Simplifying Medicare – Fall Seminar Recap

This headline may seem like an oxymoron to many individuals attempting to navigate the murky waters of Medicare health insurance. The multiple mysteries of Medicare are faced by millions of Americans every year. For that reason, Hoover Financial Advisors held an informative educational seminar this week to clear up some confusion clients could encounter. For those of you who missed it, this blog may provide some answers and the entire program can be heard here.

An audience of 85 enjoyed a delicious lunch and the Desmond Hotel’s signature bread pudding dessert (We can’t reproduce the meal online. You will have to come to the next seminar!) as they sat in rapt attention while Lisa M. Korab revealed Medicare basics and options. The health insurance specialist and founder of Positive Insurance Solutions presented an overview of Medicare and its various parts as well as valuable details concerning Medigap policies.

In short, Medicare is health insurance for people over 65, people under 65 with certain disabilities and people of any age who have end-stage renal disease. The insurance is comprised of Parts A, B, C and D. Part A, which is hospital insurance, helps cover inpatient hospital care and skilled nursing facility, hospice and home health care. Part B, medical insurance, helps cover physician and health care provider services, hospital outpatient care, durable medical equipment and home health care. It also includes preventive measures to maintain good health and keep certain illnesses from growing worse.

Part C is the Medicare Advantage plan. It includes all benefits and services covered under A and B and is operated by Medicare-approved private insurance companies. It actually replaces Part A and Part B and usually covers Medicare prescription drug coverage and may have extra benefits and services for an additional cost. Part D, which is the Medicare prescription drug arm, helps cover outpatient prescription drugs and is also managed by Medicare-approved private insurance companies. It may help lower prescription drug costs now and protect against raised rates in the future. Lisa emphasized people must have Part D even if they don’t need prescription drugs.

She pointed out that Medigap insurance policies are designed to supplement original Medicare and help pay some health care costs not covered by Medicare. A Medigap policy is different from a Medicare Advantage plan; it is only a supplement and Medicare does not pay any of the costs of purchasing the policy. It does not cover dental, vision, hearing, long-term care, disability or prescriptions. Other types of policies are available to cover such expenses. Medigap policies can be chosen during guaranteed open enrollment periods three months before someone turns 65 or six months after their birthday. Supplements can be changed, however there is medical underwriting.  The only time MedAvantage plans can be switched is from October 15th through December 7th.  To move from a MedAdvantage to a Supplement would be between January 1 – February 14.  This is not guaranteed issue.  Lisa stressed if anyone is considering switching, they should first sign up for a Medigap plan and drop their current plan only after being accepted. Once accepted, they can purchase a new plan then drop the other. You cannot have two plans at the same time. In addition, you must have Medicare A and B in order to purchase a Medigap policy.

Most states, including Pennsylvania, can only sell standardized Medigap policies, which are identified by letters A through N. They can be purchased during open enrollment, the one-time only period when Federal law allows individuals to buy any Medigap policy sold in their state. During this period, you cannot be denied a Medigap policy or charged more due to pre-existing conditions.  Lisa advised the audience that Plans E, H and I are no longer sold, but can generally be kept if someone already has one.

Before asking for questions, Lisa compared benefits of Medigap plans A through N. (See chart on Page 11: Medigap Basics) She recommended Plan F as the most comprehensive plan. This is because it covers 100 percent of the costs of coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used; coinsurance or copayment of Medicare Part B; the first three pints of blood; Part A hospice care; skilled nursing facility care coinsurance; Medicare parts A and B deductibles; Medicare part B excess charges; and foreign travel emergencies up to plan limits. However, in most states, $2,140 (2014 rate) must be paid before the policy pays anything.

The sign of a good presentation is the generation of questions. Based on this observation, Lisa’s program was excellent. You may have some of the same questions asked:

  1. If I’m on Medigap and want to switch to Medicare Advantage, when can I make the change? This year, from October 15 through December 7. However, do not drop one plan until approved by the other.
  2. How do you make a decision between Medigap F and N and will questions be asked concerning pre-existing conditions?  If switching supplements, questions will be asked. In choosing the plan, it comes down to what services you are most comfortable having included.
  3. Why should I switch to a Medigap plan if I have Medicare Advantage? It is a matter of what benefits are available.
  4. What percentage of doctors accept Medicare? A lot do and most hospitals do. Call your physician and ask when you make the appointment.
  5. Is there anything similar to health savings accounts? Although there are not too many offered, there are Medical Savings Accounts.
  6. We get lots of forms showing costs, but they are not bills. Should we keep them? Yes, and when the bill arrives compare costs to be sure they match.
  7. How often do doctors change or add charges? It’s rare but is happening more frequently. Many people are relieved they have Plan F because of excess charges.
  8. Medicare is available only in the U. S. What if we travel and something happens? Some supplements have some coverage for foreign travel. However, I recommend getting travel insurance before leaving the U. S.
  9. Do carriers put rates online?  Yes. Many will ask for an email address and send a quote and others want a phone number.
  10.  Can you be denied coverage if you have a pre-existing condition? Not during open enrollment periods if getting a plan for the first time.
  11. If I wanted to use a resource, such as Positive Insurance Solutions, what should I look for and what questions should I ask? Be sure the company has a website. Determine how long it has been in business. Check reviews. Be sure agents are licensed and certified. I get certified by each carrier every year.

Pete concluded the program with a rousing recommendation for Lisa, noting she has helped numerous HFA clients with Medicare issues. Each guest received a 50-page document filled with information, options and answers to numerous questions. Additional information can be obtained at: Medicare, Social Security and Centers for Medicare and Medicaid Services or by calling Medicare at 1.800.633.4227. The audio and handouts have been added to our website, as well, for your reference.