Author: Dan Hoelscher

Dan Hoelscher founded Seniormark in 2007 in an effort to help individuals make a successful transition into retirement. Dan is a Certified Financial Planner™ Practitioner and holds Certified Senior Advisor (CSA)© and Certified Kingdom Advisor™ certifications. Since founding Seniormark, Dan has helped thousands of retirees throughout Ohio.

Can I Really Get a Medicare Advantage Plan For Free?

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 Make One of These Common Medicare Mistakes!

Don’t Make One of These Common Medicare Mistakes!

The whole process of switching from your employer plan or private insurance to Medicare is fraught with potential costly mistakes. Misconceptions can leave you without much needed insurance. Failure to take the essential steps on time can leave you in the jaws of lifelong penalties.

 

After working in the Medicare industry for over 20 years, I see the same common goofs over and over, ones that cost people an arm and a leg. That is why I feel it is necessary to address them. Hopefully, this post will keep you on the straight and narrow, avoiding the misconceptions and missteps so many fall prey to.

 

Without further ado, let’s dive right in!

  1. Not Signing Up For Medicare When You Turn 65

“I’ll take care of that Medicare enrollment stuff later.”

Don’t procrastinate when it comes to Medicare planning. A couple weeks can easily turn into a couple months and then, next thing you know, it is a year or more later and you’ve missed the Initial Enrollment Period (the 7-month period surrounding your 65th birthday month).

 

It doesn’t seem like a big deal until you look at the penalties. Let’s just take a look at the Part B penalty alone, which is a 10% premium increase for every year you could’ve had Part B but didn’t sign up. This doesn’t sound like a lot, but if you are one year late and live another 20 years (a rough life expectancy estimate), you can easily pay over $3,000 in penalties. This is definitely a mistake you want to avoid!

 

  1. Not Signing Up For Part B Because of Retiree Insurance or COBRA

Why would I want to pay for Part B if my retiree insurance provides my coverage?”

While it is true that you can delay Part B if you have coverage through active employment, retiree insurance and COBRA don’t count. If you aren’t continuing to work past 65, you can’t delay Part B. Period.

 

If you do choose to delay, check the Part B penalties in the above section. They will apply to you, and they aren’t good!

 

  1. Getting on the Same Drug Plan as Your Husband or Wife

“We’ve got matching tattoos, matching drug plans, and a joint Facebook account.”

You can get matching tattoos, and although I question the joint Facebook account, I can let that slide too. But you absolutely can’t get matching drug plans, even if your husband or wife’s plan is low premium.

 

Why?

 

Because every drug plan is different. They each have different preferred pharmacies, different copays, and—this is the important one—they cover different drugs at varying rates. So, even though it might seem convenient to get on the same plan, your drugs may not be covered by his or her plan. This may not be a big deal for a simple blood pressure medication, but prescription drugs are often expensive. Leave the wrong drug uncovered, and it could break the bank and shrink the nest egg.

 

  1. Not Getting on a Part D Drug Plan at All

I’m not on any expensive medications right now, why do I need one?”

The key words in that quote are “right” and “now.” You may be able to get your prescriptions for a small copay now, but—as I said before—what are you going to do if a drug costs $400 or much more a month? If you wait, you will still be able to get on a plan outside of your Initial Enrollment Period (IEP), but not without a Medicare Part D late enrollment penalty. And, since you can only make changes to your Medicare health insurance plans during the Annual Enrollment Period (October 15- December 7), you will have to pay for your expensive drugs out-of-pocket until that time.

 

  1. Thinking Original Medicare Alone (Parts A and B) Will Cover All Your Health Insurance Needs

“Medicare is all inclusive, right?”

Medicare provides good coverage, but it doesn’t cover everything. Extended hospital stays, some skilled nursing care, 20% coinsurance on all outpatient services are just a few of the bigger expenses that will be left up to you. Other smaller ones include vision, dental, or hearing aids. Although I wouldn’t worry about those last three small ones, the bigger ones can be potentially disastrous. Why? Because there is no out-of-pocket maximum in Medicare. No matter how high the out-of-pocket expenses get, you are still on the hook.

 

That is why you need to get something to supplement Medicare alone. You don’t need to pay out the nose to get the most comprehensive coverage, but you can’t leave yourself vulnerable. You have lots of options from plans that cover almost everything to $0 per month Advantage plans that—although are often a hassle—do cap out your out-of-pocket spending at $4-6,000 per year.

