Finding a Medicare advisor in Omaha, NE, is not difficult. If you are turning 65, marketing companies sell your contact information, including birthday and phone numbers, to insurance agents. Lead companies are mailing you business reply cards (BRC) in hope that you will fill them out and mail them back in. Direct mail marketing companies are sending you postcards, flyers, and brochures because they want you to call their 800-Medicare number. Joe Namath and Jimmy J.J. Walker are on an endless loop of commercials coming into your living room telling you about the unbelievable Medicare benefits you do not qualify for. Dynomite!
You will have to contact the FBI witness protection program to avoid the onslaught leveled against you as you approach Medicare eligibility!
Just Having An Insurance License Does Not Make You A Medicare Advisor
As you age into Medicare, an army is coming after you–an army of insurance agents. Some insurance agents, like me, have been around for a while. I earned my Nebraska & Iowa insurance licenses in 2003. Other agents just get their license for the Medicare Annual Election Period (AEP) when Medicare beneficiaries can change their Medicare plans. During those seven weeks of Medicare Annual Election Period AEP (Oct 15th–Dec 7th)–sometimes called “Open Enrollment”—Medicare insurance agents in Omaha, NE, are looking to make some money. They want to get new Medicare clients who are looking to change their Medicare plans.
People, however, are trying to find a Medicare advisor in Omaha, Ne, who is knowledgeable, competent, and trustworthy.
What Does It Take To Become A Medicare Insurance Agent in Nebraska?
A Nebraska insurance license only means that you passed the licensing test and paid the $50 licensing fee. It doesn’t tell you how many times the person took the test to finally pass. It doesn’t tell you her score. You cannot even determine how long the person has been licensed, though you can find out their license number on the Nebraska Department of Insurance website.
While doctors, lawyers, real estate agents, and even hairdressers go through a lengthy and difficult training and testing process, insurance agents for Medicare do not. I do not say this with any sort of pride, but as a matter of fact. Many of my fellow Medicare agents in Omaha, NE, have little or no training, are doing this as a temporary part-time gig, and/or will probably let their license drop at the end of the year.
Baby Boomers Increased The Demand For Medicare Advisors
Medicare health insurance is a federal program that began in 1965. The government created it because most insurance companies did not offer affordable health insurance to seniors. Congress intervened to create a program to protect seniors who were going bankrupt handling healthcare as the American population was living significantly longer in large numbers by the 1960s.
Insurance companies quickly developed insurance products to supplement Medicare where it was lacking. Insurance agents started selling these Medicare supplements. As the baby boomers started aging into Medicare, the demand exploded. There was more demand than what insurance companies and agencies could handle, so they began mass recruiting to find people to sell Medicare supplements. Recruiters promised the usual things to attract large numbers of people–huge sums of money and easy work.
The sales pitch works because each year, thousands of people get their insurance licenses and become Medicare advisors in Omaha, NE, but quickly they find the work is not easy and they do not become rich overnight. Consequently, after they sell to a few friends and relatives, they let their license lapse. The people they signed up then lose their agent.
The Fallout from Poor Medicare Advisors
The consequence is Medicare beneficiaries are left on their own with an insurance product they probably do not understand in a health insurance program that is as foreign as a foreign language. The agent-less persons are now older. Their needs and circumstances are probably changed, and their income is even more limited. It is a bad situation.
While Medicare is not rocket science and I am not a brain surgeon, Medicare and Medicare insurance products have a certain level of complexity. A person needs a knowledgeable advisor to help them avoid pitfalls and maximize their benefits because Medicare and insurance products are always changing.
Independent Medicare Advisors in Omaha, NE
We are independent Medicare advisors in Omaha, NE. That means we do not work for an insurance company. We are not captive to an insurance company restricted to selling only one company or brand. We offer a large variety of companies in Nebraska and Iowa–the big names and the small. They all pay us the same commission, so there is no incentive to offer one company over the other. We are Omaha, Nebraska, Medicare insurance brokers, so we look for the best deal for our clients.
How to Pick a Good Medicare Insurance Agent in Omaha, NE
First, we offer both Medicare Supplements and Medicare Advantage. These are both great options for those whom they fit. Our goal is to educate you on Medicare. The official Medicare handbook, Medicare & You, is over 120 pages of incredibly dull reading. We make it simple and understandable.
Secondly, we show you the actual Medigap and Medicare Advantage plans. Our software pulls together the policies and prices in nice neat rows and columns so you can compare and contrast. You can see the plans on one big four-foot computer screen, and we print out the quotes on one sheet of paper you can take with you.
From my experience, people come to us with separate quotes from various companies and a number of different agents. The mess of papers adds to your confusion. We pull the data up and let you see all the copays, co-insurance, maximum out-of-pocket, and premiums. It is only when you can look at them side-by-side on one computer screen and sheet of paper you can really see and compare.
We print out the quotes so you can take the material home with you. There shouldn’t be any pressure to decide or buy ‘right now.’ Picking a Medicare plan should not be a rush.
Finally, we find out about you and how you wish to manage your healthcare needs. Everyone is unique in how they wish to handle healthcare. Some of that has to do with your personality. Other reasons are your health. Your budget is an important determining factor. We work with you to see what fits you and is most comfortable for you.
Find A Medicare Advisor in Omaha, NE
You will be on Medicare hopefully for a long time. You want your Medicare advisor in Omaha, NE, to walk with you during that time to help you adjust and change as needs and times change. This is an important relationship for the long haul. Give us a call and find out how we help 402-614-3389.
Medicare Modernization Caused Medicare Confusion
After Congress created Medicare and President Lyndon Johnson signed the Medicare program into law, insurance companies began designing and offering health plans to fill in the gaps in Medicare-covered services. Insurance companies started developing many Medigap policies to fill in Medicare Part A and Part B gaps. There were no federal guidelines or laws for Medigap policies at the time. Each state insurance department regulates the private plans within its own state. The growing number and complexity of the Medigap policies started to confuse consumers. Shopping and comparison among plans were difficult. Medicare needed the Medicare Modernization Act only a few years after the creation of Medicare.
The National Association of Insurance Commissioners (NAIC) develops rules for insurance regulation and coordinates those laws among the states. They devised rules for the new Medigap policies that eventually were widely accepted. In 1980, Congress established its own policy standards for Medigap plans that each state could adhere to voluntarily. Congress finally directed the NAIC to update the model regulations for Medigap plans, and Congress enacted mandatory federal Medigap standardization requirements in the Omnibus Budget Reconciliation Act of 1990 (OBRA). By 1992 state insurance commissioners standardized Medigap policies across the states. Congress prohibited insurance companies from selling Medigap policies that did not conform to the new standardized Medigap insurance regulations.
The initial standardization of Medigap policies in 1992 created ten different health plans, labeled Plan A through Plan J. Congress required each plan to provide the same benefits and provisions, regardless of the issuing insurance company. In effect, the plans were identical except for the price. The Medicare Modernization Act of 2003 enabled consumers to compare Medigap plans more easily. The plans were limited to a smaller number with the same features and benefits. The only variable was the price. By reducing the number and variations of Medigap plans, the standardization reduced confusion significantly.
The Medicare Modernization Act 2003 (MMA) added two new plans, K and L, to the lineup of standard plans bringing the total available for sale at that time to 12 Medigap plans. Congress added high-deductible options to two of the existing plans (F and J). The improvement and modernization act also included two significant changes.
Medicare Advantage Renamed & Medicare Part D Created
The Medicare Modernization Act modified Medicare + Choice and renamed it Medicare Advantage. They also added prescription drug coverage as a new and standalone plan. Skyrocketing drug costs devastated seniors, so the Bush administration spearheaded prescription drug plans to limit out-of-pocket costs. (For time’s sake, we will modify this discussion to only Medigap plans and discuss managed care in other blogs.)
Third Generation Medigap
The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 expressly authorized
the implementation of Medigap policy revisions adopted by the NAIC in 2008. Each state regulates all insurance within its borders. Federal authorities pressured state insurance commissioners to adopt the NAIC changes.
