Medical Insurance Enrollment questions

[GoHuge]

I'm an insurance broker and in the Med Supps and Med Advantage plans I always put my client in supps if they can afford it. I get paid exactly the same per policy regardless if it is a supp or Med Adv plan. Main difference is that a private company is going to take over all your Medicare benefits with med adv policies. Positives....for lower income people it's usually better than OG Medicare as they only pay roughly 80%. With Med Adv the biggest downside is they almost always have a network you must stay in and you have to get a referral from your PCP to do anything like getting any kind of imaging or need to see a specialist....some require one for the policyholder to wipe their ass...could be mistaken on that one, but you get the point. Out of network fees I've seen as low as 40% coverage. They tell you what pharmacy you have to go to as well as using their formularies or pay a higher copays elsewhere. Which means it's take it or leave it on each plan. Most Med Adv plans work like an HMO and don't cost you anymore than your part B monthly premium....usually. They are taken over by a private company. Now to the super shitty, they have copays for doctors and about everything you have done. They also have an annual out of pocket max of roughly $5300 to over $7k a year. Get really sick and a person living on $1200 a month from Social Security has an extremely tight budget and no plan for a catastrophic event. I personally think they are dogshit and will only recommend them if we can't get a better option for the client. The PPO plans aren't much better. They give you more freedom as in what doctors and facilities than can use. These plans also allow for much better coverage out of network so they travel better for people that aren't to ****in old to travel, but with that comes a higher premium. Most of the decent PPO plans are going to cost another $40 all the way up to $100 on top of your $134 Medicare premium...which is stupid. A lot of doctors and facilities don't accept a lot of Med Adv plans as their level of reimbursement is so shitty that they just refuse to deal with them. Humana is hit by that the most because they are so God damn cheap.

Now the smart way of doing it. If I have a client enrolling into Medicare part B for the first time as their primary insurance is they have 6 months before, the month of, and 6 months after that when they are in what's called Open Enrollment. Unlike private insurance for people under 65, they are allowed to deny coverage if someone can't pass through underwriting for a pre-existing condition. Beauty of Open Enrollment is the insurance companies can't ask you any questions about your health or medications. They have to take you even if you weigh 500 lbs with diabetes, a substance abuse issue, cancer, and still smoking like a chimney. Once OE is over though any time they want to make a change they have to go through underwriting. Being a broker I can usually find a carrier that I can get them approved through. Some are just ****ed though for things like being on an opioid medication, any chronic condition, stent placement in the last 2 years, pacemaker in the last 3, cancer in the last 5 years, etc. Diabetes is real bitch too as almost every carrier is different in what they allow. That is why it is imperative to get your client in the best possible med supp that fits their budget as it's more than likely going to be the last insurance policy they'll ever be able to buy if they have serious health issues.

I can't list a single negative thing about having OG Medicare as your primary and a med supp secondary....other than cost. Probably the simplest part that confuses policyholders the most until you pound it into their head as many times as necessary. If a medical provider accepts Medicare....they accept your supplement....period. Doesn't matter if it's a carrier they don't accept. The way this works is the provider bills Medicare and Medicare bills your Supplement for the rest. Another positive is guaranteed renewability as long as you pay your premiums. Could run up $2 million in one year in medical Bill's and they can't drop you or raise your rates. Rates are based on 3 factors.....age, gender, and geographic location...so another piece of mind plus.

Then travel is a big one. Medicare is accepted by 98% of providers across the country. So again if they accept Medicare....they accept your Supplement. Plans F, G, and N even cover you internationally for the first 60 days you are out of the US.

Other benefit is you are in complete control of your healthcare. No referrals, networks, wondering who accepts your coverage...all those things that suck about Med Adv.

Now the downside is obviously going to be higher premiums with supps as they pay for so much more. You will be paying probably $90-$150 more a month than if you have a Med Adv plan. I already told you that Med Adv plans have a minimum $5k out of pocket max, so if you can afford a supp it's a no brainers. The biggest reason is with all these copays and out of pocket you pay with Med Adv....you can't budget for your healthcare expenses as there are too many unknowns...and that's shitty because 80% of seniors have Social Security as their main or only source of income. If you're healthy that's great, but we all know father time is undefeated and will eventually gonna kick your ass, and have yet to see a old person get healthier as they age. You get sick at 70 and all of a sudden Med Adv sucks and you want to jump on the Supp program to stop the bleeding, but you ****ed yourself 5 years ago in OE and can't get through underwriting for a supp. Then things become really messy and frankly very sad when you have to tell them sorry.

Last part which is something that the government got right in developing a healthcare program is making each letter med supp plan standardized. The different plans are A, B, C, F, G, K, L, M, and N. They all suck except for F, G,and N.

If you have plan F you will never see a doctor bill and pay any out of pocket cost from a medical provider....of course that means plan F is going to be the most expensive.

The best plan is plan G. It's exactly the same as plan F other than you have to pay your part B yearly deductible which is only $185. Reason it's the best is over the course of the year plan F is about $400 a year more expensive than plan G. The only thing you get is you spent $400 to cover $185....which doesn't take a scholar to figure out you are paying $20 more a month with plan F over plan G for the exact same coverage. Stupid, but as a broker it's your job to give people all their options and steer them in the right direction that fits them and their budget the best. Plan N is a good option for some people to are extremely healthy and wanna save a few bucks. It's exactly like plan G other than when you go to the doctor or ER you will have copays. Up to $20 for your doctor and $50 for an ER visit. Easy way to help someone decide between G and N is ask them how many times a year they see their doctor. I would say there is about $200 a year difference between G and N. If you go to the doctor 7 times a year you take that times 20 to get the true savings. In that scenario they are only $5 a month...and if they end up sick and are having to go to the doctor a lot....plan N can become more expensive than plan G which you just explain it's $5 a month more for plan G, but they are much better protected for what is always an uncertain thing, especially with old folks.

I mentioned standardization earlier. What that means is that every plan letter plan offers the EXACT same coverage regardless of the carrier. So if plan G with Mutual of Omaha is the least expensive....pick that one. Again stupid to pay more for the exact same coverage. Some people are stupid and say "hey I've always had Blue Cross my whole life and never had an issue." Well good for them, but different players for different products. Blue Coss is one of the more expensive plans in the Med Supp market. You gotta just beat it into their heads that they are in a different market now and Blue Cross and a lot of other names people are familiar with suck in med supp.

Last thing....if you go supp over Med Adv, you will have to get a part D drug plan. Nationally they run between $16 to $35 a month. The advantage there is you get to choose the best plan for you and the medications you take, an option not offered when you go Med Adv.

In closing if you can afford to go the supp route absolutely a hands down no-brainer. With plan F and G a person can budget their healthcare cost to the dollar because no matter what they are covered at 100%. Certainty is the most priceless commodity you can offer someone. Unfortunately not everyone can afford a supp and have to go Med Adv. Can't budget that with copays and big out of pocket maximums. Just a mathematical certainty that at some point in your retirement years on your fixed income you are gonna get ****ed. Can't think of anything else in the med supp vs. Med Adv....or more appropriately private company takeover plans debate. Happy to answer any questions anyone has though. Doubtful, but possible I left something out...happens.