co pays or coinsurance at each visit.  Depending on the plan, they may not even cover your expenses at all.

 

This can be a problem for anyone, but especially for those who travel frequently. So for you snowbirds out there who fly south for the winter and leave us all to freeze, this serves you right (forgive my jealous outburst). You may find yourself with less (or even no) coverage at your vacation home. Although they will still cover you in emergencies, that doesn’t mean it won’t be an expensive hassle.

 

Inconsistency

Because Medicare Advantage Plans are funded by government subsidy, the cost and benefits can change drastically from year to year. If the government decides to spend your tax dollars elsewhere, your plan may let prices creep (or even leap) up, while benefits wane. This all depends on politics, which—as you already know—is rarely consistent.

 

Potentially High Out-of-Pocket Costs

Medicare Advantage Plans have more of a pay-as-you-go approach. Although the premium is low, deductibles, coinsurance and co pays are often much higher. This is not a problem if you are healthy, but if you are struck with sudden illness, you might be stuck with astronomically high out-of-pockets: $3,500 to $6000 a year or more! And if the diagnosis is bad enough, you may not qualify to switch to a Supplement plan.

 

Let’s take a real life example.

A client of ours came in with an Advantage Plan. He was diagnosed with cancer in fall of 2012 and started chemotherapy immediately. Since he was in charge of 20% of the costs due to his plan, he very speedily met his $7,500 annual out-of-pocket limit. Then it was the New Year, and his out-of-pocket limit reset. He continued chemo-treatments, which lead to another $7,500 expense. That is $15,000 of spending in less than 6 months!

 

And since a cancer diagnosis prevented him from switching to a Supplement, he had to stay with his Advantage Plan. He was stuck, and—needless to say—very unhappy about it.

 

So Here’s the Bottom Line…

Is there an advantage to a Medicare Advantage Plan?

If your doctors are in your plan’s network, you stay on top of changes, and—here’s a big one—you don’t get horribly ill (leading to high out-of-pocket costs), then yes! The Medicare Advantage dark side has vanished. The force is with you, and you’ve saved hundreds or even thousands in premium costs.

 

But you need to assess your situation. You need to take the risk into consideration. 1 in 4 people might be on a Medicare Advantage Plan, but that doesn’t mean it is right for you!

 

Looking to switch to or purchase a Medicare supplement? Call Seniormark at 937-492-8800 for a free consultation. We are here to help.