People come to Medicare with wildly different circumstances. This man’s story was highly unusual, albeit not unique.
He was self-employed and had no health insurance, no doctor and no prescription drugs. He was going to start Medicare in a few months when he turned 65, and then wait a year or two to begin taking his Social Security benefit. Because his $165-a-month Medicare Part B premium couldn’t be deducted from a Social Security check, he was worried about coming up with Medicare quarterly premium payments of nearly $500.
He made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor to try to get some help.
After verifying that the man’s income wouldn’t qualify him to have the Medicare Part B premium paid for him, the SHIBA counselor suggested that he create an account on the Medicare website, where he could set up monthly deductions from his bank account.
The man was clear that although he would like to have health insurance, he wanted to spend as little as possible.
The SHIBA counselor showed him the nine zero-premium Medicare Advantage plans available to Salem-area residents, pointing out two that seemed most attractive based on their $4,500 ceiling for annual medical expenses and for their patient co-pays for Medicare services. (This fellow didn’t need to consider two important elements that most Medicare beneficiaries must: how well the plans help pay for prescription drugs – he didn’t take any – or whether the individual’s doctors are in network with the insurance – he didn’t have a doctor.)
The SHIBA counselor told the man that once he had selected an insurance plan he could ask what in-network doctors it had who were accepting new Medicare patients before he enrolled.
If you would like to make an appointment with a SHIBA counselor, or to ask a question to be answered here, please see the end of this column.
Q. In recent months I’ve read several critical articles about Medicare Advantage insurance. Are they really that bad?
A. Medicare Advantage plans sometimes do pose problems. That is true with some companies more than others. Critical articles range from the breathless takedowns to those just pointing out pitfalls to avoid.
What such articles sometimes fail to point out is the contrast in prices between Medicare Advantage insurance and Medicare supplement (Medigap) insurance. Medicare Advantage plans’ premiums can cost as little as nothing, although the insured is subject to co-pays for most medical services. With a Medicare supplement (Medigap) policy, the insured can expect to pay about $130 a month for Plan G, which is the strongest policy available to new Medicare beneficiaries.
So even if some Medicare beneficiaries have trouble with Medicare Advantage plans, many cannot afford costlier Medigap insurance. For anyone considering Medicare Advantage insurance, these are elements to consider:
- When reviewing plans on the Medicare website, pay attention to the star rating. Medicare awards one to five stars based on up to 38 factors such as patients’ survey ratings and how good a job Medicare believes the plan does in promoting wellness. Five stars is considered excellent, four stars above average.
- Compare how well various Medicare Advantage plans do in covering your prescription drugs.
- Ensure that your doctors are in network with the plan you choose (that is, that your doctors will bill that insurance). It’s a good idea to ask your doctor’s billing office what Medicare Advantage plans it accepts even before reviewing the various plans.
- If you have a problem – for example, if the plan refuses to pay a charge or won’t approve a treatment – remember that you can appeal, and that appeals are often granted. SHIBA can assist with appeals.
- A Medicare Advantage insurer will mail information in September outlining any changes to the plan for the following year. Review it. Then, during Oct. 15-through-Dec. 7 annual open enrollment, compare your plan against others that will be offered the following year.
In fairness, Medicare Advantage insurance plans often offer benefits that Medigap insurance cannot. For example, some Medicare Advantage plans offer benefits such as limited assistance with dental, vision or hearing costs, gym memberships, medical transportation and delivered meal kits if the insured temporarily cannot prepare meals.
Medicare Advantage insurers are pleased to share coverage information upon request. Or, in reviewing plans on the Medicare website, click on View more information to see those extra benefits for which you might call the plan for details.
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, Zoom or in-person appointment with a volunteer Medicare counselor, call 800-722-4134.
;free
STORY TIP OR IDEA? Send an email to Salem Reporter’s news team: [email protected].
JUST THE FACTS, FOR SALEM – We report on your community with care and depth, fairness and accuracy. Get local news that matters to you. Subscribe to Salem Reporter. Click I want to subscribe!