The 2008 Act also introduced the “third-generation” of Medigap standardized plans. Medicare insurance companies introduced new Medigap plans and eliminated others effectively on June 1, 2010. Plans M and N increased cost-sharing features. Medicare insurance companies stopped Plan E, H, I, and J to eliminate duplicative and outdated Medigap plans. Center for Medicare & Medicaid Services (CMS) required Medicare insurance companies to stop offering prescription drug plans in all Medigap policies. (Those currently enrolled in discontinued plans may keep them.) CMS’s changes meant that beginning June 1, 2010, the “third-generation” of standardized plans consisted of ten different Medigap plans. Only these Medigap plans were available to purchase for new customers from that point on—including two with high-deductible options.
Latest Medigap Policy Changes
Medicare’s next stage of development from the Medicare Modernization Act was the Medicare Access and CHIP Reauthorization Act MACRA of 2015. Congress created a Medicare Quality Payment Program intended to encourage medical providers to focus on value over patient volume. Medicare Access and CHIP Reauthorization Act also included a significant change to Medicare supplement insurance options. Effective January 1, 2020, the sale of Plan C and Plan F (including the Plan F high-deductible option) policies stopped for newly eligible. “Newly eligible” means anyone who attains age 65 on or after January 1, 2020.
Individuals who purchased Plans C or F policies sold before January 1, 2020, are grandfathered into those plans. Beneficiaries may keep their Plan C or F. Those eligible for Medicare before that date may also still purchase them going forward. The eligible includes individuals who were eligible for Medicare before January 1, 2020. Medigap insurers will continue to maintain existing C and F plan policies. Still, they may not sell a new C or F (including high-deductible F) plan to anyone who was not qualified for Medicare before January 1, 2020. In other words, they turned 65 after January 1, 2020.
Medicare Access and CHIP Reauthorization Act of 2015 change is significant because Plans C and F are the only plans that include coverage for the Medicare Part B deductible. These plans were very popular. Eliminating these plan options was difficult but necessary to reduce future Medicare costs by discouraging unnecessary medical services. Congress reasoned paying a small deductible, such as the Part B deductible, would prevent unnecessary medical treatment and consequently help curb waste and abuse.
Understanding Evolution and Changes Avoids Confusion
Understanding the history of the evolution of Medigap policies and the government regulations that mandated the changes is vital to avoid confusion. Medicare beneficiaries hear about Plan F, Plan J, Plan this or that. They don’t understand why they can’t get those plans. There are fears they may lose coverage. Medicare beneficiaries do not realize CMS grandfathered them into their Medigap F or C plans. Awareness of Medicare’s continual changes prevents people from making wrong or outdated choices about their health care.
Change is a constant. Since its inception, Medicare has changed. The Medicare Modernization Act and subsequent Congressional legislation have tried to keep up with the changes in healthcare, consumers’ needs, and a drive for more efficient and cost-effective healthcare systems. Congress and President Johnson could not have imagined that what they started would become the complex and colossal system that cares for so many Americans today.
Mistake 1–The Cost of Medicare Supplement Plans is Different, but the Plans Are the Same
The line I hear repeatedly is ‘I’m looking for the best coverage for the least amount of money.’ Here are some common mistakes consumers make when selecting their Medigap plan.
The key to understanding the cost of Medicare supplement plans is knowing the law.
Since Medicare’s creation in 1965, insurance companies jumped in to fill in the gap figuratively and literally. They designed Medicare supplements or Medigap policies to fill in the gaps in Medicare coverage. The number and variety of Medigap policies grew exponentially which is the blessing and curse of capitalism. The number and kind of policies were so many that it was a problem for consumers.
Consumers were confused. They could not understand and discern the best plan and policy for their individual needs and budget. Congress eventually went through three different legislative processes over the years to regulate Medicare, the supplements, and plans. One of the purposes was to improve the consumer experience through simplification and consolidation.
The result is that Medicare supplements are limited to a certain number–plans A through N. All of these plans are standardized. They are essentially the same in their structure and coverage. A Plan G is a Plan G. It does not matter which insurance company offers the plan G. It will be the same plan G, or Plan N, or Plan A, etc. with any company.
Prospective clients have a hard time believing that the cost of Medicare supplements plans is different when the coverage is identical. They think supplements should be like other products, e.g., tires, jeans, cell phones, cars, and houses. There should be a measurable qualitative difference to correspond to the higher price.
Medicare supplements, however, are intangibles. They are a promise to provide a service. Consequently, it is more difficult to create a difference with a corresponding price point.
The other incredulity is why some people pay more if the policies are all the same? The reason is people are unaware of what I just shared, and they do not shop. They usually go for the familiar and the big names. It is human nature to go to what is familiar and perceived safe.
Mistake 2–Impartial Shopping the Cost of Medicare Supplement Plans
I suspect people want to shop for a Medicare supplement about as much as they want to go to the dentist to get their teeth drilled. They do not want to do it, so they make as little effort as possible.
Some agents count on that. They show you the most common or popular brand names. They usually are names you are asking for anyway.
Agents do this for several reasons. First, it is easy. They prefer to use the same company, application, brochures, software repeatedly. Second, they may have a preferred contract with the company that pays them or their agency more than other companies.
Sometimes this may include contest prizes, like trips for selling a certain number of policies within the year. If an agent divides up his business among several insurance companies, it is hard to hit that quota. That is why they stick to one company and push it.
And the higher the premium, the more the agent is paid. That is the game of the cost of Medicare supplement plans
Impartial & Objective
I find the best, fairest, and clearest way to show Medicare supplements is with a quoting software that puts the plans side-by-side. The only differentiator is the price. In descending price, I put the quotes assuming most people would rather pay less rather than more for the same coverage.
CSG Actuarial is the software company that I use. I believe the Nebraska & Iowa SHIP offices use the same software. It is a very robust software offering more information than most people realistically need.
The purpose of this tool is to impartially and objectively shop Medicare supplements for prospects and clients. I show you my work. I am not holding back any cards or favoring any companies.
Shop your supplement impartially and objectively.
Mistake 3–Company Strength
Some prospective clients ask me about the insurance company’s strength. I point to the rating agencies. There are four principal rating agencies: Moody’s, A.M. Best, Fitch, and Standard & Poors. AM Best is probably the premier rating agency for insurance companies. The other agencies spread out their expertise among bonds, banks, and other financial institutions and products.
The purpose of the credit rating agencies is to determine the probability a company will pay on all its obligations.
While I don’t wish to discredit the credit agencies, I would like to offer some context. Many of you may remember the Great Recession of 2008. Up until 2007, the credit agencies were still rating the CDO’s (Credit Default Obligations) as AAA. It wasn’t until after the bottom had started to fall out that the credit ratings changed.
There are some great scenes in the movie, The Big Short, where Steve Carell playing Mark Baum, asks a representative of one of the credit agencies–S&P (Standards and Poors)–why they had not downgraded the CDO’s even though the defaults on the loans were through the floor. “If we don’t give the banks the ratings they want, they will go down the street to Moody’s or one of the other rating agencies.”
The ratings that the credit rating agencies put out are helpful, but not infallible, complete, or perfect. Each company has a story. I have been around for several years, so I am familiar with many of the companies. I have worked with some, watched others, heard from other agents about some. There are many factors that should be weighed when selecting a company with which to entrust your Medicare plan.
Mistake 4–Age & Rate Increases
The two ways an insurance company prevents itself from going broke when medical costs increase, or claims are unexpectedly higher is through age increases and rate increases.
Age increases are hard-baked into the price of the supplement. There is a schedule that goes out a certain number of years. As the client ages, the price goes up.
Secondly, insurance companies can increase the premiums across the board on everyone in a pool of policyholders. Clients submit claims. The insurance company has factored in the approximate number of claims in a particular zip code, county, region, or state.
