Medicare Supplement or Medicare Advantage in 2011

You may be wondering what kind of Medicare coverage makes more sense for you next year.  You really have two options to consider.  They are Medicare Advantage and Medicare supplements.  The Medicare supplement works as a true supplement to medicare and pays things that medicare does not pay.  How much depends on the plan letter that you choose.  This coverage comes with a price, and the price is determined by your location, the company you choose and the plan letter.  The biggest benefit of this kind of coverage is that it is accepted anywhere Medicare is accepted. 


The alternative is Medicare advantage. With Medicare advantage you choose a company that is going to be most likely a PPO or HMO which means you will be working within the confines of a network.  The biggest advantage is that in many areas these companies offer little to no plan premium.  Instead you pay co-pays when you use it.  This means that if you are healthy and rarely go to the doctor, you could save a substantial amount of money by joining a medicare advantage plan.  These plans also offer extra benefits that medicare and supplements do not such as drug coverage, dental, vision, and many times health club memberships.  It's really simple, if you are healthy and not anticipating any procedures in the upcoming year than medicare advantage makes a lot of sense; but on the other hand if you are unhealthy or have some planned procedures coming up, you should probably be looking at a supplement!

Thank you Medicare Advantage for my Golden Ticket!!

Experiencing a lot of medical issues recently?  Tired of paying all of those pesky co-pays?  Just when you thought it couldn't get any worse you get a letter from your Medicare Advantage company saying they are leaving town!  Oh, the humanity!!  But wait!  That letter could be your golden ticket!!  That's right, your Medicare Advantage plan leaving town is just what the doctor ordered. 

When you lose coverage, CMS (Centers for Medicare and Medicaid) grants you something called an SEP or Special Election Period.  This SEP guarantees your coverage!  That's right, you are now able to go anywhere you want to for coverage.  In short, you are now able to go sign up for original Medicare and a supplement.  You can choose any supplement you desire and not have to go through the underwriting process.  Without the "Golden Ticket" this would not be possible.  So, don't despair; instead take advantage of the situation, and turn a bad thing into your "Golden Ticket"

Medicare Changes for 2011

"We change, whether we like it or not" - Ralph Waldo Emerson

Wow, Medicare has never undergone changes like we've seen this year!  From Part D to Medicare supplements to Medicare Advantage or Part C.  Just about every part of Medicare has seen some major changes.  You might just want to pay attention, or it could cost you!

A Medicare supplement re-alignment was completed mid-year for the first time in 16 years.  This re-alignment eliminated a few plans that were similar to other plans, but more importantly added new plans M and N that may end up being the new future of Medicare insurance coverage.  The re-alignment deserves it's own dedicated post which I will do in the near future so check back often for this vital information.

Part D is undergoing an overhaul with the "coverage gap" being closed over time.  This year anyone who hits the gap will receive $250.  In 2011, you will pay 50% instead of 100% while you are in the coverage gap.  For more detail on this topic see my post, "Where's my $250 rebate?"

Medicare Advantage or Part C has seen changes with many of the PFFS plans packing up and leaving town while the enrollment periods are being cut wreaking havoc on seniors' ability to manage their health care!  You can read more about this in my post "Medicare beneficiaries are losing their rights"

Medicare Advantage Do's and Don'ts

Now more than ever it is imperative that you do your due diligence when it comes to selecting your Medicare coverage.  I have compiled a quick and concise list of do's and don'ts that should help you when selecting the best Medicare coverage for your situation.

• Do review all of the available plans on Medicare.gov before signing on the dotted line. 
• Don't sign up over the phone.  And I mean NEVER
• Do check your drugs against the formulary to confirm coverage and pricing.
• Don't sign up for a plan based on ancillary benefits (gym membership, dental, etc...)
• Do check Physician and Hospital directories to confirm your preferred providers are listed.
• Don't take the plan's word for it that the doctor is in the plan or accepts the plan.
• Do call your doctor and have them confirm they accept the plan. (This can be tricky because you could get someone who is ignorant on the phone.  Always ask to speak with the person who files the insurance!
• Don't settle for inadequate coverage. 
• Do look at maximum out of pocket or MOOP for each plan to determine your worst case scenario.
• Don't let a captive agent (one who represents only one company) talk you into their plan
• Do look at the co-pays that would likely apply to you over the next year when making your decision

These are the must do's and don'ts when choosing the Medicare coverage that makes the most sense for you.  Keep checking back for more hints and tips!

