Category: Medicare Advantage

Attention Seniors…Beware of Sharks!

Posted on October 1, 2012 by - Medicare Advantage, Medicare Drug Plan

A feeding frenzy is about to begin.  No, I am not talking about real sharks.  I am referring to the Medicare Annual Enrollment Period (AEP).  The Annual Enrollment Period is the time of year, set aside by Medicare, during which Medicare beneficiaries can enroll in or change their Medicare Advantage or Prescription drug plans.  The AEP runs from October 15 to December 7, although insurance companies and agents can begin marketing to you beginning October 1st.

The problem arises due to the fact that this is the only time of the year that insurance companies and agents can market their Medicare Advantage and Prescription Drug plans to you – unless you are new to Medicare.  In my opinion, this leads to very aggressive marketing behavior.  Now don’t get me wrong, just like every shark in the ocean is not out to bite you, not every agent and insurance company is out to take advantage of you, but you do need to be aware.

So what steps can you take to protect yourself?

Know what you have.  It is extremely important to know what type of plan you have.  Do you have Traditional Medicare Parts A&B paired with a Medicare Supplement policy, or do you have Part C of Medicare which is a Medicare Advantage plan?  If you have a Medicare Supplement policy, what plan do you have (A – N)?  If you have a Medicare Advantage plan, do you have a HMO, PPO or PFFS plan?  Do you have a stand-alone Part D prescription drug plan or is it part of your Medicare Advantage plan?  These are all important questions to ask yourself.

Know what you should do.  The first thing you should know is that you don’t have to do anything, unless your plan is terminated for some reason.  If that is not the case, and you are completely happy with your plan, you can just leave everything “as is.”  With that said, it is important to review any benefit, premium or formulary changes to your plan.  If you have a Medicare Advantage or Prescription Drug plan, your plan will send you an “Annual Notice of Change” packet explaining any changes to your plan for 2013.  Don’t assume that because your medication was covered this year that it will automatically be covered next year.  Finally, don’t let any agent or insurance company lead you to believe that you have to make any changes.

Know what you can/can’t do.  There are a lot of rules surrounding Medicare, so be careful when you do make any changes.  Some changes could get you disenrolled from a plan you didn’t intend to get disenrolled from.  Don’t assume all agents know these rules.

Know what agents can/can’t do.  It is important to know that agents cannot cold call you in any way, meaning that if you didn’t invite them, they can’t contact you – except by mail.  Be careful when requesting free information whether by mail or on the internet.  Many times when you request this free information, you have just given an agent permission to contact you.  If you have made this mistake in the past, you know how many phone calls you can get.  The Ohio Department of Insurance put out an excellent flyer called, “Medicare & You: Understanding & Protecting Yourself from Predatory Sales practices.”  You can view this form on their website.

Work with a trusted advisor.  When you do have questions or need to make changes to your plan, make sure you work with a trusted advisor.  An advisor is someone who listens to you and helps you find a plan that is right for you based on all the options available.  A salesperson is someone who will tell you what you want to hear so they can sell you a product.  Sometimes it’s hard to tell the difference, so do your homework on this one.  How long have they been in the business?  Are they a jack of all trades or do they focus on senior insurance?  Do they have a local office?  Do they have a website to help you research your options?  Do they work with someone you know who can vouch for them?  Are they available during working hours to help you, or do you just get their voicemail?

If you will do your homework and become knowledgeable in these five areas, you will have come a long way in protecting yourself and making sure you don’t get bitten when the feeding frenzy begins October 1st.

Donut Holes Aren’t Always Tasty!

Posted on February 2, 2012 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Social Security

If your brain works like mine, it thinks about food a lot more than it should.  And it’s always food that’s not good for me, like donut holes.  Nothing beats a donut hole.  It’s like eating a whole donut in one bite…AWESOME!

But when it comes to the Medicare Prescription Drug Plan, donut holes lose their luster.  Don’t ask me why Medicare decided to give it the name donut hole, maybe it was to take the edge off its bite (no pun intended, unless you think it’s funny).  The Donut Hole, otherwise known as the coverage gap, is exactly what it sounds like.  It is a hole in your coverage.  Here’s how it works according to the Medicare guidelines:

Stage 1: The plans start off with a “Deductible Period.”  This is the amount you must pay for out of your pocket before the plan will pay anything.  Not all plans have a deductible.  The plans cannot have a deductible higher than $320.

