As an expert on appropriate Medicare plans for my clients, if I had a penny for all the Medicare myths I keep hearing day after day from those who become clients and even those who do not I would not have to be educating and assisting the Medicare population as I do each day. Here are a few.
Please do not think the myths below are a knock on any plan, as all plans have pluses and minuses. (FYI: Due to CMS regulations I cannot directly name specific carriers or companies.)
Those supplement plans (ones with the letters) you hear about from age 50 or so on from every type of media source that states “This is the only the plan endorsed by ABCD organization,” although true that it is endorsed by that ABCD organization, the ABCD organization that endorses it has nothing to do with the company selling the plan as the company selling the plan is paying (nothing wrong with that) the ABCD organization a huge endorsement fee each year to allow it to advertise same. Those same plans are now available for less money from another major carrier. That brings me to Myth 2.
The more you pay or the more well known the carrier is to your doctor, facility and their staff, the better and more efficient your care will be. Person A is paying $300/month for a top supplement plan. Person B, a $0/month premium and a $15.00 co-pay for their primary care doctor on an Advantage plan. They both have the same primary care doctor. Person A has a 2:00 appointment and Person B a 1:30 appointment for their annual physical, which takes an hour. If you think the office manager, physician staff and/or the doctor will cater to person A once they arrive and pay less attention to person B you are mistaken. The $300 from person A goes to the carrier, not the doctor. For Person B, the $15 co-pay is not going to quite cover an hour exam. The doctor will receive additional payments from Medicare and/or the carrier to cover their costs.
Similar to Myth 2. No way Major Carrier B’s drug plan costs only about $20/month and Major Carrier A’s plan, which I have been using for the last 10 years, is $80/month. Those drugs for Carrier B must be defective!
It’s true (no—not defective drugs), as I have a client now that has been paying $80/month, and when she heard about another major carrier that is actually less than $20/month she was in disbelief. The drugs themselves are $5 or less per month on either plan. Which would you choose for 2019?
That example is why you need someone to check both your Medicare health and drug plan each year whether the drugs are part of an Advantage plan or in a separate Part D drug plan. FYI: The carriers do not make the drugs so there is never a quality issue with the carrier used.
Annual open enrollment (AEP, which is from October 15-December 7 every year) is the only time during the year anyone already in the Medicare-eligible market (i.e., over 65) can change their plan. Wrong! Plans can be changed anytime during the year based on certain criteria such as being in an approved state pharmaceutical program, developing a chronic condition as defined by Medicare and others, which due to space I will not go into here.
By Robert Remin