It’s
that time of year again to choose a Medicare supplemental plan. Remember that it
isn’t necessary to have Medicare additional insurance and those with Medicare
coverage can choose to cover the 20% Medicare co-pay by themselves. In general,
however, most seniors opt for supplemental insurance.
Unfortunately,
most seniors are so overwhelmed by the complexity of choosing the right
supplemental plan that they just choose a name they know such as AARP or Blue
Cross. While both are good plans, most seniors might save money, and be better served,
by finding a plan which is the best fit for them.
There
are several ways to find the best plan: We perform that service and we consider
the insurance that your current physician accepts as well as your current
physician's ease in working with various insurance companies. We also consider
the Plan Quality and Performance Ratings posted on the Medicare web site. In addition
to that, we consider your current list of prescriptions and we try to forecast
your needs in the future (not an exact science by any means). The fee is
generally a few hundred dollars, but it is possible to save much more. We recommend at least three insurance companies and do not sell insurance.
Another
alternative is an independent insurance agent who specializes in Medicare supplemental
plans. While in some cases the determination is made only on the basis of
annual premiums, at least you will be presented with a few choices. A good
agent will go beyond price considerations. The best part about this option is
that it generally costs nothing and the agent is compensated by earning a
commission on the insurance sale.
Finally,
as part of the Medicare program, money is allocated for a program called
APPRISE and volunteers under this program will help you choose a supplemental
plan. Each county in Pennsylvania has it’s own APPRISE counselors. Whatever you do, it is very important to
obtain supplemental insurance within six months of attaining age 65, because
then your insurance will cover pre-existing conditions. The rules of Medicare
supplemental insurance are different from the rules under the Affordable Care
Act (Obama Care).
Another
separate but related consideration is whether a senior should choose a Medicare
Advantage plan or regular Medicare supplemental insurance.
Advantage
plans operate like Health Maintenance Organizations (HMO's) and are generally
less expensive. These insurance plans presume that a senior will spend most of
his or her time in a particular area. They are definitely not for seniors who
travel a lot. Although Advantage Plans have a more restrictive provider list (the
list of physicians to treat you), they usually provide more preventative
medicine support. You may receive visits from a nurse practitioner who will
assist you in maintaining your health and/or free transportation to a clinic. And
so, if you are just now Medicare-eligible (i.e. 65 to 70 years old) and in good
health, an Advantage Plan is probably a good choice because of the low cost and
the preventative support.
Under traditional Medicare nothing happens unless you visit a doctor first, and
there may be a tendency for doctors and hospitals to bill for as much as
possible while they have you. Advantage Plans cut costs through monitoring your
health and preventative medicine. Advantage plans may also offer additional
services such as dental, hearing or vision, and most cover prescription drugs.
They may also include health club fees.
On the
other hand, if you are frail and may require rehab after an injury, Medicare
Advantage plans will be more restrictive. When it comes to rehab, Medicare
itself allows 100 days of rehab and only pays in full for the first 20 days.
The remaining days are subject to the supplemental insurance 20% co-pay. An
Advantage Plan will pay close attention to your progress during therapy, and if
they do not see adequate progress, will cut of payments for continued rehab. We
have had experience with Medicare Advantage plans that denied some testing due
to cost, and that initial determination had to be appealed. Another possible
problem with Medicare Advantage plans is the wait time to see a physician.
While you can visit any doctor who takes Medicare if enrolled in a supplemental
plan, Medicare Advantage policyholders are restricted to physicians and testing
centers in the network. Also, some “no premium” Advantage
Plans have large co-pays.
To
reiterate, if you are young and need preventative support, a Medicare Advantage
Plan will have a low premium and may be a good fit. If you are on Medicare
because of a disability, or are on Medicaid for long term care, or if you’ve
had a rehab stay anytime in the past, you should consider a supplemental plan
instead.
And
don’t forget to re-evaluate your plan each year. For example Bravo Medicare
Advantage was later bought by Health ‘Springs and then that new entity was
bought by Cigna. The atmosphere and quality of service changed during the
evolution. Your prescription needs may also change. As with all insurance, you
should review your needs and your coverage.
Stay
well until the next post:
Bob Gasparro, Esq.
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