 

  1. Accidentally Missing the Medicare Supplement Open Enrollment Period or Your Initial Enrollment Period for Advantage Plans

Oops…”

The time to buy a Medicare Supplement is during your open enrollment period, a 6-month period that starts when you turn 65 and enroll in Medicare Part B.

 

The time to buy an Advantage Plan is during your Initial Enrollment Period, a 7-month period that begins 3-months before your 65th birthday month.

 

You can get on an Advantage Plan during the Annual Enrollment Period (October 15- December 7) if you miss the deadlines, but that can be problem if you need the insurance right away. What if you’ve got some big- ticket medical expenses before the end of the year?

 

And, with Medicare Supplements, although you can try to get on one anytime of year, there is no guarantee you can get one at all. You will have to undergo medical underwriting, and—if you don’t meet their requirements—they will deny you coverage. Now, you don’t have to be in perfect health to meet these requirements, but for some the underwriting can be a real problem.

 

  1. Trying to Do It All Alone

“This can’t be too hard, can it?”

Let’s face it: Medicare is complicated. It is a convoluted government program serving over 50 billion beneficiaries. There are lots of deadlines and rules—as you can see—many opportunities for blunders. At Seniormark, we’ve seen people baffled by Medicare again and again, even people who’ve spent their entire lives in the health care industry! You should definitely educate yourself so you understand your options and don’t get taken advantage of, but at the end of the day, don’t do it all by yourself!  Sit down with a professional who will help ensure you aren’t making any mistakes!

 

Don’t do it alone this Annual Enrollment Season!

We can sit down with you and guide you through the whole process. Call Seniormark at 937-492-8800 or click here for a free consultation!

 

 

 

Is There an Advantage to Medicare Advantage?

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.

The Truth About Your Barber’s Medicare Drug Plan (And Why It Shouldn’t Be Yours)

The Truth About Your Barber’s Medicare Drug Plan

(And Why It Shouldn’t Be Yours)

We hear it all the time from our clients. Their brother, mother, cousin, co-worker, pen pal, or barber is on a certain 18 dollar a month drug plan, and now they want on. They are really excited about it. It’s a deal, after all!

 

But this is actually the last thing they should do.

 

Why? Because drug plans aren’t one size fits all. What worked for their barber won’t necessarily work for them. And it probably won’t work for you either. With this in mind, I challenge you to push your friends, family, and acquaintances lovingly aside and consider these 3 things when shopping for a drug plan.

 

Medications

Drug plans only cover certain medications. And if your medications aren’t on their list, there’s a good chance it won’t be the best plan for you. There are exceptions, of course, but considering your medications is the first step in shopping a drug plan.

 

So raid your medicine cabinet. Which drugs are you on? What’s your dosage? Are they generic or brand name? If you answer these questions, you will have come a long way.

 

Pharmacy

There’s such a thing in the world of drug plans called preferred and non-preferred pharmacies. Certain plans favor (prefer) specific pharmacies by granting you better co pays for getting your medications there. You want to save money on co pays and be able to shop at the most convenient pharmacy. So, it is your best bet to get on a drug plan that prefers the pharmacy across the street rather than across the city through rush hour traffic.

 

The Total Cost

The total cost includes the plan’s

  • Deductible
  • Premium
  • Out-of-pocket drug costs

Notice how it isn’t just the premium. It includes the premium, of course. But just because the premium is the lowest doesn’t mean the plan is the best value. In fact, considering any one of these numbers to the exclusion of the others is dangerous.

 

The premium may be low, but if it takes you forever to meet the deductible, it might not be the cheapest. Yes, the deductible may be tiny, but if the premium is outrageous, what’s the point? The deductible and premium may even be phenomenal, but if you are on a $250 medication that isn’t covered by the plan…well…it’s still junk.

 

The point is you have to do some math on your unique situation to figure out which plan is the best value.

 

This drug plan comparison tool on Medicare.gov does the number crunching for you. Just plug in your information and it will rank all of the 26 drug plans specific to you and based on total cost! Use the general search to avoid putting in personal information.

 

So What’s The Truth About Your Barber’s Drug Plan?

