# For those on Medicare AEP begins today



## Palmettokat (Jul 10, 2017)

For those who are on Medicare or have family members on Medicare the Annual Enrollment Period for Medicare Advantage Plans (MAPD) and Prescription Drug Plan (PDP) begins on Oct 15th and ends on Dec 7th each year.

Feds made a major change to their web site, Medicare.gov that has hampered the search of drug coverage. Has made it where the PERSON MUST SET UP their own search to get the best info. They need to record the ID and PW the site assigns these and with them the person is able to bring up that info over and over. Many agents used that site to do a quick, massive search to make best possible recommendation to a person. We have lost that ability to a bid degree. Can still input info and get the info but no ability to retrieve it when a person remembers a drug which amzing happens often. lol

There is a major issue with some of the PDP this year and at least with Envision,Silver Script and Humana has plans the premium is doubling to almost fourfold while telling agents they have new plans that are the premium of the now "OLD" plan the people need to move to. Frankly there is no way agents along can do this, to many people and too few of days. It makes it very very important you read the ANOC or Annual Notice of Change your plan mailed you around the end of September. This is a great time to really compare all options.

We have one drug plan that is near $200 to as low as $14 per month. Sure difference in the coverage but just shows the wide variance there is. Before you lock in a plan be sure you know what pharmacy it works with. Amazing some of the local pharmacies work better than some of the major chains depending on the drug plan.


----------



## Palmettokat (Jul 10, 2017)

There is one improvement for 2020. If you have been hitting the doughnut hole as they like to call it, now you are paying only 25% of the medicine cost while in the gap. Got to love the way it worded, normally you will only pay 25%. But that is an improvement.


----------



## RockyHill (Apr 24, 2013)

Asking for a friend , suppose they were turning 65 next year. Looks like applying for Medicare starts 3 months before and continues 3 months after 65th birthday. I know there are long range consequences for not applying for something at that time. What kind of supplement does a "healthy" person need?

Thanks,

Shelia


----------



## r82230 (Mar 1, 2016)

RockyHill said:


> What kind of supplement does a "healthy" person need?
> 
> Thanks,
> Shelia


What I have is a Plan F, High Deductible. He/she might need to 'shop' to find such a policy. Some carriers have, some don't. Some insurance agents will mention, some won't (remember they do get paid, via commission usually, so you might understand the not mentioning a high deductible policy for some odd reason).

My sister and BIL, get their supplement via Farm Bureau. Even though it is a BC/BS Plan F policy, agent never mentioned that BC/BS also had a High Deductible Plan F available (for considerable less premium).

Usually, the premium reduction between the two policy's is way more than the deductible difference. In my BIL case (he's 81), the premium difference was north of $3,000 less, for a plan that he might have to pay a maximum deductible of less than $2,300. So if he wasn't healthy (had to pay the maximum deductible), he would only be around $700 a head, if he was healthier during year (with no or little co-pay deductible), he could be up to $3,000 ahead.

In my case monthy premium difference was $278, with a $2,100 deductible. Seemed like a no-brainer, pay $3,336 less premium, with a 'possible' max out-of-pocket deductible of $2,100. In my thinking I would still have over $1,200 that I could spend farming. 

YMMV

Larry


----------



## RockyHill (Apr 24, 2013)

Somewhere I got the notion that Plan F wasn't going to offered to the newbys in 2020. I've got a few months until I have to start making decisions. As of now I'm still in the thinking of lower premiums/higher deductibles.

Shelia


----------



## Palmettokat (Jul 10, 2017)

As to BCBS and Farm Bureau, no idea in any other state than SC but here BCBS pays same regardless the premium. They pay a flat dollar amount I think am correct now on all of their coverage types.

As to the High Deductible Plans, can be very good option. As a general preference find most people just do not grasp the idea that has been given of premium versus the risk taken. I tell people you buy health insurance with a calculator. Any time the amount you save is more than the extra risk you take you go for the lower premium. Great example was given.

The truth on Plan F: if you were not eligible for Medicare by 2019 you will not be eligible to ever enroll in a Plan F, the standard or the High Deductible Plan F. Plan G and High Deductible Plan G (new) will be the new go to plan there.

Going further on the idea of what does a health person need: we all know we none know how long one will remain healthy. Have a friend and client who my understanding never really had any sickness till he was 78 but he really turn bad in hurry and if blessed to live to this Saturday will be 80, I pray he makes it. But still we make the best decisions we can and go from there.

First when you age into Medicare (age) AND enroll in Part B, you are by law guaranteed you are able to enroll or buy any Medicare Supplement sold in your area regardless your health and only thing near a health question that be asked is do you use tobacco. That is considered a rating question. FYI some companies do ask and some do not. So if tobacco user you need to ask. You never have this opportunity again, there are some "Guaranteed Issue" that can happen but rare but not as broad based. After this enrollment you are allowed to change Medicare Supplement companies but they are allowed to ask health questions and they all do ask and they have the right to decline your application. NOTE IN SOME STATES the state may have a law that gives you more options here but Federal Law does not. So try to pick a solid company up front and also the plan you want, such as Plan F or G or N or which ever. How long do you have to enroll? For Medicare Supplement you have 6, six months beginning with the month your part B is in force and you are at least age 65. Unless it is the first day of the month then it begins one month earlier but Part B begins one month earlier is why.

