Category: Medicare

Medicare Supplement Insurance: Are You Insurable?

Posted on November 19, 2018 by - Medicare, Medicare Supplement

Medicare Supplement Insurance: Are You Insurable?

If you are in your Medicare Supplement Open Enrollment Period, you are 100% insurable, no questions asked. If you are in a guaranteed issue period, some plans may not be available to you but—again—you are 100% insurable. Still no questions asked.

 

But even if you are not in one of these two groups, it is likely that you will be able to get on a plan anyhow. You will have to undergo some health evaluation questioning, but that doesn’t mean your less than perfect health will prevent you from getting the coverage you need.

 

Lower Your Expectations

You’re 65 or older. Insurance companies don’t expect you to be able to land a round off back hand spring or have an empty medicine cabinet or even have decent cholesterol. In fact, I am looking at the most recent application for AARP Medicare Supplement Insurance, and they do not ask anything about blood tests or weight or most resolved issues. This is typical across most applications.

 

The only thing they look for is that you don’t have any “big-ticket” pre-existing conditions or alarming circumstances on your health resume: cancer, upcoming surgery, Alzheimer’s disease, etc. In short, they are looking to answer this question: is your health stable? They are not concerned with whether your health is particularly impressive.

 

Two Examples of Supposed “Uninsurables”

This week a client of ours called in who thought she was uninsurable because she had cancer 4 years ago. But this just wasn’t true. In fact, most insurance companies will offer you coverage if you have been cancer free without treatments for two years. After we assured her of the good news, she was promptly put on a great plan for her needs.

 

We also had another case of a man who just had a stent put in 1 year ago. Although he thought this would make it difficult to find a provider, this wasn’t the case either. We shopped some supplement plans for him and found him a plan that still insured people with stents as long as it wasn’t put in within a year.

 

Concluding Thoughts

The goal of this post is not to deceive you into thinking that no one is uninsurable, but I do want to give those people with imperfect health some hope. Even pre-existing conditions as bad as diabetes can be insured. There are a lot of insurance companies out there, so shop around. Chances are one of them will take a chance on you!

 

Great news!

Right now, we have a company who is accepting anyone without answering ANY health questions!  They are only doing this until June, so if you are interested, give us a call.  BONUS:  They offer a gym membership along with their supplement!

 

Need help finding a Medicare Supplement for your unique situation? Looking for a licensed expert with a passion for assisting retirees? Contact Seniormark at 937-492-8800 for a free consultation.

 

Take It Personally: Why Rampant Medicare Fraud Affects You and Your Family

Posted on November 12, 2018 by - Medicare

Take It Personally: Why Rampant Medicare Fraud Affects You and Your Family

In 2012, the FBI boasted the arrest of 107 individuals for 452 million dollars in false billing. In 2015, The United States Department of Justice reported a fraud takedown of 243 individuals for 712 million dollars.

 

And if you look at the June 2016 edition of the AARP Bulletin, you will see the somber mug shot of physician Jacques Roy, facing life in prison for leading a fraud scheme of 375 million in phony charges—the single most expensive home health care fraud in the history of Medicare and Medicaid!

 

Sweet Victory?

Those sound like some huge numbers, right? So big it seems like the entire Medicare Fraud Strike Force could just sunbathe in the warmth of their victories. We’ve won, after all…

 

Well…not so much. How about these numbers? 60 billion. 90 billion. 30% of Medicare’s annual spending (180 billion).

 

These are the numbers that ABC News, the National Center for Policy Analysis, and AARP (respectively) estimated as the yearly dollar amount lost due to Medicare fraud.

 

The Scope of the Issue

But the hard truth about the scope of Medicare Fraud is this: no one knows. Everyone accepts that it is a staggering amount, but it is hard to pinpoint, mostly because it goes undetected so often. In fact, even Malcolm Sparrow, Harvard professor and health care fraud expert feels uncomfortable putting an exact number on it: “the point is, we don’t know, and we shouldn’t have to guess,” he says in AARP’s Bulletin.

 

So maybe the strike force should put away the sunscreen and beach towels. They’ve got some work to do.

 

Why It Matters to You

The sheer, unpunished treachery of this madness is enough to make anyone frustrated, for sure. But beyond the foundational longing for justice that lies within us all, let’s get practical. And—more than that—let’s get personal. Medicare fraud costs you and your family money. If you pay taxes, you are paying for it. If your children pay taxes, they are paying for it as well. Medicare premiums go up? This is part of the reason.

 

The One Thing You Have in Common With a Fraudster

Now I want to cycle back to Dr. Jacques Roy.  According to AARP, when the authorities searched his lakefront house in the Dallas suburbs, they found deposit slips to a bank in the Cayman Islands and a guide to registering yachts there.

 

Go figure. You do have something in common with a hardened criminal. All those years of saving, planning, and roosting on your nest egg prove it: you both want to retire well.

 

Some people are just willing to steal from you to do it.

 

Want to know how you can recognize Medicare Fraud and make up to $1000 doing it? Click here to find out.

 

Have more questions about Medicare?  Call our office at 937-492-8800 and we will help you out!

 

10 Terms to Beef Up Your Medicare Literacy

Posted on November 8, 2018 by - Medicare, Medicare Annual Enrollment, Medicare Drug Plan, Medicare Supplement, Retirement Planning

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?

Posted on November 5, 2018 by - Medicare, Medicare Advantage, Medicare Annual Enrollment

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.

 

Is There an Advantage to Medicare Advantage?

Posted on October 29, 2018 by - Medicare, Medicare Advantage, Medicare Annual Enrollment, Uncategorized

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.

Why You Can Try a Medicare Advantage Plan at No Risk

Posted on October 8, 2018 by - Medicare, Medicare Advantage, Medicare Annual Enrollment

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.

