Medicare vs. Medicare Advantage

Most of you reading this have Medicare as your primary insurance with a Medicare Supplement to fill in gaps. We have been advocates for this type of arrangement for nearly 30 years for its high level of insurance and the extensive provider access it provides.

As we approach open enrollment season, you will undoubtedly be receiving a deluge of mailings, be exposed to TV advertisements, and even phone and text messages about Medicare related health plans that seemingly cover everything for a low, low price. These are most likely Medicare Advantage plans that fall under Part C of Medicare. These should not be confused with your insurance program. It is an entirely different way one receives their Medicare health benefits and I want to share with you some important differences.

Medicare Advantage is a strategy promoted by Medicare to transfer health care costs to the private market. In essence, you “transfer” your Medicare benefits (Part A, Part B, and Part D) over to a private insurance company who is then responsible for delivering your care. Medicare subsidizes these plans with your Medicare allotted benefits.

Medicare Advantage plans include hospital and medical benefits, and usually include prescription drug coverage. They most always include additional ancillary benefits and services such as vision, hearing, acupuncture, transportation, gym memberships, and more. By being subsidized by the government, premiums can be as little as zero dollars per month. So, what’s the catch?

The promotions often fail to accurately explain their restrictions and limitations. Provider access and financial exposure are the most misunderstood aspects of Medicare Advantage plans. First, many of these plans are HMO’s that restrict your provider access to a local network that require referrals to specialists from a Primary Care Provider (PCP). In some counties PPO style options are available that don’t require referrals but will have separate in and out of network benefit schedules. In a Medicare Advantage plan your share of costs may include deductibles, copays, and coinsurance. All MA plans will have a maximum out-of-pocket that protect you against major claim years BUT, I have seen MA plans with maximums over $7000 per year.

Compare this with Medicare as your primary insurance which gives you access to any Medicare contracted provider in the country. And, when combined with a Medicare Supplement, can provide virtually 100% coverage for hospital and medical expenses. Standalone Part D drug plans can be added to help with outpatient prescriptions. Although this combination can be higher in monthly premiums, you have the peace of mind knowing in a high-claim year your out-of-pocket costs can be minimal.

Marketing tactics purposely attempt to cause confusion in order for the “target” to reach for the phone. Phone calls with MA sales reps can lead to be more confusion and often failing to educate the consumer of the consequences of enrollment…losing your Medicare Supplement and Part D drug coverage (you can’t have both).

Medicare Advantage plans aren’t necessarily a wrong choice, but they are not the same insurance as what you are used to and they are not always easily interchangeable. Medicare Advantage plans are a different way to receive your Medicare benefits and in a way you may not want. Read the plan’s summary of benefits first before making your decision and call us if you have any questions.

Travel with Peace of Mind

Let the adventures begin! Travel is back to pre-pandemic levels according to several travel related sources. While you make your international travel arrangements, don’t forget to include travel medical insurance in your planning.

Alert! Original Medicare (Part A + Part B) does not provide coverage abroad. And Medicare Supplements offer a small benefit which we believe to be insufficient.

Travel medical insurance provides another layer of medical insurance as well as evacuation coverage for medical and emergency situations plus 24/7 support. Check out our new video below where we answer frequently asked questions regarding travel medical insurance.  And visit our webpage devoted to the products we recommend: https://www.onlyhealthinsurance.com/travel/

Or, give us a call for a free quote and advice!

These days more than ever “peace of mind” while traveling is invaluable. Let us help you arrange it with travel insurance.

Safe Travels!

Phil & Patricia

Ready To Travel?

Are you ready to travel?!  The eagerness to do so is certainly undeniable. Google Trends which provides broad insight into consumer behavior shows the interest in international travel trending skyward. Personally, I had a family trip to Europe fizzle in 2020 and I’m looking forward to rescheduling when the time is right.