Now the example of 3 moths before and 3 months after which is a total of 7 months if for the Drug Plans and the Medicare Advantage Plans. Don't you love Federal Laws? Why they could not use the same time limits makes no sense.

Now if you enroll in a Medicare Advantage Plan you are able to change to any other MAPD between Oct 15th till Dec 7th unless you have End Stage Renal Disease (by Federal Law). These plans are taking more and more of the market. Premium is good bit lower than Medicare Supplement and some include benefits Medicare itself does not. Such as dental, vision and hearing aids. There is no standard on those add ons. Some are very good and some have say a $100 per year benefit which is only a token. When you consider this plans often do include those add ons and they also have the drug coverage built into them and the premium at least here run at least $100 a month less than a Medicare Supplement and Drug plan per month you get some idea why they are gaining market share. Many people do not understand these plans. They are a great option, better than many want to admit but many many agents really do not understand them Hate to say it but there are a lot of agents who cannot explain how to pour water out of a boot when it comes to those plans. The just enroll you in what ever you tell them you want. The way the AEP works it is seasonal work like Christmas for Wal Mart with part time agents. Find a full time agent that is there in June.

If you are considering a MAPD plan here are things to look for and consider:

Be sure you understand what the cost if for in hospital stay. Normally any item related to that stay is included with the COPAY you must pay, as long as provided by the hospital. Be sure you understand what the MOOP or Max Out Of Pocket is it for both in network and out of Network. Know if it is a PPO or HMO. This agent will not sell a HMO, at least in my area too limited on providers. Verify your providers are your medication is covered (verify your medication is covered if buying a free standing drug plan also). I strong suggest you go on line and view the providers for your area and not just one hospital. Look further, if your local hospital does not handle say heart surgery or major cancer where would you go? Are they in the network?

Medicare with Plan F or Plan G is hard to beat for the Medical Coverage. Can not beat those options for providers. Any provider who accepts Medicare is there for you. No network, no referral and the most you have to pay for this year is with Plan G $185 for the full year (that is the Part B deductible). Again the premium is for age 65 here going to run from about $130 per month for the Supplement and Drug Plan. But for those who like to travel, or those who want to have full freedom on what provider they use, or who want to have a plan that can not be decreased in coverage or taken away even by Federal Law (only health insurance guaranteed it can not be cancel for any reason other than the premium is not paid by Federal and State Laws) then you want Original Medicare and a Medicare Supplement.

If you want the most for your money and your health is decent and you are willing to verify the provider is in your network and you are willing to not always able to get your preferred provider and especially you would benefit from the add ons a MAPD can really be good.

Each person's wants, needs and agility varies. I am 66 and went on Medicare Supplement and stand alone drug plan the first of this year. It cost me about $130 per month for those two coverages. I had an emergency room visit which was about $5,500, and MRI on my shoulder few months later (not related to the ER visit) and two specialist visits and I think three primary doctor visits for the year so far and all I have paid is $185. Being totally honest if that is all my claims for the year I would be better off with a MAPD. My premium on the plan I would have bought is $25 per month and what I would have had to pay in copays would have been $90 for the ER visit, $10 each for the primary office visits, $45 each for the specialist visits and $150 for the MRI. All combine good bit less than the premium I am paying.

Also for about the last four years since they improved Plan G have only sold Plan F to those who demand it. The premium difference between F and G is much more than the difference in coverage. One other thing, if you are considering a Med Supp and are age 65 do ask for rates if you were age 70. In most states rates change with age. Some companies use very low for them rates for those age 65 and by 70 have often good bit higher rates compared to some of the other companies.

One last thought here: the MAPD plans rates are the same regardless your gender, tobacco use or age. So as we get older the difference in premium between them and Med Supps grow.

Also, if you use a HSA and buy one of the High Deductible Med Supps you are not allowed to contribute to the HSA. Does not meet the deductible required to fund a HSA.

Sorry for how long this is but there is a lot to consider, I strongly recommend an agent who really works there products you can meet face to face. As I say, ask them to put there finger where it says what they are promising. I have nothing against say Farm Bureau but we all know the saying and I bet you know it well in your farming: jack of all products and master if none. The Farm Bureau agents I know and yes I have friends with them and also my farm insurance, they are expected to sell so many different products it is to me unreasonable. I use to be a partner in an agency where we sold full line of products and we split who sold what so they would know the product they were selling. I will also say when you work with an agent who can only sell Brand A, it must be the best brand for all needs, regardless how well or poor it fits.


----------

