Who has seen those commercials about Medicare Advantage saying you can get your Part B monthly premium ($174.70) put back into your Social Security check, how you can get services for $0 copays and no coinsurance, grocery benefits, free gym memberships, dental, vision and hearing coverage, and at the end of the commercial a well-paid athlete or actor says “it’s free?” And, they offer to enroll you for free.
That’s right! We all know the commercials that are on TV constantly and say you can get all of these benefits for free. However, we all know you get what you pay for, and below I’m going to outline how these plans truly work and what you should know about the plans that cost $0.
Networks: One of the most important things to remember about Medicare Advantage plans is all of the plans have a network. It doesn’t matter whether the plan is an HMO or PPO, you are forced to use the doctors and services they say you can use, and the networks change every year. Even if you have a PPO, if you don’t go to a doctor that is in the network, coverage is abysmal. They normally only cover 50% of charges or less for out of network coverage. I don’t know about you, but I’d like to choose my doctors.
Pre-approvals or Prior Authorizations: Along with networks that restrict coverage, so does prior authorizations for certain procedures and certain prescription medications. I can’t even begin to guess how many people have called me at the beginning of the year and asked for help with having their medications filled because of prior authorizations for certain medications due to either the medical provider being slow on granting them or the pharmacy not requesting the prior authorization from the medical provider. Something else that is also frustrating with Medicare Advantage plans is prior authorizations for life saving services that need to be completed now and not later causing loved ones to lose family members due to waiting on prior authorizations.
Not Everything Is Free: So, let’s address the elephant in the room. These plans are not free and cost more than most people know regarding monetary costs and costs to your health because the insurance company says what you can and can’t do. Let’s start with getting the monthly Part B premium of $174.70 back on your Social Security check every month. Only a select few people qualify to get this benefit and it’s based on income. Further, to get the monthly Part B premium back, you must apply for the Medicare Savings Program and meet certain eligibility requirements regarding income and resources. There are differing levels of the Medicare Savings Program based on income. Lower income and lower resources equal more benefits. There a select few Medicare Advantage that do have a giveback benefit. However, those plans generally have lesser benefits when compared to plans without a giveback such as higher copays, coinsurance and deductibles.
Enrollment Periods: This is where things can get confusing, as if Medicare isn’t confusing enough already. You have your Initial Election Period (IEP), Initial Coverage Election Period (ICEP), Initial Election Period 2 (IEP2), Annual Election Period (AEP), Open Enrollment Period (OEP) and your Special Enrollment Periods (SEP). Whew! That’s a lot of enrollment periods! And there are multiple Special Enrollment Periods. Sometimes I can’t keep up with all of them. The most important thing to know regarding these enrollment periods is that these periods are the only times you can change, add, or drop any plans making changes difficult. This is extremely important when your plans change which doctors are in network, and exactly why you should review your coverage annually during the Annual Enrollment Period.
Copays and Coinsurance: There are copays and coinsurance for everything unless you qualify as a Qualified Medicare Beneficiary (a.k.a. having Medicaid). Most notably, the worst of the copays are when you use your plan and stay overnight in a hospital. Copays range anywhere from $290 per day to $400 per day for days one through eight depending on the plan you select. One more important gap with Medicare Advantage plans is the copay for days 21-100 if you’re ever in a skilled nursing facility, which is $204 per day. Lastly, if you unfortunately get cancer, there is a standard 20% coinsurance for many cancer treatments such as chemotherapy and radiation therapy. So, it’s extremely important to get additional plans such as cancer, hospital indemnity and home health care plans to supplement what these plans don’t cover.
To conclude, there are more costs to these plans than the commercials want you to believe. So why are the companies pushing these types of plans on people through endless phone calls, television commercials and mail? Well, as you can guess, it’s greed. Lots and lots of money is being funneled into these plans and they are not the best plans for most seniors. Don’t get me wrong, sometimes these plans based on affordability and whether or not you qualify as Qualified Medicare Beneficiary, can be the best plans for people. But don’t be fooled by the commercials, phone calls and mail being sent to you daily from companies that don’t have your best interest at heart.
