Over the last month I’ve been busy working with people who are getting their Medicare soon. The majority of these folks are pretty healthy – and yet most of them are choosing to spend money to get themselves a Medicare supplement and a stand-alone Part D plan.
My clients who are not healthy have serious problems, which make their Medicare choices more challenging. Some are under 65 and cannot get a Medicare supplement in Arizona because our state does not require companies to offer Medigap to people under 65. So their choice for coverage is to just have Medicare or to enroll in a Medicare Advantage plan.
Having just Medicare is a risky choice because there is no cap on a person’s co-insurance. Medicare Advantage (MA) plans must all have a cap on a person’s annual out-of-pocket costs. So, while MA plans are not perfect, I think they are better than just having Medicare.
When looking at Medicare Advantage plans for my clients, I check to see if their doctors are contracted with the plans I represent (which include most of the plans in Arizona). For people with a long list of doctors, I might find only one or two plans have all of them contracted. So this factor quickly narrows down MA plan choices, unless my client is willing to change some of his doctors.
Then there is often a long list of prescriptions which need to be checked against the narrowed-down MA plan list. Are all of my client’s drugs covered by the plans, and what is the co-pay in each plan?
Here is one example: I wrote about “Terry” in 2010 when she had problems with her individual health insurance. Now she’s turning 65 and needs to choose her Medicare coverage. Terry takes takes two types of insulin, and I told her about a Medicare Advantage (MA) plan that would cover her insulin at no cost to her. Enrolling in this plan would save her $90 per month on her insulin costs, but she sees four doctors and none of them are contracted with this plan.
Which is more important to her? Staying with her doctors or saving $90 per month? Terry chose to stick with her doctors, so she enrolled in a Medicare Advantage plan with which her doctors are contracted.
By the way, I had encouraged Terry to consider a Medicare supplement and a stand-alone Part D plan. After thinking about her choices for more than a month, and many phone conversations with me, she decided on a Medicare Advantage plan with a $0 monthly premium. This is a “special needs plan” for people with diabetes and it has lower co-pays than most MA plans – but it doesn’t give her a break on her insulin costs.
Terry is very anxious about her Medicare coverage because of her health issues. I am anxious about being sure the plan she picked will work well for her. I checked her drugs through the Medicare.gov Plan Finder, but I also called the Medicare Advantage company to double check on what she will pay for her insulin.
We both spent many hours on her Medicare choices, and Terry is relieved to have set up her Medicare coverage. She has been paying around $700 per month for her health insurance, so she will save lots of money and have better coverage with her Medicare Advantage plan.
I’m happy to have Terry settled because I have yet another client with health issues and lots of anxiety. On the one hand, the complexity of Medicare choices means people need my services. On the other hand, I have to ask, “Why does this all have to be so complicated?”
To see a short presentation on your Medicare choices, click here: Intro to Your Medicare Choices