For seniors ready to board or plan their next travel abroad, remember that Medicare’s coverage stops at the border. Most Medicare Supplements, insurance that fill in the gaps in Medicare, provide foreign travel coverage but for emergencies only and with a lifetime limit of $50,000. And, this doesn’t include valuable assistance services to help coordinate care or a medical evacuation. Be prepared to pay for services on your own and submit receipts upon return including translated doctor notes and invoices. The added complexity of a foreign claim often leads to processing and reimbursement delays.

…Enter Travel insurance. Travel Insurance can add another layer of medical coverage, evacuation benefits, assistance services and more. Claims can often be submitted online with less hassle. Coverage for pre-existing conditions are included in most cases as well as for COVID related medical treatment. Travel products include plans for single trips, long term stays and annual plans covering multiple trips. And, many people find premiums surprisingly affordable! We offer a variety plans from GeoBlue, a Blue Cross/Blue Shield affiliate, and have a web page devoted to their products where you can learn more, obtain a quote and enroll online!  But don’t hesitate to call or email me with questions or a quote.

Happy Travels! Phil Dougherty

two people sun bathing on a beach

The Annual Election Period for the 2021 Plan Year is approaching!

Dear Friends,

The Annual Election Period begins October 15 and runs through December 7, 2020 and is when you are allowed to change your Medicare Part D Prescription Drug Plan for the 2021 plan year or, if eligible, enroll in a plan for the first time.

We have enjoyed helping hundreds of clients during this time over the past ten years and we look forward to making our advisory service available this year as well. Our recommendations are largely dependent on the functionality and accuracy of Medicare’s online Plan Finder tool. Due to changes in the tool and the complexity of drug pricing, our analysis is more difficult and time-consuming, especially with complex drug lists. To keep our consulting fee the same ($175 per person) we ask that you complete our drug form thoroughly. To help in this regard, we’ve added an online form and the ability to pay by check or credit card. More on that below.

2021 Facts & Figures:

  • Next year there will be thirty-two plans available offered by eleven companies, same as 2020.
  • Of the two million Californians enrolled in Part D drug plans, eighty-five percent are covered by four carriers (AARP, Humana, SilverScript and WellCare).
  • Ten plans will lower their premiums and nineteen will see increases.
  • Overall, the average monthly prescription drug plan premium in CA will increase 1.45% to $45.75 per month.
  • SilverScript is introducing a new plan at $7.20 a month, the lowest premium plan available.
  • CMS has released a Part D Senior Savings Model that will cap the cost of many insulins. Recipients can expect a maximum copay of $35 for a one-month supply in those plans that participate.

If you would like to proceed with our service, which will include a plan analysis, recommendation and enrollment assistance, please complete our <<Online Drug Form>> and pay by credit card or mail a check to our new address below for $175 per person payable to OnlyHealthInsurance. If you prefer a paper form, just let us know and we’ll email or mail you one to complete and return with a check. Our last day for accepting new consultations is Friday, December 4th. Note: we do not sell or represent any Medicare Part D drug plans.

Whether you participate in our service or not, it is very important to review your plans renewal material and confirm that your current medications will be covered next year. Changes to your plan’s deductible, copays and premium will also be communicated to you in your renewal packet.

We will be supplementing information from other resources to complete our reviews and make our recommendations which are listed in the self-help section below.

Important for you do-it-yourselfers! The Medicare Plan Finder tool has a more intuitive interface and some enhancements that make it more user friendly. If you log-in or create a Medicare account, you can save your work for future use and view past drug purchases for reference. You can now enter up to five pharmacies to compare pricing and share of costs. Remember that Preferred pharmacies can provide some additional savings over Network pharmacies.

We appreciate the opportunity to assist you.

Respectfully yours,

Phil Dougherty, John Wheeler & Lois Whitley

OnlyHealthInsurance  

Self-help resources and free services:

www.medicare.gov – Using their Plan Finder tool  you can enter your medications and preferred pharmacies, review all plan options, and enroll online.