That is the art of actuarial science. Sometimes they are spot on. Other times, they miss, even a great amount. The number they are shooting for, of course, is always moving as medical costs rise due to inflation–or pandemics.
Insurance companies cannot pick out an individual or group that may cost them more because of claims. It must be on the wider group or pool of policyholders.
Mistake 5–Understanding Customer Service
Customer service is a perennial concern. We have all been on hold with customer service with different companies and had atrocious experiences. They hang up on us after a long wait. The customer service rep’s accent is too strong to understand. We are caught in a labyrinth of auto prompts that take us in a circle.
Medicare supplements insurance is quite simple. If Medicare pays, the supplement pays. If Medicare does not pay, the supplement does not pay. It is rare for someone to need to call about bills. Generally, then you call Medicare itself, not the insurance company.
Quality of Service
Not all companies’ customer service is created equal. The difficulty I sometimes have with clients is convincing them that one insurance company with which they had a good experience on their employer health plan is not so good on the Medicare side.
On the reverse, clients who had a negative experience with a certain insurance company on a particular plan are great when it comes to Medicare.
It is funny that people generally blame the insurance company for a bad plan when an insurance company has many different health insurance plans from which to choose. People do not often deduce that their employer is the one who picked the plan, and if they picked a poor-quality plan–to save on employee overhead–employees may have a poor experience of healthcare from that company.
Feedback On Customer Service
One of the experiences I have had as an insurance agent is daily feedback. That is why I am not a great fan of the SHIP programs. SHIP is a semi-government group of paid and unpaid volunteers who help citizens with Medicare. They are supposed to be impartial. The problem is they do not get feedback from consumers on the advice they gave. Policyholders are not calling them complaining when something goes wrong when procedures are denied when Medicare or the insurance companies mess something up. No one calls them two years later to say, “I got a 15% increase to my Medigap policy with the company you suggested.” The person they talked to is probably no longer there.
Dealing with many insurance companies over time and in various situations and circumstances is important in helping consumers get a fuller context for their plan selection.
When people talk about Medicare Part C or Medicare Advantage insurance plans in Omaha, Nebraska, they are usually making a comparison. The comparison is generally to Original Medicare and a Medicare Supplement with Part D. These are the two main ways most people get their Medicare. These two ways are very different, and I don’t believe it is really possible to make a legitimate comparison. But, as we used to say as kids, everyone does it. So let’s do it.
Medicare Advantage Insurance Plans in Omaha Nebraska vs. Medigap
The principal reason I don’t believe you can compare Medicare Supplements to Medicare Advantage is that Medicare Supplements are the same across the country. A Plan G in Arizona is the same as a Plan G in Maine. Medicare Advantage programs, however, are different from state to state and even from county to county. So I will compare Medicare Advantage insurance plans in Omaha, Nebraska, to Medicare Supplements here.
Low-Cost Medicare Advantage Plans in Nebraska
Price is the main attraction for many of my thousands of clients to Nebraska Medicare Advantage (MA plan). Most of the plans have no premium. A couple of them have minimal premiums, like $19, but the majority is zero. Clients like that, but they especially like the price in comparison to Medigap monthly premiums. A Plan G in this area for a male is approximately $150 per month on the low end. A drug plan could be $20 more or less. The simple math for a Plan G and a Part D prescription drug plan, including the Part B deductible, is around $2,200 a year. Most people do not spend anything close to that in annual copays on a MA plan.
Yes, one year or maybe two years, you might spend more than that on a Medicare Advantage plan in Nebraska, but over five, ten, fifteen years, most clients will pay out far less than the monthly Medigap premium that is constantly increasing with age and rate increases.
Medicare beneficiaries constantly compare notes, which is an excellent source of referrals for me. I had a young lady come in recently. Her son, a client, brought her to the office to save money on her Medigap policy. She was 96 and paid $500+ per month for her Medicare Supplement. We submitted an application for a lower-cost Medigap policy since she was in good health. She passed, and we saved her over $3,000 a year. The cost of many Medigap policies can get entirely out of hand.
An agent should have been helping her keep her costs down all this time, but regardless, people see the price of supplements. They look at the Medicare Advantage insurance plan in Omaha, Nebraska, with no premium and very minimal copays, and they ask themselves, ‘Why?’
Why Pay Thousands of Dollars in Medigap Premium Each Year?
In the last analysis for most people, Medicare Advantage will result in less out-of-pocket costs than Original Medicare and a supplement and Part D plan in the long run. In the short run, most people will pay less with a Medicare Advantage plan. The general population recognizes this, which is why the continuous increase in enrollments throughout the country into Medicare Advantage plans.
Medicare Advantage Insurance Plans in Omaha, Nebraska, Maximum Out-of-Pocket
The downside of Medicare Advantage plans is when someone is seriously ill. One of my clients, a high school math teacher, developed leukemia, and the treatment was costly. The illness and treatment began in the fall. He hit his maximum out-of-pocket at that time, which was $4,900. The following year the treatments continued, and he reached the maximum out-of-pocket again. Dan was not happy about being on a Medicare Advantage plan. His cancer appeared a year after he started on the plan.
We discussed switching to a supplement once his cancer went into remission. I waited two years and called Dan to do a supplement. Medigap plans usually have a two year gap required of being cancer-free. When we talked, he had decided to stay with the Medicare Advantage plan. He saw how over time, it saved him money. It must have been the math teacher in him. I was surprised, and I reminded him how upset he was a couple of years ago. He assured me that he was ok remaining on the plan, and he reminded me how emotional cancer can be.
I always remind people the maximum out of pocket is an actual number. The chances of one hitting that number at some point are real. I highly encourage clients to save the money they would otherwise spend on monthly premiums to offset the cost of copays and a challenging year.
Doctor Networks In Medicare Advantage Programs Omaha, Nebraska
Yesterday, I met with a lady who told me, “I don’t want a plan that tells me what doctors to see.” When I hear that phrase, I know they have listened to a Medicare Supplement advertisement or someone on YouTube deriding the evils of Medicare Advantage.
Medicare Advantage plans have networks just like the employer health plans most people were on most of their lives. Insurance companies develop networks for the purpose of keeping prices down.
As I said earlier, Medicare Advantage plans are local plans. They design the Medicare Advantage plan around a particular area, and the networks are no different. In the Omaha Metro area, which includes Lincoln, Bellevue, and Council Bluffs and all the small towns surrounding, there are three networks. Virtually every health professional in the area is associated with one or all of these networks. There are a couple of independent hospitals, but they also affiliate with the local Medicare Advantage plans in Omaha, Nebraska. In our area, there is absolutely no issue, and the networks and plans are going nowhere. These local plans and networks have been working together for years.
In other places, like Kansas City, where I have clients, the Medicare Advantage network criticism has some merit. I carefully check and double-check doctors and hospitals in that area because it is not as homogeneous as the Omaha Metro area. Of course, the Kansas City Metro is much more significant in terms of population and area. With 35 Medicare Advantage plans in Kansas Metro, finding the doctors and hospitals you prefer is not hard.
National Networks And PPO Plans
But the network issue is actually becoming irrelevant as Medicare Advantage plans develop and grow. A larger and larger majority of doctors and medical facilities are becoming part of the MA network systems, and many of the insurance companies that offer Medicare Advantage plans also have national networks. With some plans, even HMO plans, clients may access doctors and hospitals across the country and pay in-network prices.
For a while now, the insurance companies have included PPO (Preferred Provider Organization) plans. With a PPO plan, you have the in-network providers, like an HMO. Those doctors and medical facilities are at the lower in-network copays. The doctors and medical facilities not in-network cost a little more and have a higher total maximum out-of-pocket. As long as the doctor and hospital take Original Medicare, they will accept the PPO plan. Either way, this issue is becoming more and more a non-issue.
I also try to bring people back to reality. I ask, ‘How many times in your lifetime or your family have you left your area to go to a doctor or hospital over a hundred miles away?’ The reality for most people is zero. Sometimes the emotional sales language of the Medigap only insurance agents can cause a disconnect.
