By Mary Johnson
TSCL has received a growing volume of email from seniors who say their new Part D or Medicare Advantage plan isn’t all it’s cracked up to be. Many of you complain of higher-than-expected costs, and quite a few asked how you could drop your plan. Selecting the right Medicare supplement or Medicare Advantage plan is highly complicated. The system has stymied almost everyone who works with it, Medicare advocates, pharmacists, insurers, and — especially — government employees. How can the average senior be expected to figure it out?
Your chance to make some changes is coming up, November 15 through December 31. Since Medicare’s open enrollment period is in the middle of Thanksgiving and Christmas holiday season, your best bet is to do your homework by starting now. Here are some things you should know:
Watch your mail for information from your current Medicare supplemental or Medicare Advantage, and drug plan insurers. Your insurers will send you notification of changes in coverage, such as premiums, deductible, and co-insurance or co-payment costs for 2008. Carefully review these documents and compare them with your costs in 2007. File these documents where you can easily refer to them because you will need to use them for comparison when comparing other insurance options.
Understand the type of Medicare options available to you. You can receive coverage for the costs that Medicare does not pay in two main ways: through a Medicare supplemental (sometimes called Medigap) or through a newer Medicare Advantage managed care plan, like an HMO or PPO. Both types of plans cover medically necessary hospitalization as well as doctors’ and outpatient services. Many, but not all, Medicare Advantage plans also offer Part D prescription drug coverage. There are significant differences between these two types of plans that affect what you pay out-of-pocket. And those differences are often buried in all the tedious-to-read fine print.
Medicare supplemental or Medigap policies tend to charge higher premiums, but cover most or all of the co-insurance costs for brief hospitalizations or doctor visits and other Medicare covered services. Medicare Advantage plans generally work in just the opposite fashion. Currently premiums are very low, but there could be considerable out-of-pocket co-payment costs should you require health care services.
Many seniors have been confused by Medicare Advantage plans, because they are aggressively marketed as offering Part D drug coverage, in addition to hospitalization and doctor’s insurance. Some seniors have enrolled in the plans thinking they were getting drug coverage only to add to supplemental coverage they already had.
Medigap plans by law are now barred from offering drug coverage, and beneficiaries need to add “drug only” coverage to their Medicare supplement.
The government has made it much easier to drop out of an older supplemental Medigap plan and join a new Medicare Advantage plan than the other way around. In fact, if you drop your older supplement, you may not be able to get it back again should you discover your new plan is not what you thought it would be. Failure to read the fine print can expose you to thousands of dollars in unexpected out-of-pocket costs should you require even just a few days of hospitalization or have a health condition that requires multiple visits to the doctor and lab services.
Understand which type works best for you. Medicare supplemental or Medigap premiums currently tend to be higher, often by hundreds of dollars, than those of Medicare Advantage Plans. In fact, there are Medicare Advantage Plans that offered hospital, doctor, and prescription drug coverage for $0 premiums in 2007. Don’t let the lure of zero premiums fool you, because you will pay in other ways, especially if you get sick.
Unlike Medigap plans, Medicare Advantage plans charge a co-payment every time you visit a doctor, use a lab, or have a brief hospital stay. In fact, Medicare Advantage plans can charge a very hefty $125 — $175 per day co-payments for hospital stays that generally would cost nothing at all under Medigap supplements for the same period. Seniors, especially those who are older, and who might require hospitalizations or have chronic health conditions, may wind up spending as much or even more out-of-pocket in a low, or no premium Medicare Advantage Plan as they would with under a Medigap plan. Medicare Advantage plans appear to be more advantageous for seniors who:
— are relatively young and,
— have few or better yet — no health problems, and
— who have no Medicare supplement through a former employer.
Compare costs. Before making any decision to drop your current plan ask for a breakdown of costs of the plan you are considering. However, keep in mind the information supplied by an insurer or agent may be incomplete or omit important cost information. Don’t sign anything without consulting several outside sources of information.
Use tools on www.medicare.gov. The Medicare website offers data bases that allow you to compare health plans and Medigap policies available in your area. There is also a drug plan finder. You will be able to find a significant volume of information, but much of it may appear difficult for the layman to interpret. Don’t despair. Grit your teeth, print out information, and read it through.
The database that compares health plans and Medigap policies does not give specific costs, but supplies a range of likely costs. I find some of the estimates confusing and misleading because they are based on certain government assumptions about the services an “average” Medicare recipient uses. Because nobody is “average,” this may over or under state costs in your specific case depending on your health.
The Drug Plan Finder can help you get very specific information because you can input the prescriptions you currently use and then find the lowest cost plan that covers your drugs. However, the lowest cost plan may not always be your wisest choice, especially since your doctor may change your prescriptions in the future or you may be close to the doughnut hole coverage gap. You may benefit by spending a little more and getting a plan that covers 95% of all drugs and covers at least generics in the gap.
Get unbiased counseling. NEVER, EVER drop your Medicare supplemental or switch Medicare Advantage plans based solely on the sales pitch of an insurance agent! This is especially true if the agent is trying to pitch you from a table set up in a discount store, or pharmacy window. DO NOT do business at all with anyone who calls on the phone or knocks on your door, regardless of who they say they are. There have been very widespread reports of con artists who tell seniors they are calling from Medicare or Social Security. You have no safe way of confirming who they are. Don’t respond. Hang up and keep your doors locked!
In fact, your best bet, and one that could help you save hundreds of dollars on your health insurance costs, is to get the unbiased advice of a trained Medicare benefits counselor through your state Health Insurance Assistance Program. The program provides free one-on-one local health insurance counseling through many local Area Agencies on Aging. To find the agency nearest you, consult your phone book or The Eldercare Locator. You may find the information resources at www.eldercare.gov/Eldercare/Public/Home.asp or you may speak to an Eldercare Locator information specialist by calling toll-free at 1-800-677-1116 weekdays, 9:00 a.m. to 8:00 p.m. (ET).