I met yesterday with a woman who is an artist here in Tucson. She is turning 65 soon and when her Medicare kicks in she will have health insurance for the first time in 15 years. She had health insurance back when Arizona had an insurance program for small business owners that was subsidized by the state. But when the subsidy ended and premiums skyrocketed, she decided to take her chances and go without. She couldn't afford to pay $400 or more per month for a high deductible plan and she was healthy so she dropped her insurance.
Now she is looking forward to getting a checkup and not worrying about getting a health problem that could bankrupt her. We talked about her options for her Medicare coverage and she said her mother is on a Medicare Advantage plan. But she wants to stay with Medicare and get a Medicare Supplement because she figures she can afford the $90/month premium for a Plan F with United of Omaha. (Arizona has very good rates for certain supplement plans.)
The one thing she did not want was the Part D drug plan. She doesn't take drugs and doesn't plan to, so she can't see why she should pay $15 per month (for a Standard plan) for something she won't use. I told her she would be penalized if she finds she needs drug coverage in the future, but she said she'd take her chances.
I guess, having been self-employed for many years, she is a risk taker and knows what it means to deal with "taking chances".
Showing posts with label medicare supplement. Show all posts
Showing posts with label medicare supplement. Show all posts
Medicare beneficiary in financial trouble
I got a phone call the other day from a man on Medicare who is in big financial trouble because of the 20% of his medical bills that Medicare doesn't cover. He has limited income ($1100 per month) and gets help with his drug costs, but he never got himself a Medicare Supplement plan to cover the 20% co-insurance and deductibles in Medicare.
Last month he was rushed to the hospital in an ambulance. Upon arrival at the hospital he was told he needed to pay the Part A deductible of $1,068 in order to be admitted. After three days in the hospital undergoing multiple tests he got a bill for thousands of dollars for his 20% of doctor services and lab tests. He was shocked because he thought he had coverage through Medicare - which he did - and he was surprised to learn how much his 20% co-insurance would be.
This man is a good candidate for a private Medicare insurance plan which would have limited his co-payments. Private plans, called Medicare Advantage, each have different benefit structures, but all cover hospitalization the same way - there is a co-payment by the patient and all services provided during the stay are covered. There are no separate bills for doctors and tests and there is a limit on what the patient pays. Some plans have hospitalization co-pays of $200 per day. Others have "per stay" co-payment of $500.
As an insurance agent, I tell seniors that their best coverage is to stay with Medicare and get a Medicare Supplement (plan F). If this man had a Medicare Supplement he would have had no co-payments. However, on an income of $1100 per month, he might have felt he could not afford to spend $120 per month (the AARP Plan F Med Supp price in Arizona) plus another $35 per month for a Part D drug plan.
This man would be a good candidate for a Medicare Advantage plan which would have limited his co-payment to somewhere between $500 and $1,000, depending on his plan. And his monthly premium for such a plan would be $0.
I go back and forth on my view of Medicare Advantage plans because I have concerns about Medicare paying out billions of dollars each year to private insurance companies. These companies take a big chunk of this money for marketing and commissions (to agents like me) along with sizable profits for themselves (plus multimillion dollar salaries for their CEOs).
But when I hear from people like this man, I see Medicare Advantage more positively. And I wonder if Democrats, in their desire to stop the "privatization of Medicare", are not throwing out the baby with the bathwater. And I wonder what seniors' reactions will be when the see their Medicare Advantage co-payments rise and benefits reduced. In states like California, Arizona, and Florida, where over 30% of seniors are on Medicare Advantage plans, there could be some serious backlash.
Last month he was rushed to the hospital in an ambulance. Upon arrival at the hospital he was told he needed to pay the Part A deductible of $1,068 in order to be admitted. After three days in the hospital undergoing multiple tests he got a bill for thousands of dollars for his 20% of doctor services and lab tests. He was shocked because he thought he had coverage through Medicare - which he did - and he was surprised to learn how much his 20% co-insurance would be.
This man is a good candidate for a private Medicare insurance plan which would have limited his co-payments. Private plans, called Medicare Advantage, each have different benefit structures, but all cover hospitalization the same way - there is a co-payment by the patient and all services provided during the stay are covered. There are no separate bills for doctors and tests and there is a limit on what the patient pays. Some plans have hospitalization co-pays of $200 per day. Others have "per stay" co-payment of $500.
As an insurance agent, I tell seniors that their best coverage is to stay with Medicare and get a Medicare Supplement (plan F). If this man had a Medicare Supplement he would have had no co-payments. However, on an income of $1100 per month, he might have felt he could not afford to spend $120 per month (the AARP Plan F Med Supp price in Arizona) plus another $35 per month for a Part D drug plan.
This man would be a good candidate for a Medicare Advantage plan which would have limited his co-payment to somewhere between $500 and $1,000, depending on his plan. And his monthly premium for such a plan would be $0.
I go back and forth on my view of Medicare Advantage plans because I have concerns about Medicare paying out billions of dollars each year to private insurance companies. These companies take a big chunk of this money for marketing and commissions (to agents like me) along with sizable profits for themselves (plus multimillion dollar salaries for their CEOs).
But when I hear from people like this man, I see Medicare Advantage more positively. And I wonder if Democrats, in their desire to stop the "privatization of Medicare", are not throwing out the baby with the bathwater. And I wonder what seniors' reactions will be when the see their Medicare Advantage co-payments rise and benefits reduced. In states like California, Arizona, and Florida, where over 30% of seniors are on Medicare Advantage plans, there could be some serious backlash.
