Articles from October 2019

Throughout the year, we take calls from clients saying that someone called them saying things along the lines of “there are changes to Medicare and you’re not receiving the benefits you are entitled to,” or “if you have the Plan F, it is going away and you will lose your coverage.”  Today, I want to clarify what these people mean and what they want from you so that you aren’t worried for your coverage or make a change to your coverage that may be irreversible.

“My Plan F will be cancelled?!?!”

Firstly, NO. If you have the Plan F, you can keep it and it will NOT be cancelled or taken away from you. The news you hear about F going away pertains to people turning 65 AFTER 1/1/2020. There are lots of agents and call centers that are using false statements about the F “going away” in order to try to get you to buy something from them. The hard and quick fact is that if you are turning 65 after 1/1/2020, you will not be able to buy the F. That is all. Again, if you have the F, you get to keep it. Some agents and call centers are also assuming that Plan F premiums will skyrocket and are using that as a high-pressure sales tactic. When we look historically at other plans that were discontinued and their rate of premium increase, it does not justify the assumption that the F will “blow up.”  If you have concern for the future of your rate stability, we can discuss with you the option of moving down to the Plan G (same as the F except you pay the Part B deductible) and if you would pass underwriting (health questions/recent medical history) to do so.

“Changes to Medicare and your plan doesn’t cover them.”

Every single time someone calls you or sends you mail that says there are changes to Medicare’s coverage and that your plan has holes/doesn’t cover new services, they are going to try to sell you a Medicare Advantage plan (MAPD) or a home-healthcare policy.  There have been no changes in Original Medicare’s coverage that a Medicare Supplement would not cover. When Medicare updates its deductibles/copays/co-insurance, your Supplement automatically reflects any changes and your benefits remain the same. Advantage plans and home-healthcare policies are not bad things, but they may not be suitable for your particular situation or be the type of insurance you want because the costs are different.

A lot of marketing callers like to tout the routine vision/dental/hearing and over-the-counter benefits of a Medicare Advantage plan, which are great additional benefits that you don’t get with a Supplement, but you have to make the trade-off of always having copays for visits/services and a network of doctors. Lots of people love their Medicare Advantage plan and the extra benefits that you can access from them, but MAPDs aren’t for everyone and not everyone feels comfortable with the potentially high accrual of copays in the event that a serious or unexpected change happens in your health. If you think that your Supplement is no longer suitable for you and would like to investigate a Medicare Advantage plan, call us because we have been here for you and always look out for your best interest. We want you to receive ALL the pros and cons and be well informed before you make a coverage change because sometimes, depending on your health, changing can have long-term consequences to your options.

Medicare Supplements and Medicare Advantage plans are very different and this is maybe the most asked question we receive. So what is the difference between a Medicare Supplement (Medigap) and a Medicare Advantage plan?  It’s actually very easy to boil it down and we are going to keep it relatively high-level and simple here.

Medicare Supplements

A Medicare Supplement is a secondary policy that you purchase to cover the deductibles and copays that Original Medicare has. Your doctor bills Medicare first, then bills your Supplement. Depending on which plan you have, you may have no financial responsibility or limited responsibility.  There are several different plans, but the most popular are the F, G and N. The benefits of these plans are standardized by the government, which means that no matter what insurance company you buy the plan from, you get the same exact benefits.  Supplements do not have networks of doctors, so you are free to see any doctor in the U.S. that accepts Medicare and will have the same coverage.

Typically, but depending on your plan, you will have no charges at the hospital or doctor, or will only pay the Part B deductible then be covered 100%.

Medicare Advantage w/ Prescription Drug Plans (MAPD)

Medicare Advantage plans bundle your Part A (hospital & skilled nursing), Part B (outpatient services) and Part D (drug coverage) into one plan. These plans are commonly called “Medicare Replacement plans” because it is Medicare’s coverage outsourced to private insurance companies. You are still enrolled in the Medicare program, but Medicare no longer pays your claims or provides benefits; your insurance company does. They must cover all services that Medicare covers, but can set the rules for how you access your care, like having networks of doctors and copays for all visits and services.  Insurance companies can create different plans and make the copays whatever they want, although the copays are typically reasonable and customary. So there are many plans that all have different benefits.

With a Medicare Advantage plan, your monthly premium will be lower than a Supplement, but you will always have some level of cost associated with every visit and service you receive. Each plan has a maximum-out-of-pocket, so there is a cap to your annual financial responsibility.

We have heard from several clients that they are receiving calls from people pretending to be Medicare saying that their Medicare.gov account has issues.  The scammer is requesting their Medicare Number and/or other personal information.   Medicare will NOT call you about your Medicare.gov account, but they do send you a letter after you have created your account to let you know that your account creation was successful.  If you receive a letter that says there is an issue with your account and has a number to call, do not call it; it is also a scam unless it has Medicare’s phone number on it (see below.)

