Mistakes to avoid when deciding on the best Medicare Advantage plan
Website design By BotEap.comIt was a harrowing reunion… sitting with a couple at the kitchen table with tears streaming down their faces. He was very ill, losing weight rapidly due to digestive problems, and his constant migraines were so painful that ending his life seemed to be the only option to live without pain. To say that they were afraid would be an understatement. Doctors associated with your current Medicare Advantage Plan (Medicare Part C) were unable to diagnose the problem. They just prescribed more medication, which exacerbated his problems. In addition to his medical puzzle, the Plan denied medical tests, which could have finally diagnosed his problem. It was October 2011, and through tears they painfully asked, “What are our options?”
Website design By BotEap.comIn this case, together we decided that it was in his best interest to switch to a Medicare Supplement (MediGap) plan, which would allow him to go to any doctor or facility that accepts Medicare, along with a “Standalone Part D Prescription Drug Plan” . .” It was important that you be able to shop for the best of the best, anywhere in the country. We chose a “Supplemental Plan F” with an insurer that would allow you to switch between a lower and higher cost plan WITHOUT proving insurability (if in the future , you decide to keep the Supplement Plan after your current medical problem is resolved).
Website design By BotEap.comCould I have avoided this problem in the first place? Possibly. Here are a couple of errors I’ve seen, along with solutions, to help you choose the right option for YOU:
Website design By BotEap.comMISTAKE #1: Who are you working with?
Website design By BotEap.com* Work with a “captive insurance agent” (direct employment with the carrier, many times compensated by W2, commissions and/or bonuses) or work with a “career independent agent” (1099 contractor with the carrier and provided of tracks). This last term is very confusing to me. They are classified as independent, but if they write an application with another company because it was suitable for the beneficiary, their contract can be terminated. What incentive does the agent have to be impartial, if he will lose his main source?
Website design By BotEap.com** Another mistake is working with an agent who is not certified to market all types of Medicare health plans. They can only market “some” MediGap supplemental plans without certification.
Website design By BotEap.com*** Go directly to the insurance company. If something goes wrong, it helps to have an advocate on your side, especially one you can see who lives or works in your community.
Website design By BotEap.comSOLUTION #1:
Website design By BotEap.com* Choose an independent insurance agent who represents more than one insurance company. Why? Because independent agents will know the pros and cons of ALL plans and will be able to pass along this information so you can make an EDUCATED decision. They receive compensation from insurance companies, but have no allegiance to any particular company. Also be on the lookout for carriers that force their ‘independent agents’ to sign an exclusive agreement. I have seen this happen with ‘Dual Eligible Plans’ (Medicaid/Medicare Plans). Again, how can the agent be ‘not biased’ if they are contractually obligated to market only one Plan?
Website design By BotEap.com** Choose a “certified” Medicare broker who can market Part C, Part D and MediGap plans. They have additional training and supervision.
Website design By BotEap.com*** When you go directly to the carrier, you’re eliminating a valuable person who will fix problems if one arises, while giving you additional peace of mind throughout the process.
Website design By BotEap.comMISTAKE #2: Choose a Medicare Advantage plan that requires you to get insurance company approval before undergoing a procedure/test.
Website design By BotEap.comSOLUTION #2: When comparing plans, please refer to the ‘Summary of Benefits’. All operators must publish them and they must be similar and easy to compare.
Website design By BotEap.comMISTAKE #3: Not paying attention to the “maximum out of pocket” (MOOP) limit. All Medicare Advantage plans have a MOOP, and many agents overlook it when helping you choose your plan. However, if a catastrophic medical issue were to arise (cancer, organ transplant, extended stay in a skilled nursing facility, etc.), there’s a good chance you’ll hit your MOOP, so you want to make sure it’s as low as possible. The reason: Chemotherapy and anti-rejection drugs are considered Part ‘B’ outpatient drugs, not Part ‘D’ prescription drugs, and many Plans only pay for 80% of Part B drugs. on the hook for 20% and they are very expensive.
Website design By BotEap.comSOLUTION #3: Compare, compare, compare and choose a Plan with a lower MOOP.
Website design By BotEap.comMISTAKE #4: Choosing a plan just because drug copays are slightly lower. Many smaller insurance companies will lure you into their Plan with very low copays on their drug formulary, but have a smaller network of doctors/facilities to choose from. The problem is that if a medical issue arises, you may be locked into the smaller network of doctors/facilities until Medicare’s annual open enrollment.
Website design By BotEap.comSOLUTION #4: If you are having trouble paying your prescription copays and your income/assets are low enough, you may be eligible for Extra Help through Social Security. A good insurance agent will mention this and guide you, or visit https://secure.ssa.gov/i1020/start. When getting help with your medication, you can choose the best Plan based on other options (your network size, authorization rules, doctor/facility convenience, additional optional benefits, etc.)
Website design By BotEap.comMISTAKE #5: Choosing a plan because you want a PPO plan and not an HMO.
Website design By BotEap.comSOLUTION #5: Many people have the misconception that with a PPO plan they can go to any doctor/facility they choose. In reality, PPO Plans still have a network of doctors/facilities that you must stay with to get the lowest costs. The biggest difference between a PPO and an HMO is that with a PPO you won’t have to get a ‘referral’ to see a specialist. With an HMO, you must get a referral. In order to choose ANY doctor/facility in the country that accepts Medicare, you must consider a Medicare Supplement Plan (MediGap).
Website design By BotEap.comI’ve seen most of the mistakes and solutions when it comes to choosing Medicare Advantage health plans. Outside of California, there are additional varieties of Plans and there may be additional challenges.
Website design By BotEap.comWhat happened to my client, you ask? Since I keep in constant contact with my clients, in June I was overjoyed to hear him exclaim the great news. Using the same test that was denied by your previous Medicare Advantage Plan, two doctors from a major Los Angeles medical group identified the problem. He was slowly losing spinal fluid and was dangerously close to having nothing left. With a quick outpatient procedure, they basically laser-glued the area of the leak, replaced his spinal fluid, and he’s healthier, happier, and better than ever. Since you’re doing well now, we’ll review your coverage during Medicare’s Annual Open Enrollment (October 15 to December 7, 2012) and decide whether to keep you in Supplement or switch to a Medicare Advantage Part C Plan.
Website design By BotEap.comAs an insurance agent for many years, I have stories like this and many more. With compassion, our profession helps navigate the best options, explains the pros and cons based on our clients’ individual needs, and offers peace of mind. Plans change every year and your health/financial status can change too, so it’s a good habit to do a comparison every year. To finish, choose a good local and independent insurance agent, educate yourself and stay well informed.