It is specific to him! And why shouldn’t it be yours?  Because yours should be tailored specifically to you! Shopping for a drug plan this way isn’t as easy. And it certainly takes more time. But it’s worth it. It will save you many headaches, long drives, and—wait for it—cold, hard cash…cash that you can use to spoil your grandkids, travel the world, and make the most of your hard-earned retirement life.

 

Looking to get started researching various drug plans? You may need to know a few terms. Click here to read our post “Know the Drug Plan Lingo! 5 Terms to Get You Started”.

Why You Can Try a Medicare Advantage Plan at No Risk

Why You Can Try a Medicare Advantage Plan at No Risk

 

Infomercials have done it for years. When people feel uneasy about trying a new product, they offer a free trial or a money back guarantee.  It provides security for the buyer to know that even if the supposed benefits of a product were oversold or blown out of proportion, he can still send it back.  There’s no risk.

 

Well, Medicare offers something very similar.  It’s called the “Medicare Advantage Trial Right”.

 

A lot of people are uncomfortable with trying Medicare Advantage because they don’t want to feel trapped in a plan they hate until the next Annual Enrollment Period.  The trial period takes this risk away.  As long as it will be your first time enrolling in a Medicare Advantage Plan, you qualify for Medicare Trial Right!  This means that—no matter what time of year it is—you can drop your Medicare Advantage plan with no penalty and enroll in a Medicare Supplement Plan.  This “free trial” period lasts 12 months from the date the Advantage Plan coverage goes into effect.

 

But as the infomercial cliché puts so obnoxiously…

 

 WAIT…There’s More!

Some people believe that if they have pre-existing conditions and get on an Advantage Plan, they will be denied switching back to a Medicare Supplement Policy based on their health.  In other words, they think that if they give up their Supplement for an Advantage Plan, they will never get it back.  But that’s where the “money back guarantee” part of the deal comes in.  Regardless of health, the Medicare Trial Right guarantees that you will be able to get back on a Supplement, no medical underwriting involved.

 

It’s true that Medicare Advantage plans are alluring with their sometimes shockingly low premiums.  But they aren’t always the right  (LINK TO IS THERE AN ADVANTAGE TO MEDICARE ADVANTAGE) fit for retirees.  They change unpredictably and can be quite a hassle.  This is why the Trial Right is so beneficial.  It allows you to try a plan on for size, and then toss it back on the rack.  To test drive it around the block, and then park it in the lot if it doesn’t meet your standards.  And all the while, it guarantees that your old, trusty Medicare Supplement will be there.

 

Want to look into switching to a Medicare Advantage Plan? Call Seniormark at 937-492-8800 for a free consultation.

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

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.

Why You Can Try a Medicare Advantage Plan at No Risk

Why You Can Try a Medicare Advantage Plan at No Risk

 

Infomercials have done it for years.  When people feel uneasy about trying a new product, they offer a free trial or a money back guarantee.  It provides security for the buyer to know that even if the supposed benefits of a product were oversold or blown out of proportion, he can still send it back.  There’s no risk.

 

Well, Medicare offers something very similar.  It’s called the “Medicare Advantage Trial Right”.

 

A lot of people are uncomfortable with trying Medicare Advantage because they don’t want to feel trapped in a plan they hate until the next Annual Enrollment Period.  The trial period takes this risk away.  As long as it will be your first time enrolling in a Medicare Advantage Plan, you qualify for Medicare Trial Right!  This means that—no matter what time of year it is—you can drop your Medicare Advantage plan with no penalty and enroll in a Medicare Supplement Plan.  This “free trial” period lasts 12 months from the date the Advantage Plan coverage goes into effect.

 

But as the infomercial cliché puts so obnoxiously…

 

 WAIT…There’s More!

 

Some people believe that if they have pre-existing conditions and get on an Advantage Plan, they will be denied switching back to a Medicare Supplement Policy based on their health.  In other words, they think that if they give up their Supplement for an Advantage Plan, they will never get it back.  But that’s where the “money back guarantee” part of the deal comes in.  Regardless of health, the Medicare Trial Right guarantees that you will be able to get back on a Supplement, no medical underwriting involved.

