This is my week to tell people they don’t need my services.  I talked to three people who have the state Medicare retiree plan because they are retired teachers. They thought they were paying too much for their Medicare Advantage plan (about $100 per month), and they had issues with referrals that come with an HMO.  I went through their evidence of coverage book and concluded that their plan is awesome, and I told them so.

The plan I was looking at is a Medicare Advantage plan, but it’s not like the ones I enroll people in.  Here are just a few of the awesome benefits:  Hospital co-pay: $100 (that’s it!); Part B drugs (like chemotherapy): 0% co-pay; Radiation therapy: 0% co-pay. Part D coverage: no donut hole!!

As an insurance agent I’m not supposed to mention benefits, but I am describing a plan I do not sell. And it is a plan that other insurance agents should not move people out of to put them into a $0 premium Medicare Advantage plan they sell.

Some people don’t need Medicare.

Yesterday I got a call from a man who turns 65 in November. He told me his wife is still working and her employer is a big company, which is a very important factor. This man has his Medicare card and will start paying his Part B premium next month.  I told him to find out how much his wife is paying to have him on her insurance and to find out if the insurance is good coverage. But because her employer is a national, large company, the health insurance is probably pretty good – and he may not need his Medicare.

If a person is covered by employer health insurance after they turn 65, they don’t need to enroll in Medicare Part B and pay the premium. The company must have more than 20 employees. However, people who work for small-to-medium size companies (with over 20 employees) often have lousy and expensive health insurance, so they might be better off using their Medicare.

I told this potential customer to investigate his health insurance, how good it is, and how much it costs. I also told him he could use Medicare as secondary insurance to (possibly) cover deductibles and co-pays. But I had to admit I have not dealt with this, so I referred him to the Medicare.gov website.  I told him he could also call 1-800-MEDICARE to learn more about how Medicare co-ordinates with other health insurance.

Medicare Advantage plans in Arizona are not changing a lot for 2012. But everyone enrolled in these plans must check to be sure their Advantage plan will work for them next year, because the time to change plans is coming up. The Open Enrollment Period runs from October 15 – December 7.

If a person has issues with their Medicare Advantage plan, now is the time to act, or remain in that Advantage plan for 2012. Some people have discovered that their Medicare Advantage plan is not working for them for various reasons.

*Will your doctor(s) still accept the plan in 2012? I have heard that some doctor groups and some primary care physicians will no longer work with certain Medicare Advantage plans in 2012. (Sorry, I can’t name names because I am an insurance agent.) You should call your doctors and ask if they will be taking your plan next year.

*Have you discovered that your plan’s doctor network is too restricted/small? Some people have discovered that their plan has a limited number of specialists and other providers in its network. If that matters to you, now is the time to look into other options.

*Have prior authorizations or referrals made it difficult or impossible to get tests your doctors want you to have? Some plans make it very difficult to get approval for tests like MRIs. If this has been an issue, now is the time to look at other options.

*Are all of your brand drugs still covered by your plan?  I was looking at the Annual Notice of Change for one Medicare Advantage plan and the instructions said something like, “We have decided to no longer cover certain prescriptions. We suggest you look up your prescriptions on our on-line formulary to be sure all your drugs will be covered by the plan in 2012“.  That’s not a direct quote, but that was the message. It seems it is up to each person enrolled in a Medicare Advantage plan or Part D plan to check to be sure their brand drugs will still be covered in 2012.  Yikes.

An email being sent to seniors, warning of large increases in the Medicare Part B premium.  But is the email accurate?  Factcheck.org looked at the accusations in the email and found them all to be false.

EMAIL BEING SENT TO SENIORS:

MEDICARE PAY INCREASE:  For those of you who are on Medicare (or will be soon), read the short article below.

It is about the monthly amount of money you are going to pay into Medicare in 2011, 2012 and the huge increase you will pay in 2013. You will pay it.

Social Security:  Congress will not allow an increase in the social security COLA (cost of living adjustment). However, the per person monthly Medicare insurance premium will be increased from the 2009 premium of $96.40 to $104.20 in 2010, $120.20 for the year 2011, AND a yearly increase to a wonderful $247.00 in 2014. Thank You Obamacare!

In the meantime, Congress gave themselves a $3,000 a month Cost of Living Adjustment!

Send this to all seniors that you know.

REMEMBER IN NOVEMBER 2012

THE TRUTH:                                 

Factcheck.org investigated these claims and found:

It falsely claims “Congress gave themselves a $3,000 a month Cost of Living Adjustment,” when the truth is that Congress voted to deny itself any pay increase at all, both for 2010 and 2011.

§  It wrongly blames Congress for disallowing any cost-of-living increase for Social Security recipients. It’s true there was no COLA for Social Security recipients in 2010 or in 2011, but that was due to the workings of a long-standing formula and not the result of any vote by the current Congress or the previous one. We covered this in detail in 2009 and the Social Security Administration has an explanation posted as well.

§  It claims that “those of you who are on Medicare” can thank “Obamacare” for increases in the per-person monthly Medicare premium — “to a wonderful $247.00 in 2014.” This is also false. The basic premium for Medicare Part B (which covers physician services) was indeed $96.40 in 2009. But the other numbers are all wrong. It was $110.50 last year, for example, and not $104.20 as claimed. And it is $115.40 this year, not $120.20 as claimed.

Actually, only 27 percent of Medicare beneficiaries are paying the basic rate. The rest — 73 percent — are paying less under a “hold harmless” provision triggered by the lack of a cost-of-living increase in Social Security this year or last year. Most are still paying $96.40.