2011 Medicare Advantage Plans Now Available

The 2011 Medicare Plan Information is now available on www.medicare.gov.  This is a great tool for comparing the different plans available in your area.  The site can still be cumbersome, but your primary objective here is to just compare co-pays between the plans.  When you find one you want, you will need to visit that company's site and search for your providers to make sure your doctor is included in the network.  As I stated in a previous post, the assistance of an agent who works with and understands all of the plans is an absolute must!

Where's my $250 rebate?

Perhaps you've heard your neighbor, golf partner, friend, etc.. gloating about receiving a $250 check in the mail from the gov't.  Don't be too envious because that check comes with a price!!  As part of the Affordable Care Act the government is slowly closing the "infamous" coverage gap in Medicare part D that seniors loathe!  This is a several step process that consists of a $250 AUTOMATIC rebate that is sent to those Medicare beneficiaries who hit the part D coverage gap in 2010.  You do not have to do anything to claim this rebate which means no need to fill out forms or file any paperwork.  In 2011 the rebate goes away and all of your brand name prescription drugs are discounted by 50%.  This discount happens at the drugstore with no rebate or paperwork! 

Medicare Plans are Leaving in 2011

If you have not already, you may soon be receiving a letter in the mail from your friendly Medicare insurance company saying they are leaving town!  This has already happened in my area, and is sure to be coming to a town near you.  The assumption from some clients is that these companies are going out of business; however, that probably is not the case.  For example Universal which was operating as a PFFS in our county did not get approval for this year so it is no longer available here.  They are still in business in other counties in the state.  The impact though is significant for those of you that have a plan that is leaving or is no longer available. 


You will NEED to shop for another plan ASAP.  You will not be left without coverage because CMS (Centers for Medicare and Medicaid Services) will automatically enroll you into another plan if you do not select one.  Do you really want the government selecting your health care for you?  Well, I'm sure they would select the best one for you so on second thought, no need to rush out and choose one for yourself (wink, wink).


Anyway, a great source of information for shopping the 2011 Medicare Advantage plans is http://www.medicare.gov/.  Here you can compare plans, and at least get an idea of the best one.  I still recommend using a local agent to help you, and I would also try to find one that works with several of the plans versus one that is representing only one of the plans.  That way the agent should not try to steer you to one plan versus another.  I'll do a separate post on why you should use a good agent instead of trying to do this on your own.

Medicare Beneficiaries Are Losing Their Rights in 2011

Thanks to recent legislation you now have less time to make a decision on your Medicare coverage!  In previous years you had the AEP or Annual Enrollment Period and the OEP or Open Enrollment Period.  The AEP ran from November 15th to the end of the year while the OEP ran from January 1st until March 31st.  These enrollment periods applied to Medicare Part C also known as Medicare Advantage. 

Unfortunately, Medicare beneficiaries are slowly losing their rights.  In 2011, you will no longer have the OEP in order to make a change.  This enrollment period was essential because it allowed you to be able to "try" out the plan that you had enrolled in.  If that plan was not to your liking, you could always sign up with a new plan through the end of March.  Congress, in it's infinite wisdom has done away with this necessary enrollment period and in it's place instituted the MA Disenrollment Period.  This period runs from January 1st through February 15th. 

 At first glance one might think that they just shortened the period, but in reality during this time period you may only drop your plan!  You only have the option of going back to original Medicare and a PDP (Prescription Drug Plan).  Not really much of an option unless you're willing to shell out the big bucks for a Medicare supplement! 

So, after you finish writing your congress person, make sure you do your due diligence when it comes to selecting your Medicare plan for 2011.