Medicare Advantage plans manage care like your employer’s health plans. The insurance company monitors the treatment you receive to make sure it is within customary standards of treatment. If not, the insurance company will question the requests. So the insurance company must approve a majority of the procedures before they are performed.
Original Medicare does not manage care in the same way. Providers must meet the same standard of care, but there is no thorough review or preapproval process.
Ironically in the same turn, Medicare hammers hard on the subject of Medicare fraud. CMS (Center For Medicare & Medicaid Services) encourages Medicare beneficiaries or whistle-blowers to report waste, fraud, and abuse, but they do not have the same preapproval process that would significantly reduce waste, fraud, and abuse.
How To Stop Waste, Fraud, & Abuse?
Fraud is fairly self-explanatory. It is financial gain through deception, but waste and abuse are what the insurance companies try to avoid through their managed care practices. Doctors will sometimes overprescribe. They recommend treatments that are more–and consequently more expensive–than is customary and necessary. For example, the doctor recommends an MRI for a shoulder problem instead of physical therapy to handle the issue. You might say to yourself that it’s up to the doctor, but there are customary and standard procedures of diagnosis and treatment. What would prevent a doctor from ordering a whole list of tests and procedures because he wants to be extra special careful.
An MRI is much more expensive than a couple of visits to the physical therapist that may solve the problem. If the physical therapist concludes that more than a few treatments are required to repair the issue or the treatment does not work, then the treatment moves to the next level, which may be getting an MRI at that point.
Some people may like that more liberal approach to health care. Original Medicare and Medigap policies will be a good fit. For those who are not concerned about the insurance company managing the care, as you experienced during your working years, then managed care or MA plans are a good fit.
Dental, Vision, Hearing, & More In Medicare Advantage Plans In Omaha, NE
The feature that is a big attraction for Medicare Advantage plans is the additional benefits, such as dental, vision, fitness membership, etc. Original Medicare does not cover dental or vision in the form of eyeglasses. Those are benefits seniors want and do not want to pay an additional premium for a dental & vision plan.
The Medicare Advantage insurance plans in Omaha, Nebraska have those benefits in varying amounts–teeth cleanings, $1,500 toward crowns & root canals, $300 for eyeglasses. The fitness memberships are attractive because it not only saves a member $500+ in gym fees annually, but it also gives them the flexibility to go to multiple gyms.
Part C or Medicare Advantage reduces the monthly cost for health coverage, provides broad access to doctors and hospitals, and adds additional benefits at little or no cost. For Medicare Advantage insurance plans in Omaha, Nebraska, the disadvantages that are problems in other places are not really issues here.
For those who do not wish to be on the hook for medical bills that may exceed $3,000 or $4,000 in a given year, MA plans may not be the best fit. If there is some concern that an insurance company may have more control over the management of their health care than Medicare itself, Original Medicare may be a better choice.
So, What Questions Should You Ask Your Medicare Insurance Agent?
What Is Medicare Advantage?
Sometimes there is confusion about Medicare Part C or Medicare Advantage insurance plans in Omaha, Nebraska. I have heard doctors’ offices call it “Medicare replacement plans” or “it is not Medicare.” So when asking what questions to ask your Medicare insurance agent, the definition of Medicare Advantage should be top of the list.
The key is in the name–Medicare Part C, like Medicare Part A and Part B. The Official Medicare.gov website says:”Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. They are sometimes called “Part C” or “MA Plans,” which are offered by Medicare-approved private companies that must follow the rules set by Medicare.”
Medicare mandates what the private insurance companies cover and even how they cover patients’ needs. The monitoring is incredible. This is definitely a question you should ask your Medicare insurance agent.
When I moved into my neighborhood, I got to know my next-door neighbor. He was a partner in a large public accounting firm in Omaha. When he saw my license plate–it says “Medigap”–he asked me to guess who his most prominent client was.
CMS (Center for Medicare and Medicare Services) administers Medicare. CMS is an enormous bureaucracy, but they do not have the capability to monitor something as complex and large as many insurance companies, so they hire auditors. My neighbor’s biggest client is Medicare.
His firm and many other accounting firms audit the financial and billing records of the insurance companies offering Medicare Advantage because Medicare is not directly administering the insurance programs like they administer Medicare Part A and Part B. Small world.
Even though private insurance companies design and administer the Medicare Advantage plans. “Medicare Advantage Plans must cover all of the services that Original Medicare covers,” as it says on Medicare.gov. Confused? These are questions you should ask your Medicare Insurance agent.
What Other Questions Should You Ask Your Medicare Insurance Agent?
Why Medicare Advantage?
In the early 1970s, Congress was trying to figure out how to keep the costs down for Medicare. They imagined involving private insurance companies and creating an atmosphere of competition. Over the decades, the program developed into what is now Medicare Part C or Medicare Advantage.
The number of Medicare beneficiaries on Medicare Advantage is over 40% and growing each year as the plan strengthens. The plans improve health outcomes from beneficiaries, more benefits, and lower costs to Medicare.
How Does Medicare Advantage Work?
How Medicare Advantage works is a question that you should ask your Medicare insurance agent. CMS, in effect, hired a private insurance company to develop a Medicare plan. The plan gives the same coverage as Medicare Part A and Part B. CMS pays the insurance companies an amount based upon the number of clients, ages, services, and outcomes. The formulas to determine payment have become increasingly complex as CMS and the insurance companies try to devise a system that motivates healthcare workers, institutions, and insurance companies to curtail costs and improve health outcomes.
You Should Ask Your Medicare Insurance Agent How To Compare Medicare Advantage To Medigap
Each type of Medicare plan is structured the same from place to place. The plans, however, vary in costs. High population centers like cities will have very rich plans compared to isolated rural areas.
They are not like Medigap plans that work with Medicare Part A and Part B, which are universally the same from one part of the US to the next. The population has absolutely no effect on Part A and Part B. The Medigap plans maybe even less in rural areas because older populations tend to move to higher population areas around doctors and hospitals. Thus Medigap claims in rural areas are fewer and smaller.
You cannot compare Medicare Advantage to Medigap in any way that is fair. They have two separate and distinct delivery systems for health care. Those who do attempt comparisons are usually building straw men to know down to serve their purposes.
One of the Most Important Questions to Ask Your Medicare Insurance Agent:
The first metric I like to consider is the maximum out-of-pocket. The maximum out-of-pocket (MOOP) is how much you potentially could spend out of your pocket while on that particular health plan in one year. During your working years, your employer’s health plan had a MOOP.
Many people confuse MOOP with a deductible. A deductible is the amount of money you pay before the plan begins to cover medical costs. For example, you have a $2,000 deductible. You go to the emergency room, and the bill is $20,000. You pay the first $2,000 upfront.
Then, you pay a coinsurance of 20% on the next $18,000, which would be $3,600 ($18,000 x 20% = $3,600).
This is how the maximum out-of-pocket (MOOP) works. The $2,000 deductible + $3,600 coinsurance = $5,600. If the MOOP is $6,000, you would pay $5,600. If the MOOP was $5,000, you would pay $5,000. This information is crucial, and it should definitely be part of the questions that you ask of your Medicare insurance agent.
I see the maximum out-of-pocket as the most important number because that is your potential maximum risk, which is why it’s so important to ask questions of your Medicare insurance agent about it. While it is highly unlikely that you will arrive at the maximum each year or any given year, there is some probability. Because of that chance, you should be prepared to cover that expense because you are contractually obliged.
If you have two years back-to-back of expense–imagine chemo and radiation for cancer over a year’s time–you could conceivably have two consecutive years together when you reach your MOOP both years. While the probability of hitting that maximum is very low, the possibility is always there.
You can either cover that risk by purchasing a Medigap policy instead of a Medicare Advantage plan and pay the monthly premium or save that amount each month until you have reserves equal to or greater than your MOOP.