Problem with AARP Enrollment over Phone
Elaine is a friend of mine in Rhode Island who is 80 years old. She had seen the advertisements on television for AARP's Medicare Supplements. When she talked to her friends they said they had supplements to fill the gaps in their Medicare coverage, so Elaine called AARP to sign up for their Medicare Supplement policy which would cost her $175/month.
I was visiting Elaine last summer and the topic of Medicare came up, so I asked Elaine what coverage she had and asked to see her Medicare-related cards. When Elaine went through her wallet she pulled out not one, but two cards that said AARP on them. One was for a Medicare Supplement and one was for a Medicare Advantage plan - both from AARP.
I was puzzled and so was Elaine. Which coverage did she have? Elaine wasn't sure herself, but she knew she had called AARP three months earlier to sign up for the Medicare Supplement policy (at a cost of $175/month). So, even though it was Saturday, I called 1-800-MEDICARE and asked the question, "What do you see in Elaine's Medicare record that shows if she is covered by "Original Medicare" or a "Medicare Advantage plan?".
The answer from the Medicare representative was that Elaine was in the AARP Medicare Complete plan (which is a Medicare Advantage plan that includes a Part D drug plan). I asked if Elaine's Medicare Supplement policy would work with Elaine's Medicare Advantage plan. (I knew the answer but wanted the Medicare Rep to tell Elaine.) The answer was that a Medicare Supplement only works when a person is on "original Medicare". The "Med Supp" covers the gaps in Medicare - but when a person signs up with a Medicare Advantage plan (some call them "Medicare Replacement plans"), the plan pays their bills, not Medicare. Therefore, Elaine's AARP Medicare Supplement was "useless".
"Let's call AARP."
So, with Elaine's Medicare coverage clarified, I called AARP to find out how Elaine got signed up for a Medicare Supplement and was paying $175/month for a useless policy. The AARP representative said all callers are asked "if they have coverage already and are switching to AARP coverage". When I asked if customers are required to answer more specific questions about their "coverage", the AARP rep said that was not part of the phone interview.
So, what was Elaine to do? Her friends all had Medicare Supplements, so Elaine thought she should have one too. But, as it turns out, Elaine had no choice but to keep the Medicare Advantage plan because there is a "lock-in" for people in these plans. This conversation was taking place in July and Elaine could not change her Medicare Advantage plan until January. She could make changes as of November 15th and they would take effect on January 1.
I told Elaine to cancel the Medicare Supplement policy and to ask AARP to refund the premiums she had paid. Medicare Supplement policies can be cancelled at any time - but Medicare Advantage plans and Part D Drug plans can only be cancelled at the end of the year.
I supposed I am biased when it comes to advising people against signing up over the phone for something as important as Medicare coverage. I have met several seniors who thought the AARP Medicare Supplement would cover the co-payments in their Medicare Advantage plan - and when they called the AARP phone number, they were signed up without questions being asked about what kind of coverage they had.
I was visiting Elaine last summer and the topic of Medicare came up, so I asked Elaine what coverage she had and asked to see her Medicare-related cards. When Elaine went through her wallet she pulled out not one, but two cards that said AARP on them. One was for a Medicare Supplement and one was for a Medicare Advantage plan - both from AARP.
I was puzzled and so was Elaine. Which coverage did she have? Elaine wasn't sure herself, but she knew she had called AARP three months earlier to sign up for the Medicare Supplement policy (at a cost of $175/month). So, even though it was Saturday, I called 1-800-MEDICARE and asked the question, "What do you see in Elaine's Medicare record that shows if she is covered by "Original Medicare" or a "Medicare Advantage plan?".
The answer from the Medicare representative was that Elaine was in the AARP Medicare Complete plan (which is a Medicare Advantage plan that includes a Part D drug plan). I asked if Elaine's Medicare Supplement policy would work with Elaine's Medicare Advantage plan. (I knew the answer but wanted the Medicare Rep to tell Elaine.) The answer was that a Medicare Supplement only works when a person is on "original Medicare". The "Med Supp" covers the gaps in Medicare - but when a person signs up with a Medicare Advantage plan (some call them "Medicare Replacement plans"), the plan pays their bills, not Medicare. Therefore, Elaine's AARP Medicare Supplement was "useless".
"Let's call AARP."
So, with Elaine's Medicare coverage clarified, I called AARP to find out how Elaine got signed up for a Medicare Supplement and was paying $175/month for a useless policy. The AARP representative said all callers are asked "if they have coverage already and are switching to AARP coverage". When I asked if customers are required to answer more specific questions about their "coverage", the AARP rep said that was not part of the phone interview.
So, what was Elaine to do? Her friends all had Medicare Supplements, so Elaine thought she should have one too. But, as it turns out, Elaine had no choice but to keep the Medicare Advantage plan because there is a "lock-in" for people in these plans. This conversation was taking place in July and Elaine could not change her Medicare Advantage plan until January. She could make changes as of November 15th and they would take effect on January 1.
I told Elaine to cancel the Medicare Supplement policy and to ask AARP to refund the premiums she had paid. Medicare Supplement policies can be cancelled at any time - but Medicare Advantage plans and Part D Drug plans can only be cancelled at the end of the year.
I supposed I am biased when it comes to advising people against signing up over the phone for something as important as Medicare coverage. I have met several seniors who thought the AARP Medicare Supplement would cover the co-payments in their Medicare Advantage plan - and when they called the AARP phone number, they were signed up without questions being asked about what kind of coverage they had.
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