Stage 2: After you have met your deductible (if you have one) you go into what is called the “Initial Coverage Level.”  During this stage you will pay approximately 25% of the cost of the medication.  Most drug plans set up copays during this stage based on the medication which they assign to a Tier.  For instance, you might pay a copay of $5 for generics (Tier 1), $25 for formulary brand names (Tier 2) and $45 for nonformulary brand names (Tier 3).

Stage 3:  Once you have had $2930 in total drug costs, you will go into the “Donut Hole.”  Notice I said “total drug costs.”  This means what you paid for the medications plus what the plan paid.  For example, if the total cost of a medication is $100 and you only had to pay a copay of $25, it’s the entire $100 that goes toward the donut hole number.  Once in the donut hole you will pay 50% of the full cost of any brand name medications and 86% of the full cost of any generics.  Due to the new healthcare reform, these percentages will continue to decrease each year until they reach 25% in the year 2020.

Stage 4:  Once you have paid a total of $4700 in out-of-pocket costs (not including the premium for the plan), you enter the “Catastrophic Coverage Level.”  Notice that this amount is out-of-pocket meaning that you would have to pay a total of $4700 before you entered this next level.  Once you hit this level you would only pay approximately 5% of the cost of the medication for the rest of the calendar year.

Once you reach the end of the calendar year, all plans start back at Stage 1 on January 1st.

According to a report from the Kaiser Family Foundation, approximately 19% of Medicare beneficiaries reach the donut hole at some point during the year.  So not everyone has to worry about hitting the donut hole, but if you do your expenses can add up in a hurry.  For those of you who are in this situation, maybe you can ease the pain with a box of donut holes (the good kind from the local bakery).

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Bullies Ain’t Just in Elementary School

Posted on January 27, 2012 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Social Security, Uncategorized

Everyone remembers the bully from their elementary and high school days.  In most cases it was the stronger picking on the weaker.  You would think that 30, 40, or 50 years later things would be different, but it seems nothing has changed.  Not a month goes by that I don’t hear a story from one of my clients about an insurance agent bullying them or someone they know.  Bullying in the insurance industry comes in many different sizes and colors.  A few of them come to mind based on recent events…

1.  They prey on your fears!  I just received a call today from a new client of ours who we saved money by switching her from her existing medicare supplement policy to a policy with one of the companies we represent.  She had called very upset because she had just received a phone call from her previous agent.  He had called to tell her about all the coverages she would be losing by switching to the new supplement company.  He had proceeded to tell her that she would no longer be covered for preventative services (not true), that she would be responsible for a $155 deductible (this was the deductible amount for 2010, he was off a couple of years) and that one of her routine tests would no longer be covered (also not true).  If this agent was sincerely looking out for his client, then I apologize.  But at the least, he should know the plans he is representing.  If he was only concerned with the loss of his commission, then SHAME ON HIM!

2.  They prey on your good will!  No one “likes” to tell someone NO, or hurt someone’s feelings.  Pushy agents know this, that’s why they continue to push.  If they push long and hard enough they know that you will give in and buy, you don’t want to hurt their feelings, right.  You would recognize these agents if you ever told them NO, because many times they will get angry and rude when they don’t get the sale.  I recently met with a woman who was TOLD by an agent that the agents plan was much better than what she had and the agent proceeded to fill out an application without asking the woman if she wanted to move forward.  Not really knowing if the plan was better or not, and not wanting the uncomfortable feeling of saying NO, she proceeded to sign the paperwork and complete the sale.  She had told me afterward that she felt very uncomfortable with the agent.

3.  They just plain bully you!  Another recent experience I was told was from a woman we had switched from her current policy to a new policy with us.  She ended up cancelling the new policy because her existing agent had called her and TOLD her that she couldn’t switch because HE was her agent and HE was the one she had to work with.  Worse yet he told her that he was on vacation and that he would deal with it when he got back.

Now don’t get me wrong, there are a lot of agents out there who really do care about you and are doing their best to help.  I also know that the above examples are just one side of the story, so if I was getting the wrong side I apologize.  But I hear stories like this more frequently than I should, which tells me that many of them are, unfortunately, probably true.  When did money become more important than people?  To the agents who are bullying, KNOCK IT OFF!  To those of you who are being bullied, STAND UP AND SAY NO!