When looking at Medicare Advantage plans in Omaha, Nebraska, the first number I look at is your maximum risk–the maximum out-of-pocket (MOOP).
What Other Questions Should You Ask Your Medicare Insurance Agent?
Medicare Part C Many Times Include Prescription Drug Coverage
Most Medicare Advantage also includes the Part D prescription drug plan, especially Medicare Advantage Plans in Omaha, Nebraska. I would run your medications through the Medicare.gov plan finder before going any further in plan selection. Many times I thought I had the best plan picked out, and then I come to find certain medications for that person or not covered. Or the cost of the medications is significantly higher than on other plans. Check the medications before doing anything else.
While you can ask for drug exceptions from a plan, I would absolutely not go into a new plan with that expectation. Ask your Medicare insurance agent to make sure all of the medications are covered and covered at a reasonable rate compared to the other plans in the area.
They Tell You What Doctor to Go See
Many times I will hear someone say, ‘Medicare Advantage plans tell you what doctors to see.’ When I hear that, I know that person only sells Medigap policies. Here’s a prime example of when you need a Medicare insurance agent to ask questions from.
Networks are important. The Medicare Advantage insurance plans in Omaha Nebraska are embedded in the three hospital network systems here.
You, of course, want to go to the medical professionals with whom you already have relationships. All three networks work with the principal insurance companies offering Medicare Advantage in the area. Those doctors, hospitals, and clinics are in-network. Even the few independent firms in the area also have relationships with the plans.
In other areas, the plans may not be as connected. You need to verify your doctors and hospitals before considering a plan.
What Are The Copays?
A question you need to ask your Medicare insurance agent is: what are the copays? Once you have determined the amount of MOOP you are comfortable assuming, verified your prescriptions and doctors, you look at the copays. Everyone has their own way of evaluating prices. Compare the various copays among plans, doctors, x-rays, MRI’s etc. Narrow down the number of plans. There is no perfect plan. There are always trade-offs.
Extra Benefits in Medicare Advantage Insurance Plans in Omaha, Nebraska
Many people focus on the extra benefits that Medicare Advantage offers, like dental and vision. Those are real benefits and should be weighed. However, dental expenses are usually not life-threatening nor do they run into the tens of thousands like health insurance or prescription drugs. This is a crucial place to ask questions of your Medicare insurance agent.
A particular plan may have a nice dental benefit of $1,500, but if the MOOP on that plan is $7,000 versus another plan with no dental at a $2,800 MOOP, I would favor the plan with the small MOOP. You can always purchase a separate standalone dental plan.
Many people do not realize that Medicare Advantage plans do not have underwriting like Medigap plans. During your Annual Election Period (AEP) October 15th–December 7th, you may change from one plan to the other without answering any health questions. The plan cannot refuse you. You may also change during the course of the year if you have a special reason for changing.
You Can Change During Annual Election Period (AEP) October 15th-December 7th
The Annual Election Period is the time when you may change your Medicare Advantage Plan. You don’t need a reason, but you could have one. You are not happy with the service. Another plan appears with richer benefits or lower MOOP and copays. You plan on doing extensive dental work and you want a plan with more dental for that year. There can be multiple reasons or no reasons for changing. You may change.
Ask Your Medicare Insurance Agent: Does Your Plan Have A National Network?
A concern people have with Medicare Advantage plans is with the network. The network concerns extend quite often beyond the local area. People are concerned about travel, outside of the service area, going to specialists not located in the service area.
Many of the major insurance carriers, including in the Omaha Metro area, have national networks. That is, you can go to doctors and hospitals outside of the local service area and still be in-network and pay in-network prices because the doctors and hospitals participate in the insurance company’s national network. This includes HMO (Health Maintenance Organization) plans. PPO (Preferred Provider Organizations) plans cover doctors and hospitals by design out of the local area. You may pay more, but you will have access. For emergencies, you are covered anywhere on Medicare Advantage plans. For some people, especially those who may travel, this is a concern.
Medicare is incredible health insurance. It comes in various forms to fit your needs and how you wish to be serviced. Medicare Advantage Insurance Plans in Omaha, Nebraska are a powerful way to receive your Medicare. Understanding the trust about Medicare Advantage and sorting through the exaggerations and distortions is important to make sure your needs are authentically served.
#1. Can You Change Your Medicare Supplement Without Underwriting in Omaha?
Outside of your Open Enrollment or Guaranteed Issue (GI) situation, you must go through Medicare Supplement underwriting in Omaha. This means all of Nebraska and Iowa as well. I had an incredible case a couple of years ago.
Several financial advisors refer their clients to me for their Medicare needs. One young man referred to me was 92. He had been on the same Medicare supplement since he was 65. His Plan F was $565 per month. I about fell out of the chair when he told me how much. The agent hadn’t contacted him in decades–probably dead!
I was concerned that he might not pass the Medicare Supplement underwriting questions here in Omaha, but I took an application—the same exact coverage he currently had. In a couple of days, I got the email from the insurance company he was approved and the policy issued. I saved him over $3,000 a year. I feel bad he had been neglected all those years and had overpaid thousands of dollars.
That’s why you want to check on your Medicare Supplement regularly. It may save you money to change. All you have to do is fill out the Medicare Supplement underwriting application and answer a few questions.
#2. What Is Medicare Supplement Underwriting in Omaha?
Insurance is about covering risk. Actuaries are super-mathematicians who figure out the risk. They mathematically determine the odds that something will happen and how much that something will cost.
What are the odds you will be in a car accident? How much will it cost? What are the odds you will get sick, and how much will that cost?
Actuaries use the statistical data of tens of thousands of people and your personal medical history to determine the probability something will happen or not. They also figure out what that something will cost—figuring that all out is as much an art as a science.
Medicare supplement underwriting questions attempt to uncover your current health. Actuaries ask the questions, collect data and “guess-timating” costs. The purpose of Medicare Supplement underwriting in Omaha is to determine your eligibility and the cost.
An applicant can qualify for a Medicare Supplement in one of three ways. Federal and State laws guarantee an “open enrollment” to those turning 65 or enrolling in Medicare Part B for the first time. During this time, anyone may apply and purchase a supplement without answering any health questions. The insurance company can neither deny nor rate you based upon your health. I am focusing on underwritten policies, so I will leave this to another discussion.
The second way is through Guaranteed Issue (GI). Guaranteed Issue can come in several ways. But, again, I will leave that to another blog.
The third way to qualify for a Medicare Supplement is by going through the underwriting process. An insurance company determines your eligibility for health insurance coverage based upon listed criteria.
What A Terrible Question!
The first question: “What is your height and weight, please?”
Most people–including myself–are not at the weight we would like or should be. All of the Medicare Supplement underwriting in Omaha have a chart for height and weight. Some companies are more generous than others. Along with other factors, we consider weight when we start an application. Some of our clients are not tall enough for their weight, so we guide them to certain companies.
If you are extremely short for your weight, it could be an issue. Always call and find out. Sometimes I have had clients delay and delay because they have convinced themselves that they will lose that thirty pounds before they apply. The thirty pounds never comes off. I convince them to make a Medicare Supplement underwriting application anyway, and it turns out the thirty pounds didn’t matter. As Nike says, “Just do it!”
I had another client last summer lose about 4o pounds. A few months before, the insurance company denied her coverage. After a wonderful weight loss regime, she passed Medicare Supplement underwriting and saved almost $1,000.
Medical History – Knockout Questions
I don’t think “knockout questions” is official actuarial language. But, it’s the language insurance agents use because these questions knock people out of the running for a supplement.
These are some examples of Medicare supplement underwriting questions for preexisting conditions.
