COLUMN: Sometimes, free isn’t the best price when it comes to health insurance

The woman was new to Medicare. She came to the counseling session believing she wanted a no-premium Medicare Advantage insurance plan.

But after reviewing her insurance options, she instead chose insurance that would cost about $150 a month.

The reason?

The costlier insurance would save her money in the long run.

She said she makes four or five medical specialist visits a month, which, with the no-premium insurance she was considering, would have cost her $160 to $200 a month in office co-pays.

Even with Medicare Advantage plans with lower co-pays, the monthly premiums would have more than offset the co-pay savings.

She elected to enroll in the costlier Medigap supplemental policy that has no co-pays. Her experience is evidence of the potential rewards of getting answers to health care questions. To ask a question to be answered in this column, or to make an appointment for SHIBA’s free Medicare counseling, see the end of this column.

You’ve written about a website that shows premiums for various types of Medigap supplemental insurance policies. How does it work, and what information does it provide?

The tool delivers current premiums for every Medigap policy available to Oregon residents. To obtain the list of premiums, one enters only eight pieces of information: person’s age, gender, ZIP Code and county, whether the person is a tobacco user, the type of plan (such as Plan G),  preferred start date and how to sort the information (such as by price or rating). SHIBA Medicare counselors have access to this password-protected Web site, as do some insurance brokers.

My doctor is retiring and closing her practice, leaving me to find a new doctor. Aside from asking friends for recommendations, what else might I do?

If you have a Medicare Advantage plan, find the customer service phone number on your insurance card and call the plan. Ask what local doctors are “in network” with your insurance and are accepting new Medicare patients. These companies are required to have doctors available.

If you instead have a Medigap supplemental policy, go to Medicare.gov and click on Find Care, then click on the “Doctors & clinicians” icon, then follow the prompts. Be sure to click on the “Medicare-approved payment” option because with Medigap insurance your doctor must be willing to bill Medicare. These steps also apply if you have Medicare Part A and Part B only without separate insurance.

Here’s an insurance idea that appeals to me: I enroll in a Medigap policy for my medical needs and in a zero-premium Medicare Advantage plan for my prescription drug coverage. Do you see anything wrong with this strategy?

Yes, Medicare prohibits it. What you describe, albeit clever, isn’t permitted because it would significantly increase Medicare’s cost. With your Medigap supplemental policy, Medicare would pay 80% of your approved medical expenses. Then it would pay another $800-plus a month to subsidize your Medicare Advantage premium.

You say SHIBA Medicare counselors are volunteers. What sort of training do they get?

Before being certified, volunteers study Medicare law and rules after which they must pass a series of tests. Then they shadow an experienced counselor. After that, counselors typically receive three days’ training annually, sometimes more, plus available class and Webinar trainings.

In addition, if they want help, they may reach out to a national Medicare hotline or to Medicare experts in Salem at the Oregon Department of Consumer and Business Services. Counselors undergo a criminal background check, are fingerprinted, and must abide by zero-tolerance confidentiality standards.

Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected] To schedule a free SHIBA phone appointment with a volunteer Medicare counselor, call 800-722-4134.