Fall enrollment for independent brokers like myself starts long before Oct. 15, which is the first day of the annual enrollment period for folks on Medicare.
Medicare requires captive agents and independent brokers, like myself, to endure eight hours of required Medicare recertification curriculum. Each carrier requires another three hours of course work on all their new 2023 plans.
Friends in my business ask me why would I waste my time getting licensed with 10 different advantage plan companies rather than just the big three?
My answer is that, unlike Medicare supplements, which are standardized, and have no restrictive network or hospital copays, and no 20% co-insurance for cancer treatment or no 20% for outpatient surgeries, advantage plans can change drastically from year to year.
Independent brokers have an obligation to offer every possible solution from every carrier, because every client has different needs, doctors, drugs, etc. So, if you have a Medicare advantage plan – which in most cases I do not advocate – then you owe it to yourself to call your agent and have them type in your drugs, your doctors, and any providers you use.
An independent broker has software that will break down to the penny your total cost for drugs, doctor copays, hospital copays, which this year are more along the lines of $350 a day up to $500 per day.
Make sure your agent finds a plan where you have a copay – not coinsurance – for outpatient surgery. One of my clients wanted the $2,000 in “free” dental that an advantage plan offered last year. I pleaded with him, but the man wanted to eat steak again and needed dentures. Unfortunately, he also needed a stent put in, and they did day surgery rather than a hospital stay.
His share of the procedure was $3,000 and, what’s worse, he had to drive 65 miles away to see the only dentist that accepted the plan’s “free” dental.
Dental should be seventh or eighth on your list of important deciding factors when choosing a plan. You’re better off getting a separate dental/vision plan with a robust network and more extensive coverage.
Your biggest danger with an advantage plan is getting sick and actually having to use the plan, because with most plans your annual maximum-out-of-pocket is $7,500 in-network and $10,000 out of network, before the plan pays 100% of all costs for the remainder of the year. This resets every Jan. 1.
As far as Medicare supplements, also known as Medigap plans, the biggest pitfall to avoid is rate instability. Avoid the Plan F and Plan G Medigap plans. Since Jan. 1, 2020, if you were not yet 65, you can never again enroll in a Plan F. It’s discontinued to healthy young, new-to-Medicare folks. Plan F has an older, sicker pool of people with more claims, thus higher rate hikes to compensate.
Plan G since Jan. 1, 2020, MUST take chronically ill and unhealthy people who exercise their Guaranteed Issue Rights.
The Plan N, which offers virtually the same coverage as the Plan G, is forecasted by all the major insurance company actuaries, to have the most stable rates moving forward. It’s the supplement with the most value.
To learn more about Plan N, email me at mayrivermedicare@gmail.com and I’ll send you a video and independent studies verifying its value.