- Treated for or advised to have bone marrow or organ transplant
- Diagnosed or treated for AIDS
- Treated for or diagnosed as having internal
- Cancer, melanoma, leukemia, Hodgkin’s disease, or lymphoma
- Treated or diagnosed as having congestive heart failure
- Alzheimer’s disease, Organic Brain Syndrome, or Senile Dementia
- Treated for or diagnosed as having Amyotrophic
- Lateral Sclerosis (ALS), Parkinson’s disease, or Multiple Sclerosis
- Cirrhosis of the liver, chronic renal failure, kidney failure, or have had dialysis
- Diagnosed as having Hepatitis C, Lupus or Crohn’s disease
- Diagnosed with COPD and/or Emphysema
- Requiring any injectable medications for treatments
- Uses or has oxygen tank for lung disease
- Hospitalizations within the past 60 days or three or more within the past two years
- Requiring assistance for dressing, bathing, toileting, walking, or is bed-ridden
- Radiation or chemotherapy treatments within the past two years.
- Diagnosed with Bipolar or Schizophrenia
- Diagnosed with Myasthenia Gravis
- Peripheral Vascular Disease
These are some of the medical history questions that would result in an immediate denial. This is not a complete list. Some Medicare Supplement underwriting in Omaha have more questions, but this list gives you a good idea of what is permissible or not.
Again, the individual insurance company can make a big difference. Not all insurance companies have the same Medicare supplement underwriting guidelines. They vary from company to company.
There is one company that denies coverage if you have rheumatoid arthritis. Another company will cover rheumatoid arthritis if it is not currently debilitating. Again, knowing the subtleties of the company’s Medicare supplement underwriting guidelines makes a difference.
#3. Can I Still Get My Medicare Supplement Underwritten In Omaha If I Have Diabetes?
Diabetes is problematic, depending upon your situation. The company’s Medigap underwriting questions will determine if it makes sense to apply. Some companies will outright deny coverage if you are on insulin. With other companies, the amount of insulin will make a difference. Some put a limit of 50 units, and above that amount, they deny coverage. Quantity is critical.
With other companies, weight may be the deciding factor when you have diabetes.
Medigap underwriting questions can be a complex web of guidelines varying from company to company. On top of that, companies change their guidelines. A couple of years ago, I had one insurance company that was my go-to company for people with diabetes. Then, it made its eligibility process more restrictive. An insurance company can change at any time for new applicants.
Future procedures Questions
An issue that most people do not think about is future procedures. I have had many an application torpedoed because the client did not mention they were planning a knee replacement in a couple of weeks.
Insurance companies will not take on known expenses, such as pending surgeries or procedures. They want those completed, the patient discharged from treatment, and everything working without side effects before taking on a new client. Before applying for a Medicare supplement, the patient must complete any joint replacements, cataract surgery, hernia surgery, etc.
People have asked me what if a future procedure is uncertain. For example, your knee is not in good shape. You have discussed knee replacement with your primary care physician, but the doctor did not recommend surgery. At least, it is not an order in the medical records. After a few months on the new Medicare Supplement, you have a knee replacement. Could that be a problem? Absolutely!
The insurance company could go back to the application you signed and say you did not disclose a pending surgery and thus refuse to pay for the procedure. That is a real possibility.
On the other hand, the insurance company cannot hold you captive forever from having any procedures. Six months or a year is usually the term limit. If you have a procedure outside of the initial six months, the company may not question it. Situations do come up, so it is not possible to foresee every possible contingency.
Changing In Health Condition
I remember a prospective client I visited with about changing supplements. She was scheduled for a hip replacement, so we couldn’t fill out an application. For various reasons, she delayed the procedure for several months. Every time I called back, the surgery had been delayed. Finally, she had surgery, so we set a date to complete the Medicare Supplement underwriting application.
It turned out there were complications. She had to go to physical therapy for several months. Each time I called, the physical therapy had been extended. Finally, the doctor released her from physical therapy, so we scheduled an appointment.
As I began the Medicare Supplement underwriting application, she disclosed that she was recently diagnosed as bipolar and on medication for her condition. I stopped the application.
Depression and other mental ailments are common. A person can pass underwriting who has depression, bipolar, etc. Insurance companies approve people with depression all the time. The issue, in this case, was the recency.
An insurance company is looking for stability in a condition. How long has the person had the condition? How has the treatment gone? Are there side-effects or costly consequences? All of those elements go into consideration. For example, someone recently diagnosed would probably not pass.
Health insurance is not cheap. So I try to help my client keep those costs down. One way I do that for my clients on Medicare Supplements is to check in with them on a regular basis to see what they are paying. Then, if I can save them some money, we make an application with another company.
In that process, I navigate the Medicare Supplement underwriting guidelines for some of my clients with health issues. It is not always easy. Weight, history, current conditions, medications, and future procedures all come to bear on what can or cannot be done. I’m here to help make getting Medicare insurance for you or your loved ones in the Omaha Nebraska area a little less painful.
If you need help navigating the labyrinth that is Medicare Supplement underwriting in Omaha or anywhere, please give us a call at 402-614-3389.
#1. A Good Medicare Insurance Agent Should Ask “What Kind of Prescription Medications You Are Taking?”
After almost a decade of being a Medicare insurance agent, I still get nervous when prospective clients push their list of medications across the conference table. When I look at the list, I either tense up or breathe a sigh of relief.
Medication Costs Can Be Devastating
As a licensed Medicare agent in Omaha, Nebraska for more than 10 years, I see examples of this every day. Yesterday I was completing an application for a relative of mine in Texas. He is a great guy. Jim is older than me. I remember playing together when we were kids. He was like a big brother. Being the firstborn in my family, I didn’t have an older brother, so I idolized Jim.
Jim is retiring in a few days. He is bone tired and is looking forward to getting out of the rat race. For the past year, his doctor gave him samples of Entresto for his heart. The manufacturer offered coupons for the medication too, but those stop once you are on Medicare. He was mainly paying nothing for it. When I told him the medication was around $600 a month, you could feel the ice-cold silence through the phone.
The Reality of A Fixed Income
On the Medicare Part D plan, the deductible would be $445 upfront, and the monthly dose would be $47 per month. After his icy pause, the response that we Medicare Insurance Agents hear too often came, “I can’t pay that.”
Like many people going on Medicare and retiring, his Social Security is really all he has. Even a part-time job isn’t a viable option when his body and nerves are shot. So I took a big swallow.
Jim thought I had it wrong or made a mistake. I explained the reality to him about Medicare Part D and prescription costs if you are on high-dollar medications. I don’t think he believed me even after that.
His response was he would quit the medication, which is what many of my Medicare insurance clients say. And a few do that. Others listen to their doctor, a pleading spouse and children, or their body that sometimes tells them they need the medication.
A Medicare Insurance Agent Should Find Out The Medication Costs At the Beginning
It is painful to watch people go through this. Consequently, I have learned early on as a Medicare insurance agent to find out what medications people are on right away. The various software, including the Medicare.gov website, are helpful–though not infallible. I explain to clients the reality that sometimes Medicare and the Medicare insurance companies make mistakes in listing their medications. They may take medications off the formulary or raise the tier level. Consequently, even if we do everything right, there may be some surprises down the road on their medications.
As a longtime Medicare insurance agent, an old trick I’ve seen insurance companies pull is to put a medium-cost medication in tier 3, so you get hit with the deductible versus keeping it in tier 2, where it has been for a long time.
Fortunately, most of these problems are infrequent, but expensive medications, like Entresto, insulin, or other anti-diabetic medications, can be bank-breaking.
If you are on no medications, very few medications, or inexpensive medications, God bless you. Of course, circumstances can always change, but you should still understand that a good Medicare insurance agent will very carefully ask about your medications and conscientiously show you the plans that best address those medication needs. “What are your medications?” is a very important question, and it should be one of the first.
#2. A Good Medicare Insurance Agent Should Ask “How Do You Handle Risk?”
When you go to the casino, which slot machines do you play? The nickel slots? The quarter slots? Or the dollar slots? Or don’t you play at all?
Everyone handles risk differently. When I was in the investment side of financial services, before becoming a Medicare agent, we would put clients through a risk assessment. We walked them through several scenarios of their investments going up and down based upon the level of risk they were willing to take.