Call Medicare at 1-800-633-4227 – Medicare representatives are available 24/7 to provide free analysis, recommendations and enrollment over the phone.

www.q1medicare.com – Best private website on the subject of Medicare Part D. This site has the most information available with tools to compare plans by a number of sorting options and research drug plan formularies. You can also compare your current plan with its 2021 version. If you visit the site, be sure to choose CA from the list of states to show relevant plan options.

www.goodrx.com – A free price comparison resource for shopping prescriptions. Access coupons for discounted scripts at major pharmacies. Note: Cannot be used in conjunction with Part D plans.

 

Medicare’s New Part D Senior Savings Model

The Centers for Medicare and Medicaid Services (CMS) has released a new demonstration program that will begin on January 1, 2021. It is designed to provide Medicare enrollee’s affordable access to insulin by capping the cost of a 30-day supply to a maximum of $35. For enrollees who take insulin and enroll in a plan participating in the model, insulin prescriptions will not be subject to a plan’s deductible or see any coverage gap cost increases. CMS states that beneficiaries should save an average of $446 in annual out of pocket costs for insulin. With the Medicare Part D Election Period approaching (Oct 15- Dec 7) when members of Part D drug plans can make plan changes for the next year, it will be especially important for diabetics to review their plan’s renewal information as well as look at other plan options. For more on the Medicare Part D Senior Savings Model, visit this CMS web page: https://innovation.cms.gov/innovation-models/part-d-savings-model.

Correction to recent post: Medicare Prescription Drug Plan Annual Open Enrollment 2020

Correction: it was an acquisition of Aetna by WellCare.

The Medicare Prescription Drug Plan (Part D) Annual Open Enrollment begins October 15 and runs through December 7, 2019. This is the period when you are allowed to change your Medicare Prescription Drug Plan for the 2020 plan year or, if eligible, enroll in a plan for the first time.

2020 Update: Next year there will be thirty-two plans available, two more plans than this year. The recent accusation acquisition of Aetna drug plans by WellCare will result in some plan name changes. The trend is for additional lower premium plans; six more plans will be priced under $25 a month. However, the number of plans with deductibles will increase too. Next year only five plans will have a $0 deductible, the cheapest being $74.20. Ten plans will see premium decreases with seventeen having increases. The parameters within the Part D plan benchmark design will increase slightly (deductible, initial coverage, donut-hole and catastrophic level) resulting in a potentially higher out-of-pocket.

It is very important to review your plans renewal material and confirm that your current medications will be covered next year. Changes to your plan’s deductible, copays and premium will also be communicated to you in the renewal packet.

If you would like our assistance in evaluating all plans, we again will be offering our advisory services. For our evaluation, recommendation and enrollment assistance, we charge a $175 fee per evaluation. (Note: we do not sell market or represent any Part D drug plans).

If you would like our assistance, please request our Prescription Drug form and we’ll send you one. Once you have completed the form, mail it to the address below along with a check for $175 payable to OnlyHealthInsurance. We will then contact you with results, a recommendation, and assist with enrollment as necessary.

Important for you do-it-yourselfers! It will be important to get an early start this year. Medicare has changed their Plan Finder tool significantly. It offers a much more user friendly experience however some key information and functionality have been removed. We will be supplementing information from other resources (some are listed in the self-help section below), to complete our reviews and make our recommendations.

We appreciate the opportunity to assist you.

Medicare offers free resources to assist you in evaluating plans and enrollment:

  • www.medicare.gov – Using their Plan Finder (www.medicare.gov/find-a-plan) you can enter your medications and preferred pharmacies, review all plan options, and enroll online.
  • Call 1-800-633-4227 – Medicare representatives are available 24/7 to provide free analysis, recommendations and enrollment over the phone.
  • www.q1medicare.com – Best private website on the subject of Medicare Part D. This site has the most information available with tools to compare plans, search the drug formulary of any plan and review star ratings.