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

Posted on October 1, 2018 by - Medicare, Medicare Advantage, Medicare Annual Enrollment, Medicare Drug Plan, Medicare Supplement

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.

A Little Known Reason Why Medicare Will Deny Coverage For Your Nursing Home Stay

Posted on September 17, 2018 by - Medicare, Medicare Advantage, Medicare Supplement

A Little Known Reason Why Medicare Will Deny Coverage For Your Nursing Home Stay

There are few things more wrinkle-inducing than the stress of any unexpected bill, let alone a $6000-8000 nursing home expense left uninsured by Medicare.

 

But it happens everyday. If you receive only custodial care at the nursing home, Medicare will not cover you.  (Read this blog for a few answers.)   And even if you are receiving skilled nursing care, there is still a chance you won’t be insured.

 

Here’s the reason: Many people don’t receive 3 days of inpatient care before moving onto the nursing home. This is a requirement for coverage!

 

Check Your Status!

What really throws people for a loop is that not all hospital stays qualify as the required inpatient care. So even if you stay a week in the hospital’s luxurious half-room with a moaning mystery patient on the other side of the curtain, that doesn’t mean you satisfied the requirement (even though you definitely earned it, in my opinion).

 

Why, you ask?

 

It has to do with your official status. Some people are formally checked-in, but others are filed under “observation status”. In other words, they are not receiving any specific treatment but are rather checked in for the purpose of evaluation, testing, and monitoring. In almost all respects, they receive similar care to those who are formally checked in, but these patients are billed and covered like they are receiving outpatient services. They don’t fulfill the 3-day inpatient requirement and—when they move on to a skilled nursing facility like a nursing home—they are denied coverage when they need it most.

 

Sounds a bit unfair, right? I agree wholeheartedly. Luckily, the government is aware of the issue and is taking steps to resolve it.

 

Baby Steps

One of these small steps occurred in August of 2015 when Obama signed the Notice of Observation Treatment and Implication for Care Eligibility Act. I know—legislators have a knack for snappy titles. But in all seriousness: What the article lacks in creativity, it makes up for in functionality. This Act requires hospitals to alert you of your observation status and how it will affect your Medicare coverage in both writing and in person.

 

Potential Strides

The Notice Act doesn’t solve the whole issue, of course. It would be better to just allow all hospital stays to count toward the 3-day inpatient requirement. The good news is—yet again—politicians are working toward this.

 

But until then, be aware and ask about your status.  It pays to be educated. And it can save you an arm and a leg to know what others don’t and what hospitals neglect to tell you.

 

Turning 65 soon and confused about Medicare?  Call Seniormark at 937-492-8800 or click here to sign up for a free consultation!

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

Posted on September 13, 2018 by - Medicare, Medicare Supplement, Retirement Planning

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.

Why Dental Plans Aren’t Worth Their Weight in Premium For Retirees

Posted on September 10, 2018 by - Health and wellbeing, Medicare

Why Dental Plans Aren’t Worth Their Weight in Premium For Retirees

If you’re coming off your employer plan and onto Medicare, you might have been surprised to find out that neither Medicare nor Medicare Supplements cover most routine dental services. So I understand why you might find it quite attractive to get on a dental plan in addition to Medicare.   After all, who else will insure your million-dollar smile?

 

But allow me to reason with you. Because I believe that—in most cases—a dental plan just isn’t worth it.  Don’t believe me?  Using the pictured plan as an example, give me a few minutes to explain.

 

Scaling Benefits, Depleting Value

Way back when, Dental Plans had much better benefits. Their maximum benefits started on day one and continued until you dropped the plan.  But people abused it.  They got on a plan when they found out they needed a major surgery, let the insurance company foot the bill, and then cancelled the plan, getting away with no more than $30-40 in out-of-pocket costs.

 

The insurance companies needed to get smart if they were going to make any money.  So what did they do?  They fought fire with fire, and introduced scaling benefits.  Now most plans do not grant you full benefits until much later, after you paid your dues in premiums.  In the example below, the full benefits aren’t granted until 2 years.  In other words, not until you spend $800 in premiums!  The only thing the plan pays in full on day one is preventative services such as cleanings and exams.

 

Maximum Benefits

Here’s where a dental plan can really get you: the maximum benefits per calendar year is $1000.  This means you will never squeeze anymore than one grand out of them per year, no matter how long you’ve paid into the plan.

 

So what do you pay in premiums per year for this plan?  Let’s crunch the numbers.  $33.71/ month X 12 months per year = $404.52.  So, for all intents and purposes,  you pay about $400.  Consider this:  if you put the money you would’ve paid in premiums into a savings account, you would cover the maximum benefits in 2.5 years.  So—as long as you don’t expect to spend well over $1000 in 2.5 years—why would you bother with a dental plan?  For most people, it is just not reasonable.

 

You might’ve notice that you can upgrade your maximum benefits to $2000 dollars for an extra $7.61 in monthly premium.  But did you notice the fine print?  Without squinting, you probably didn’t.  So let me help you out with the gist: despite the upgrade, major services will still not exceed $1000.  In other words, for the services that actually have a chance of exceeding $1000 like dentures and oral surgery, the benefit limit is the same.

 

What to Do Instead

If you are still concerned about paying for routine checks, I would recommend telling the dentist you don’t have insurance and asking about “network pricing.”  A lot of times they are willing to cut the price (as much as 50% for exams and cleanings).

 

And if you are still concerned about major services that are going to cost up to $1000 or more, I recommend saving up what you would’ve paid in premium to put into a savings account.  In 2.5 years, you will have a thousand dollars of self-insurance for that million- dollar smile.

 

Need help with your retirement transition? Seniormark is here to help! Call us at 937-492-8800 for a free consultation.