Of course, everyone was happy when the investments went up, and no one was happy when the investments went down. They understood, however, unless they were going to put their money in a can and bury it in the dirt, they would have to assume some level of risk.
What Is Your Tolerance For Risk?
People’s risk tolerance was all over the board. Some were conservative. Others moderate. A small group was high-risk takers. In the end, they would sign and date the risk assessment form, and it was put in their file. Then, the investment advisor would invest their money based upon how much risk they were willing to take. What does this have to do with Medicare insurance? I’ll explain.
I remember when clients came back during downtimes in the market. All of them were angry that their assets went down. The advisor showed them the history of the different asset classes and how they go up and down depending on markets and the type of assets. Clients were not impressed.
In the end, the clients complained their money went down too far. So then the advisor pulled out the risk assessment the clients all had completed months or years earlier. Right there in black and white was their signature next to the level of risk they were willing to assume, and their assets went down precisely what was predicted.
When the asset went up, they never called. A Medicare insurance agent should be testing your ability to handle risk.
Over the years, in my role as a Medicare insurance agent, I have talked with clients months and years after choosing their Medicare Advantage plan or Medigap policy. I go through the same presentation with everyone. Thousands of clients have heard the exact same words over the years. I could do it in a coma.
People still come back and say I didn’t think the copays on my Advantage plan would end up being this much. I didn’t think my supplement premium would go up this high.
Whether you purchase a Medicare supplement or a Medicare Advantage plan, there are costs. Over time and as you age, those costs will go up. Unavoidable. The reality of those costs hit us differently than the idea of those costs when we are considering our options. It is crucial when considering your options to look at how you have handled risk in the past.
Did you pick the car insurance or the homeowners insurance with the high deductible? Were you ok when s__t happened?
Or did you pay the much more expensive premium, so you didn’t have a hefty deductible? Or did you switch after a while? That will tell you more about the type of Medicare insurance you should choose. How do you handle risk?
#3. A Good Medicare Insurance Agent Should Ask “Which Way? Pay As You Go Or Pay Upfront?”
Would you prefer to pay upfront and not worry, or would you rather pay when you actually use the service?
I love to travel. Over the years, I have been all over the United States and the world for pleasure and business. No style of travel is more appealing. I have gone on tours. Put some stuff in a knapsack and just gone out the door with no place in mind.
Depending on what I’m doing and how much money I have for the project, I make my strategic travel plans.
When I have gone on the cheap, I pay for the bare minimum. It saves money. I don’t mind sleeping on overnight trains and park benches–at least when I was younger. I paid for things when I wanted them or really needed them.
Other times, usually when I had more money, I did the all-inclusive thing. I didn’t have to worry about the nickel-and-dime stuff. I was comfortable with everything being taken care of and paying a lot for it.
Two different styles. Two different experiences. Two different outcomes. What type of experience do you want? As a Medicare insurance agent, that’s a question I need to ask.
What Kind of Experience Do You Want with Medicare?
Medicare Advantage is pay as you go. You don’t pay any copays unless you see a doctor, get a test, have surgery. The nice thing is you save money at that moment. But when something serious happens, like cancer treatment, you may be paying thousands of dollars–with a limit–for that year.
On the supplement side, you pay your monthly premium. Remember, this premium will keep going up each year. So when you are probably your healthiest on Medicare in those initial years, you may not use Medicare and your supplement much, but you are paying.
As you get older, the premium will go up. It may double at some point from what you initially paid when you turned 65. At that point, you are older. You are starting to have medical needs, but nothing serious yet. Do you change to an Advantage plan because supplement premiums are going up? But now the likelihood of something costly happening during the twilight years of life significantly increases. You have already forked out a considerable sum on Medigap premium. Do you keep trudging along and pay increasing premiums, or do you cut your losses? Do you risk potentially high copays or pay certain higher premiums? What if I can’t afford Medicare premiums anymore?
Which scenario is less damning? What do the questions cause you to think and feel?
A good Medicare insurance agent asks these hard questions, but only you can answer them.
Every year there are changes to Medicare. The changes are usually not as drastic as the television commercials would lead you to believe. The purpose of the advertisements is to stimulate fear, uncertainty, and greed. They hit it hard to motivate you to call the 800-number. They will claim to offer a free objective evaluation. I find their objective evaluation inevitably ends with you changing to their plan. Know about Medicare 2021 changes before they flip you.
Unique One-Time Medicare 2021 Changes
My grandmother used to say, ‘live long enough, and you will see everything.’ The changes this year are unique because of the pandemic. COVID tests will have no co-pays. The vaccine is free. The federal government wants to overcome the virus, so Medicare is reflecting that public health policy.
Many Medicare plans had already offering telehealth options. With the pandemic, insurance companies now hardwire their plans with these options–most with zero co-pays.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes began in 2015. CMS implemented the changes slowly over the years so Medicare, the insurance companies, and beneficiaries could more easily adjust. Starting in 2020, those turning 65 did not have the opportunity to purchase the Medigap F or C plan. Medicare fazed out those plans with plan G being the principal plan with the most comprehensive coverage. They grandfathered in those 65 and over before 2020. They can still own and purchase plan Fs and C’s.
The most significant Medicare change to know about in 2021 for most people is the Part B premium. This year it will increase from $145.60 to $148.50 per month per person, which is a $2.90 increase. Each year the premium amount is a hard-fought debate in Congress. Usually, Congress threatens to raise it much more. Constituents call in, and advocacy groups lobby, so the price usually goes down.
Part B Deductible in 2021
Medicare Part B consists of many different services. It has its own deductible, which is separate and distinct from the Part A deductible. The deductible increased from $198 in 2020 to $203 in 2021, only $5. The deductible is a flat amount. The consumer pays the deductible before the 20% coinsurance starts. For plan G, the Part B deductible is the only payment, aside from the monthly premium. The Medigap policy fills the remaining gaps in Part A and Part B coverage.
Social Security and Supplemental Security Income (SSI) benefits for approximately 70 million Americans will increase 1.3 percent in 2021. The 1.3 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 64 million Social Security beneficiaries in January 2021. The Social Security COLA increase should not be less than the Medicare Part B premium increase. There are exceptions around this. If you are receiving Social Security benefits, you will be held harmless on the increase, but those who do not take Social Security benefits will pay the increase.
Medicare 2021 Changes for Part A
Medicare Part A covers inpatient hospitals, skilled nursing facilities, and some home health care services. About 99 percent of Medicare beneficiaries do not pay a Part A premium since they have at least 40 quarters of Medicare-covered employment. The Medicare Part A inpatient deductible that beneficiaries will pay when admitted to the hospital is $1,484 in 2021, increasing $76 from $1,408 in 2020.
The Senior Savings Model is an experiment in modeling that tests the impact of offering beneficiaries an increased choice of enhanced alternative Part D plan options that offer lower out-of-pocket costs for insulin. One in every three Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more of the common forms of insulin. For some of these beneficiaries, access to insulin can be a critical component of their medical management, with gaps in access increasing the risk of serious complications, ranging from vision loss to kidney failure to foot ulcers (potentially requiring amputation) to heart attacks.
Unfortunately, sometimes the cost of insulin can be a barrier to appropriate medical management of diabetes. CMS’s designed Senior Savings Model for Part D plans to address President Trump’s promise to lower prescription drug costs. The model provides Medicare patients with new choices of Part D plans that offer insulin at an affordable and predictable cost. A one-month supply of a broad set of plan-formulary insulins costs will be no more than $35 each.
Medicare changes to know in 2021 are your drugs listed in the formulary. Part D premiums for 2021 will probably rise an average of 9%. The average stand-alone Part D premium is $41 in 2021. The premiums range from $7 a month for the SilverScript SmartRx plan to a high of $89 for the AARP MedicareRx Preferred plan.
Part D Deductible 2021
The Part D drug deductible went up from $435 to $445 on most plans. That is the max deductible CMS allows insurance companies to set the deductible. They can set it lower, though few plans did this year, and for those plans with zero deductible or a lower deductible, the cost is offset by either higher monthly premiums or co-pays or both.
