The annual enrollment period for Medicare Advantage and Prescription Drug Plans is coming to a close on Dec. 7. It’s time to stop procrastinating.
We have all heard the extensive advertising on TV. What they do is list every benefit possibly offered on every Medicare Advantage plan, including those designed only for people on Medicaid or those with veterans’ prescription benefits, then urge you to call to see if you qualify. Few people qualify for all of them.
It can be incredibly confusing. I advise you to ask a pro who is trained to listen to you, then help figure out the best plan for you. Everybody is a bit different. Otherwise, you are making an uneducated guess.
Agents get paid by the insurance companies when we write a new plan, not by you. Our services cost nothing to our clients. There are two styles of coverage, traditional Medicare with a supplement and a prescription drug plan, or Medicare Advantage (Medicare Part C).
With a supplement like F or G, you pay up front, every month, and pay little or nothing when you use it. With Medicare Advantage, you pay small premiums each month and make copays when you use medical services.
Medicare Advantage plans come with or without prescription coverage. To get these, you agree to work within a network and there is an out-of-pocket maximum.
I am on a Medicare Advantage plan with a $34-a-month premium. I had hip replacement surgery in July. I recently got my year-to-date explanation of benefits. I have had $47,000 in doctor and hospital care, and have received $550 worth of prescription drugs. So far this year, my out-of-pocket expenses have been $405.
I lucked out and they waived physical therapy copays due to COVID-19. I would have paid another $240 if they were in place.
I am a very happy camper. The downside is that there are out-of-pocket maximums ranging from around $5,000 to around $7,500 in network and more out-of-network.
I’ve asked how many people hit the maximum, and the answer is around 2 percent. It isn’t easy to do. Elaborate cancer treatment can get you there. If you happen to max out, you can make a payment arrangement. However, we know that many more than 2 percent are getting cancer treatments.
The cost of supplements in New Hampshrie is age banded. It starts when you turn 65, then grows in to your 80s.
In Maine, they are community rated, so one price is for all. When you are first eligible, they are guaranteed issue. After that, you can be rejected or charged more for pre-existing conditions only when you change.
On the Medicare Advantage side, pre-existing conditions are not a factor. I was speaking with a person who thought they weren’t eligible due to diabetes. That is not the case. I can write Medicare Advantage Prescription Drug Plans for anybody who has Medicare along with Parts A and B.
Under 65 Social Security Disability has a different set of rules. Ask about them.
Bert Weiss is a life and health insurance agent licensed in New Hampshire and Maine, focusing on Medicare Advantage. He writes about the basic components to help the public understand how to manage Medicare insurance choices. Contact him at (603) 694-3058.