Here we go again. It is that time of year when television ads, celebrity endorsements, and social media posts invade our lives talking about Medicare enrollment. They use big words and terms that are difficult to understand creating a sense of urgency and confusion that is designed to drive viewers to call the number on the screen. It sounds like if you don’t call, something catastrophic will happen and you will lose your benefits. The truth is you may not need to do anything to maintain your Medicare benefits in the coming year. Medicare enrollment doesn’t have to be confusing.
The reason for all of the marketing is the Medicare Annual Enrollment Period (AEP) runs from October 15th through December 7th, 2023. A person can make adjustments to their Medicare Advantage plan and Stand Alone Prescription Drug Plan (PDP) in this window, resulting in effective benefit changes starting January 1st of the following year.
Insurance companies take advantage of this time frame to increase business and sell new products. Offers for free dental exams, free hearing screenings, health club memberships, and vision insurance can be enticing but may cause the important benefits of a Medicare Advantage Plan to get lost in all of the marketing hype.
But what about the scare tactics in health insurance advertising? Indeed, there may not always be a clear answer to the best Medicare option. Medicare Advantage plans can look the same with only slight differences in Medicare Supplement or Medigap plans.
Mike Dietz, president of MIB Health Insurance says, “This is the busiest time of year for us. The best part of our job is to help our clients navigate their Medicare plans and explain benefits in simple terms so they can feel confident they are making the best decision to enroll in a plan that offers the best value and financial protection.”
Finding the best Medicare plan does not have to be scary or confusing. Sometimes just having a real person to answer questions about the subtle nuances of Medicare can make all the difference in having peace of mind about these important decisions. Let’s take a look at the three main types of supplemental Medicare plans (Medicare Advantage, Medicare Supplement, and Medicare Stand-Alone Prescription Drug) you may need to consider.
A Medicare Advantage Plan, sometimes referred to as Part C, is a type of secondary coverage provided by private insurance companies that are approved by Medicare. These Medicare Advantage Plans cover your government Medicare Plan. If you join a Medicare Advantage Plan, the plan will provide all your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage and in most cases your Medicare Part D.
If you feel confident your Medicare Advantage Plan is meeting your needs, there is no action required to stay on your current plan. Normally an annual notice of change in your benefits will be mailed to you to see if any adjustments are required, but no action is required to stay with your Medicare Advantage Plan.
Comparing Medicare Advantage plans
There are many different types of Medicare Advantage Plans and comparing them can be difficult. There are many different types of Medicare Advantage Plans and comparing them can be difficult. There are Health Maintenance Organization (HMO ) that may restrict your access to certain doctors, Preferred Provider Organizations (PPO) that is more flexible than the HMO option; Private Fee For Service (PFFS) may have greater access to doctors with adjustable fee scales; Special Needs Plans offer coverage for people who may be on both Medicare and
Medicaid, have a chronic condition, or live in a nursing home; HMO Point of Service (HMOPOS) Plans offer out of network benefits for a higher co-pay; Medical Savings Account (MSA) plans offer high deductibles linked to a bank account but require a Prescription Drug plan if that coverage is needed.
People with Medicare Part A and B who live in the plan’s coverage area are eligible. Medicare Advantage must cover everything that original Medicare covers. When choosing which Medicare Advantage plan is best for you, we start by advising our clients to give the best guestimate of their medical needs for the following year. Our advice is to select a plan that maximizes medical care benefits first. The extra benefits like health club, dental, hearing, and vision benefits are secondary.
Tanya is a 65-year-old woman who recently retired and started Medicare. She was confused about all the different Options for Parts A, B, C and D. Tanya has MS and needs expensive medications monthly. She has a good rapport with her doctor and wants to stay with him to continue her care. She also has some dental concerns. She needed a plan that allowed her to stay with her doctor, have excellent drug coverage, and would supply her with dental coverage. Like many of our clients, Tanya was concerned about dental coverage. Her dentist was NOT in-network with many of the plans we reviewed. We determined that the issue most important to her was staying with her doctor, so we showed her a PPO Medicare Advantage plan with dental benefits and a Medicare Supplement Plan with a separate Stand-Alone Prescription Drug plan. Sitting down with Tanya allowed us to better understand her health insurance needs and come up with the best solution for her. In the end, Tonya enrolled in the Medicare Supplement plan with a Stand-Alone Prescription Drug plan. She did not want to give up the quality of her medical care for dental benefits.