 

It’s true that Medicare Advantage plans are alluring with their sometimes shockingly low premiums.  But they aren’t always the right (see here for related article) fit for retirees.  They change unpredictably and can be quite a hassle.  This is why the Trial Right is so beneficial.  It allows you to try a plan on for size, and then toss it back on the rack.  To test drive it around the block, and then park it in the lot if it doesn’t meet your standards.  And all the while, it guarantees that your old, trusty Medicare Supplement will be there.

 

Want to look into switching to a Medicare Advantage Plan?  Call Seniormark at 937-492-8800 for a free consultation.

Drug Plan Check Up: Is your Drug Plan Still the Best Plan for You?

It’s annual enrollment…is your Part D drug plan still the best plan for you?

As most of us remember, there are some VERY important dates associated with Annual Enrollment.  As we discussed earlier in “Don’t set it and forget it” we don’t want to miss these dates.  There are several things that need to be done during annual enrollment but for now let’s focus on the Part D drug plan.  DON’T ASSUME THAT SINCE YOUR PLAN COVERED YOUR MEDICATIONS LAST YEAR THAT YOUR MEDICATIONS WILL BE COVERED THIS YEAR.  Yes, I know, it isn’t convenient that things change, but they do.  So please make sure you review your part D plan this annual enrollment.

For 2019 there will be more than 20 drug plans available in Ohio.  How in the world do you know which is best for you?  Well, there are several things to consider.  Your medications.  The plan’s formulary.  Your preferred pharmacy.  The plan’s preferred pharmacy.  The premium cost.  And so on…  You should have received the Annual Notice of Change for your current plan in late September so make sure you review it!   How do you know if your current plan is still the best plan for you in 2019?  Let’s face it, even if you try and do your homework this stuff is confusing!  As much as we would love to help everyone review their prescription drug plan for 2019, annual enrollment is just too busy for us.  We unfortunately can’t help with the Part D comparisons BUT there are people that can!    If you are still confused and unsure if you’re in the right plan for 2019, please call OSHIIP (Ohio Senior Health Insurance Information Program) at 1-800-686-1578.  OSHIIP trained volunteers are happy to help.  Make sure you have your Medicare card and list of prescription drugs handy.  If you don’t want to make a phone call, check with your pharmacy and see if they will help you re-shop your plan.  Some pharmacies will assist with this process.  And of course, if you are internet savvy and comfortable doing the comparisons on your own, visit www.medicare.gov and shop it yourself.  Please click here for more information on comparing your plan online.   No matter which way you choose – please make sure you review your Part D drug plan this annual enrollment period starting October 15th through December 7th!

And, as always, if you still have questions, do not hesitate to give our office a call at 937-492-8800.

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

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.

How to Choose A Medicare Supplement (A Comparison of the Three Most Popular Plans)

How to Choose A Medicare Supplement

(A Comparison of the Three Most Popular Plans)

So, you’ve likely come to realize that Medicare leaves some expensive coverage gaps wide open. In other words, you’re going to need some Supplemental coverage to ensure you won’t get hit with any high, unexpected out-of-pocket costs.

 

But let’s face it: comparing benefits among Medicare’s eleven lettered plans isn’t easy. There’s a lot to consider, and many people don’t even know where to start.

 

Although I won’t detail all of Medicare’s plan options that we offer (that would require an encyclopedia-length blog post), I will compare the cost and benefits of the most popular Medicare Supplements our clients choose: Plans F, G, and N. I will outline what each plan offers, highlight the major differences, and go over the pricing based on the current lowest rates of the diverse range of companies we represent.

 

Let’s meet the line-up.

Plan F—The Luxury Plan

Plan F is Medicare’s most popular plan, accounting for 53% of all policy types. Plan F is what many like to call the “Cadillac plan” because it is provides the most comprehensive coverage of all Medicare’s supplement coverage options. And, judging by this chart, detailing its benefits, it definitely lives up to its name:

Medicare Supplement Benefit Does Plan F Cover It?
Part A Hospital Coinsurance—and up to 365 additional hospitalization days after Medicare benefits end YES
 The 20% Part B Coinsurance and Copayments YES
Blood (First 3 Pints) YES
Part A Hospice Care Coinsurance and Copayments YES
Skilled Nursing Facility Coinsurance YES
$1340 Part A Deductible YES
$183 Part B Deductible YES
Part B Excess Charges YES
Foreign Travel Emergency YES

 

So, in other words, Plan F guarantees little to no out-of-pocket costs. The only things that aren’t going to be covered in Plan F are health care costs that aren’t covered in any of Medicare’s supplemental coverage options such as dental, vision, and hearing care. But I usually don’t recommend insuring these costs.