Do not give out your Medicare Number or any other personal information to anyone who makes a call to you saying they are Medicare or any other agency. If you think there is an issue with your account, just go to Medicare.gov and try to log in. If you login works fine, then there are no issues. If the Username or Password are not correct, just use the “Trouble Logging In” link to reset your password.

You should only ever give your Medicare Number out if YOU made the call TO Medicare’s number 1-800-633-4227.

Week one of the Annual Enrollment Period is underway and we are so excited to say that Medicare has corrected the biggest issue in the Plan Finder Tool (what we use to compare drug costs) to now calculate Premium + Drug Costs.  This means that the most concerning setback to reviewing plans has been eliminated and all of the plan costs’ are being calculated properly.

The Plan Finder Tool still will not allow you to set the quantity of a drug to once per year. This is an issue for those of you that use expensive creams/etc that you rarely fill. This means that your total cost is being grossly inflated because the calculator must assume that you fill it every month. We are using our years of professional experience and knowledge to work around this issue.

How are we doing and how can you help?

We have hit the ground running since Tuesday and are completing reviews and returning calls as quickly as we can.  Although, what we are realizing is that it takes us much longer to do a review than in the past because of the numerous additional steps. Please be patient as we work as accurately and quickly as possible. We still want to be sensitive to your questions and give you the time that you may need while we discuss plans.  We cannot work on a first-come-first-serve basis or alphabetically and choose clients at random as we go along.  If you call for an update on your status in our process, we may not be able to return your call for these reasons.

While we are here to answer your questions, we also need to manage our time wisely so that we can help as many of you as possible during this time. If you have questions regarding your current plan, consider calling the Member Services number on your card or sending us an email.  Also, as a reminder, our administrators (Gina & Meagan) cannot answer benefit related questions.

If you would like to request a review, please check out our Resources page for the forms that you need to complete.   You need to create your personal www.Medicare.gov account and return our forms to us in order to join our review process.   Following our instructions ensures that everyone has a fair opportunity for a review and allows us more time to be efficient.
If you can edit your drug list in your Medicare.gov account, it helps us help you by completing one of the steps we have to take.   If you find it difficult to edit your drug list, it’s okay.

If you would like to review your own plan, please contact Gina (extension 5) or Meagan (ext 6) to request our Plan Finder Tool Guide.  We have almost completed our Guide and it should be ready next week. If you review your own plan and decide you would like to change plans, if you want us to be the agent (so that we can provide assistance/answer questions next year), just let us know which plan you want and we will send you the application paperwork and complete the enrollment like we always have.

Thank you so much for your business and friendship. We treasure chatting with you during this time and care for you and your wellbeing.
Again, we are working as quickly and accurately as possible while being mindful of our own health and limitations.

The Medicare website’s Plan Finder Tool is what we use to compare prescription drug plans and the drug component of Medicare Advantage plans.  It is the easiest and most efficient way to compare your plan to other plans and determine if it would be beneficial to change.  In order to view drug costs specific to your medications, you need to have a personal www.Medicare.gov account.  Here, we will provide step-by-step instructions.

1. Go to www.Medicare.gov.    Only go to “.gov”, NOT “.com”
2. Click “MyMedicare.gov Login” in the top-right.
3. Scroll down and select “Create Account”
4. You will enter the following as it appears on your Medicare card:
4a. Medicare Number.  Do not include the dashes or spaces. Enter it as one unbroken sequence.
4b. Name exactly as it appears on your card.  If you go by another name or suffix, such as Jr, but it is not on your card, do not enter it that way. It must match your card.
4c. Email address, if you have one. You do not have to have an email or include it. Just select the “I don’t have an email address” box.
4d. Birthdate.
4e. Resident zip code.  This is the zip code for the address that Social Security has for you.
4f. Part A effective date.   If you do not have Part A, select “I don’t have Part A” and it will prompt you to enter your Part B effective date.
4g. Click both boxes to agree to the Terms & Conditions.
5. A security warning will appear. It states that you cannot use the Medicare site for fraud. Select “OK”
6. The next page asks you to create a User ID.  This can be whatever you want it to be. You can use your email address.
7. Then create a password.  The guidelines for password creation are on the right side of the screen.
8. Finally, you will choose a security question and answer. This is used to reset your account if you forget your User ID or password.

Make sure to write your User ID and password down and secure it safely!!

9. Select Done.  It will redirect you to the log-in screen and tell you that your account was successfully created.   Log in with your credentials to make sure it works.