aminsure No Comments

Medicare Supplement or Advantage plan?

There are two ways to “plug the holes” in original Medicare Part A and Part B. Most people don’t understand the difference between the two and often they regret their decision. A description of how a supplement works is on the main page under Medicare but I did not give a description of Medicare Advantage plans or how they differ.
A Medicare Advantage plan is offered by the Federal Government but by an insurance company or a not for profit hospital system. With these “Advantage Plans” (also known as Part C) you must use the doctors in their network (or pay appreciably more for service with some plans). Their network will have almost every type of doctor imaginable but perhaps not the one you want. You must use the hospital in their network. If you want to use Hopkins but belong to Medstar you will be paying much more or if you want to use Union Memorial and belong to Hopkins same thing. It must be noted that in the event of an emergency you may go to any facility but once stabilized you will go at your own expense to a network hospital.
With Advantage plans you will likely pay $25 or so to see a primary care physician or $50 or so for a specialist. A hospitalization is in the neighborhood of $250 per day for the first week. The prices change every year.
With Supplement plans you likely are going to pay less than $200 per year for your doctors and hospital copays. Under no condition will you pay more than $2,900 for any plan that I will sell. Advantage plans have a maximum out of pocket of at least $5,000 and as much as $10,000 per year! Unlike Supplement plans you will pay fully 20% of all costs for things like chemo or radiation or pacemakers. You will pay 20% towards durable medical equipment like wheelchairs and walkers. This all counts into your annual maximum out of pocket.
When you get a Supplement policy you can do it automatically when you turn 65 (or first get Part B) after that you will have to answer health questions including whether you are a smoker. With Advantage plans the only health question is whether you are on dialysis. For this reason, Advantage plans will likely end up costing you more not less over the years even though the monthly premiums are lower.
Now nothing is right for everyone and I have certainly enrolled many people in Medicare Advantage plans but after 25 years of representing Supplements and 10 years of representing Advantage plans I can tell you without questions that I have fewer people complain or drop their supplement plans than I have people want to switch into an Advantage plan. This article is not all inclusive, this did not talk about special need plans, Medicaid, or drug plans. Please call or write to discuss.
I am linking an interesting article from the Wall Street Journal “A recent report says many buyers of Medicare Advantage plans are confused”

Neither Abrams/Mendelsohn Insurance or Al Mendelsohn are connected to the US Government, the Medicare program or the State of Maryland. This is a solicitation for insurance in the State of Maryland. You may be contacted by an agent if you solicit information.


aminsure No Comments

Are you scared of high deductibles and copays?

Do the high deductibles and high out of pocket maximum on your health insurance scare you? They should and here’s why. In the last open enrollment period the average deductible that I placed was over $3,000 with an annual out of pocket maximum of over $6,000 for individuals and $13,000 for families. Remember, not everyone is smart enough to get sick or injured in January. A broken bone in December that has X-ray and MRI and cast in the winter will likely have physical therapy in January.
What can you do about it?

I am a believer in an accident policy with a critical care rider. Here’s how it works: you pick a deductible that you can sleep easily with, say $250, and a maximum amount of coverage of say $6000 and you are a family of 4 you would be looking at under $400 per year for a policy that protects against any kind of accident (certain exclusions apply like riots, drunk driving, professional sports). And that $6,000 is per person not total. Two kids falling out of a tree house or playing high school sports can be financially devastating. But what about sicknesses? A separate rider will protect against the financial catastrophe of cancer, heart attacks and strokes. $10,000 of coverage for these critical illnesses would be another $250 a year for all members of the family.

Now this policy does nothing for strep throat or appendicitis but those aren’t really the events that often lead to bankruptcy.

The situation today is that high deductible health plans have shifted responsibility for the lion’s share of health costs away from the insurance company and on to you. Did you know that 60% of bankruptcies in America are medically related?

It is easy to get one of these plans. For accident, the policies are guaranteed issue with no health questions for those under 64 and the critical illness policies are easy “yes” or “no” questions and you will know if you are going to get this policy before you sign the application.

Isn’t this a good time to get a quote so you can sleep a little more soundly at night?

These policies also pay no matter what other coverage you have. If you are in a car accident and you have PIP or if your health coverage paid for it all because you had already hit your deductible or out of pocket maximum, you get to keep the money no strings attached.