 

However, as you may have guessed, with such a high-quality benefit package, you are going to pay for it in premiums. Here are our current lowest rates:

  • For a female, age 65:  $125.72 per month
  • For a male, age 65:  $140.06 per month

 

Before we meet Plan G, there is one other thing you need to consider about Plan F: it is being discontinued in 2020 (click here for more information). You can still hop on a Plan F, and you will be allowed to stay on even after 2020, but this is very important to consider (because rates can increase dramatically when a plan is discontinued).

 

Plan G—The Second Place Winner

Plan G is silver medalist when it comes to benefits. It covers everything that Plan F covers, except for one thing: the Part B deductible. This means that in a Plan G you will have to meet that $183 deductible before Medicare pays anything for outpatient costs each calendar year. With that in mind, let’s look at the costs:

  • For a female, age 65:  $100.57 per month
  • For a male, age 65:  $110.52 per month

 

So, this is an easy comparison. A Plan G is about $300 cheaper than Plan F per year. Subtract the $183 from that, and you come to a net savings of, well, $117 per year. So, in other words, it’s a wash. However, you have to keep the following things in mind:

  1. This is assuming you meet the deductible every year. If you don’t, the savings can be much higher.
  2. This is based on our current rates.  When you sign up, there may be a bigger difference in premium between Plan F and G.
  3. This isn’t taking into account that Plan F is historically more prone to rate increases and that these rate increases are likely to happen more frequently after Plan F discontinues.

 

Now, moving on to our third most popular plan.

 

Plan N—The New Kid on the Block

Introduced in June of 2010, this plan showed up late to the party, although it still holds its own when it comes to high-quality benefits at reasonable prices.

 

However, there are some things that Plan F covers that Plan N does not. Like Plan G, you will have to pay the $183 deductible. In addition, you will also have to pay up to a $20 copay for each doctor’s office visit and up to a $50 copay for each emergency room visit.

 

Finally, the last thing that a Plan N doesn’t cover is Part B excess charges. Allow me to explain a little bit of what this is…

 

For every imaginable procedure, Medicare has an approved amount of what it should cost to perform it. In Ohio, healthcare providers are never allowed to charge above this Medicare-approved amount, no matter what. However, outside of Ohio, some states allow providers to issue an excess charge of up to 15% more than the Medicare approved amount. Plan N may leave you on the hook for that 15% outside of Ohio.

 

So, here’s my recommendation for my fellow citizens of the buckeye state: If you rarely leave Ohio except for a few weeks out of the year, whether a Plan covers Part B excess charges shouldn’t really factor into your decision. But if you are a snowbird in a state where those excess charges are allowed or you travel frequently, it may be something to consider.

 

Now, without further ado, the costs:

  • For a female, age 65:  $80.97per month
  • For a male, age 65:  $93.21 per month

 

So, compared to a Plan G, you pay about $300 less in premiums. Whether this pays off in the end depends on how much you visit the doctor or emergency room in a given year, which—not surprisingly—is impossible to pin down. Taking the Part B excess charges out of the decision, you would have to go to doctor 10 times and the emergency room twice for a Plan G to be worth it. I hope that puts it into perspective, and you can make a decision based on your unique situation.

 

Because, in the end, no matter which plan you choose (if any of them), it is a personal decision.

One More Vital Piece of Advice

After you’ve decided on one of Medicare’s 11 plans, I have one piece of advice for you: Shop with an independent agency!

 

All of these plans will offer the same benefits, no matter which company you chose, but the premiums can vary dramatically. If you just call one company, they will only sell you their plans, which may or may not be the best value on the market. Independent agencies, on the other hand, can compare rates across companies to find the best value for you.

 

If you want to compare Supplement rates now, you can use our free quoting tool. We do not ask for any personal information, so you can be sure you are not in for an onslaught of junk emails!

 

Or, if you are ready to talk to a local, independent agent, call Seniormark at 937-492-8800. We are here to help!

Note: All pricing is based on the zip code 45365. They are very good estimates, but prices may vary.