If you want to better understand how dental coverage under Medicare Advantage works, here are some links to different Medicare Advantage plans and their Find a Dentist search engine.
Anthem Look For Program: Medicare
Delta Dental (Network Health (NHP), Medica, Quartz, Security Health Plan (SHP))
Make sure the Network name says “Delta Dental Medicare Advantage”
Coverage Type: All Dental Networks, Network: Humana Dental Medicare
Medicare Supplement (Medigap)
A Medigap policy is private insurance that helps supplement original Medicare by covering the gaps in coverage such as copayments, coinsurance, and deductibles.
Most people with a Medicare Supplement plan will not leave this plan to change to a Medicare Advantage plan. There is no action you need to take to stay with your Medicare Supplement plan. Most of the Medicare Supplement plans renew on an annual basis based on the date you enrolled. So, if you started your Medicare Supplement plan on June 1st. You should get a notice from the insurance company about 60 days before June of the following year of any rate increase. Rates may increase due to age or inflation.
So, how do you know if a Medicare Supplement or Medicare Advantage Plan is best for you? Look at this chart for a very simple overview.
Prescription Drug Plans
Some Medicare Advantage plans, and all supplemental policies do not include prescription drug coverage. There are many options for people to supplement their drug coverage. To choose a drug plan or revise an existing plan, it is good to evaluate your current and projected drug usage. Many plans have annual changes to premiums and coverage that can be tricky to navigate especially for prescription drugs that are more expensive or one of the Tier 3 or higher prescription drugs. For example, in 2024, two new plans offer a $0 premium PDP. This could be a good option for people on generic medications or no medications. Federal law requires drug coverage for anyone on Medicare and a 1% monthly penalty can be imposed for any lapse in coverage. The Medicare Annual Enrollment Period (AEP) is a good time to review your prescription drug needs to avoid expensive mistakes and lapses in coverage. The experts at MIB Health Insurance can help review your drug lists to determine if there might be a better option for you.
Senior Care is a State of Wisconsin prescription drug plan that costs $30 per year. The benefits are based on income but most people on Senior Care use it to avoid the Part D late enrollment penalty for going without prescription drug coverage. For more information about Senior Care drug plans visit this Website: https://www.dhs.wisconsin.gov/seniorcare/index.htm
Doug is a grandpa and just retired from his job of forty years at age 67. He knew he wanted a Medicare Supplement Plan and needed a drug plan. Doug does not take any medications, but the federal government requires Doug to be enrolled in a drug plan or pay a penalty. Instead of choosing a federal stand-alone drug plan, Doug enrolled in Senior Care which is a Wisconsin State prescription drug program with benefits based on his income. This drug plan only costs Doug $30 a year and is Medicare Part-D creditable. With Doug’s Senior Care plan, it is important to make sure he renews each year to avoid a penalty for going without prescription drug coverage.
For more information about Original Medicare coverage, Medicare Advantage, or Medigap policies, visit https://www.medicare.gov to review plan types and find plans that may be available. Or better yet, call an MIB health Insurance Medicare expert to help you understand the complexities of Medicare. MIB Health Insurance is a family-owned health insurance brokerage with a team of caring health insurance professionals in the Fox Cities who want to understand your unique health insurance story. Together we can find the right Medicare solutions for you and your family. The Health Insurance experts at MIB are committed to providing peace of mind to help you better understand your Medicare and health insurance choices.
Call an MIB Health Insurance expert at 920-731-2100 to schedule a free consultation to see how we can help you navigate your Medicare and health insurance options. We can help take the confusion out of Medicare enrollment.
* The names in these stories have been changed to honor the confidentiality of our clients.