Most of the time, that deductible is only applicable to tiers 3, 4 & 5 medications.
The first of the year is the time when I get the distressed phone calls because people must meet their deductibles. Many forget the deductible starts over again in January, and they are shocked when they show up at the pharmacy counter. I have to remind clients they need to meet the deductible first to get to the lower copay.
Medicare Advantage Changes in 2021
In the nine years, I have offered Medicare Advantage plans, I have seen the number and especially the quality of the plans increase significantly. Nationally more Medicare Advantage plans are offered now than ever before. In Nebraska and Iowa, I have seen the number of counties offering quality plans explode.
There are now over 4,800 Medicare Advantage plans, an increase of 76% over 2017. The average person will choose from 33 plans offered by eight different insurance companies, with some areas having as many as 60 different plans.
Besides, the number of Special Needs Plans (SNP) also increased to nearly 1,000 in 2021, a sizable jump. The increase in SNP means more people have access to low-cost plans with extra benefits to manage chronic conditions and diseases.
Medicare Advantage Premiums in 2021
Average Medicare Advantage premiums dropped for the fourth consecutive year to $21 in 2021, down from $25 in 2020. Nearly 90% of all Medicare Advantage plans include Part D prescription drug coverage.
Of note, the Medicare Advantage out-of-pocket maximum will increase to $7,550 in 2021, up significantly from $6,700 in 2020. However, the vast majority of insurance companies set their out-of-pocket max well below the government limit. In 2020, the average Medicare Advantage out-of-pocket maximum was $4,900.
Medicare Advantage and ESRD
The most heartening plan change for Medicare Advantage is ESRD (End-Stage Renal Disease). When I first started, the only pre-existing condition that excluded me from enrolling someone in a Medicare Advantage plan was ESRD. While I didn’t have that situation very often, it was sad when I couldn’t offer Part C to clients.
ESRD is one of the health issues that almost always automatically makes you Medicare eligible. Still, if you are younger than 65 in Nebraska and Iowa, you are not eligible for a Medicare supplement. The dialysis falls under the unlimited 20% coinsurance of Part B. The cost can be incredible. Even for those on Medicare Advantage, beneficiaries can easily hit the maximum out of pocket.
At least now those with ESRD can get on a Medicare Advantage plan and limit their out-of-pocket costs.
There’s good news for people with ESRD in 2021. In the past, those with ESRD could not join Medicare Advantage unless there was an ESRD Special Needs Plan available. However, new rules grant guaranteed issue rights to people with ESRD for any Medicare Advantage plan offered in their service area.
Access to Medicare Advantage when you have ESRD is massive. Long-standing rules allowed Medigap companies to deny coverage to people with ESRD outside their Medigap Open Enrollment Period. Even many states that enacted laws forcing insurers to offer Medigap to people under age 65 failed to extend that protection to people with ESRD.
What this means is that, for the first time, people with ESRD have low-cost options to control their health care expenses with a Medicare Advantage plan. If that applies to you, you could have used the 2020 Annual Election Period to shop for a new Medicare Advantage plan.
Congress made significant changes to the billing process behind Medicare in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA changes how Medicare rewards providers for qualify over volume inpatient care. It streamlines provider reimbursements through the Merit-Based Incentive Payments System (MIPS) and even grants bonuses for participation in alternative payment models (APMs). Still, the change that gets the most attention is the eliminating of Plan F and C in the Medigap lineup. The plans completely covered the Part A deductibles and Part B co-insurance, so beneficiaries did not have to pay anything aside from their monthly premiums. Congress found the lack of co-pays and deductibles was an incentive for waste and abuse of the Medicare system. Starting in 2021, you could no longer purchase Plan F or C when you turned 65. Those who turned 65 before that period were grandfathered into Plan F and C.
The other most obvious change was the Medicare number is no longer your Social Security number, but a unique eleven-digit number combining letters and numbers. Everyone’s card should have been replaced by the end of 2019, though I still have some clients who have their old numbers and card. It is a simple matter of calling Medicare for a replacement card.
Medicare makes slight changes over time. Many times the Medicare changes to know about in 2021 do not apply to you, but you, or your agent, still need to be aware of what is going on to always maximize your benefits and avoid disadvantaging yourself temporarily or permanently.
All Medicare Advantage (MA) plans must provide at least the same level of coverage for home health care as does Original Medicare, so Medicare Advantage pays for home health care. However, an MA plan may have different rules, costs, and restrictions on services. For example, depending on a person’s MA plan, it may require him to:
- Obtain care from a home health agency that has contracted with the plan.
- Receive prior authorization or a referral before receiving home health care.
- Pay a copayment for home health care.
Center for Medicare & Medicaid Services (CMS) recently announced that Medicare Advantage plan will be able to cover certain types of home health care related services that were not previously able to be offered, beginning in 2019. This will be possible because CMS has expanded the definitional scope of “supplemental benefits” that Medicare Advantage plans can offer. Starting in 2019, insurers can offer additional services to help improve enrollees’ health and quality of life.
Medicare Advantage Can Pay for Home Health Care Supplemental Benefits
Medicare Advantage plans may offer additions benefits not offered by Original Medicare. Previously, CMS did not allow any item or service to qualify as a supplemental benefit. Supplemental benefits were items of “daily maintenance.” In other words, MA plans could not offer items and services that were not directly for medical treatments. The agency has now reinterpreted the requirement for supplemental benefits to include a “primarily health-related” definition as follows:
an item or service that is used to diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization
Accordingly, this reinterpretation of supplemental benefits will allow Medicare health plans to offer coverage or benefits for the following:
- Adult daycare services are services provided outside the home, such as assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
- In-home support services are services a personal care attendant provides. She assists disabled or medically needy individuals with activities of daily living, such as eating, bathing, and transferring, and instrumental activities of daily living. These activities may include managing money, preparing meals, and cleaning a house. Services must be performed by individuals licensed to provide personal care services, or in a manner that is otherwise consistent with state requirements.
- Home-based palliative care services Medicare does not cover if life expectancy is more than six months. Palliative care (“comfort care”) is to diminish symptoms of a terminally ill patient.
- Transportation for nonemergency medical services is transportation to obtain Part A, Part B, Part D, and supplemental benefit items and services. The transportation must be used to accommodate the enrollee’s health care needs: it cannot be used for nonmedical services, such as groceries or errands.
- Home safety devices and modifications are safety devices to prevent injuries in the home and/or bathroom. The modifications must be non-structural and non-Medicare covered. This benefit can include home and/or bathroom safety inspection to identify any need for safety devices or modifications.
A physician or licensed medical professional must recommend these home care services.
Medicare’s expansion of MA plan benefits, like adult days care, helps patients remain in their homes as they age rather than being institutionalized, which could also result in lower costs for Medicare and Medicaid.
The Advantage of Medicare Advantage for Home Health Care
Medicare Advantage plans may impose different rules, limitations, and costs than Original Medicare, but they must provide at least the same level of home health care benefits.
Starting in 2019, Medicare Advantage plans may offer supplemental benefits that help enrollees with daily maintenance, including transportation for medicare services, in-home support services, and home-based palliative care. Consult the individual MA plan for the details of coverage.
In the Omaha metro area, the MA plans offer some of these benefits. Currently, the plans that do offer a lot of these benefits are the “Dual” or “Special Needs” plans. Those plans are for a person on full Medicaid as well as Medicare or have some special needs because of chronic illness, such as COPD, Diabetes, etc.
In other areas with high population densities, many of the MA plans are much richer with benefits. As it stands in eastern Nebraska and western Iowa, principally Omaha, Lincoln, Bellevue, and Council Bluffs, the supplemental benefits seem to be growing in number and scope each year. A couple of insurance companies recently added transportation to their health plans. More insurance companies are developing Medicare Advantage plans and including this type of home health services.