It was a heartbreaking meeting ... sitting with a couple at the kitchen table, when tears flowed down on both faces. He was very sick, quickly lost weight from digestive problems, and his constant migraine headaches were so painful that his life seemed the only way to live without pain. To say that they were afraid would be an understatement. The doctors associated with his current Medicare Advantage plan (Medicare Part C) could not diagnose the problem. They only prescribed more drugs, which aggravated his problems. At the top of his medical puzzle, the Plan denied the medical tests that may have very well diagnosed his problem. It was October 2011, and through their tears they painfully asked: “What are our options?”
In this case, together we decided that it was in his interest to switch to the Medicare Supplement (MediGap) plan, which would allow him to contact any doctor or institution that took Medicare, as well as the “Individual Drug Prescription Plan D” plan. so that he can search for the best of the best anywhere in the country. We chose Supplemental Plan F with a carrier that would allow it to switch between a lower and higher spending plan WITHOUT insurance (if in the future he decided to keep the Supplemental Plan after his current medical puzzle was solved).
Could he avoid this problem in the first place? Maybe. Here are a few errors that I saw with the solutions to help you choose the right option for YOU:
MISTAKE # 1: Who do you work with?
* Work with a “concluded insurance agent” (direct work with a carrier, many times when they are compensated for by W2, responsibility and / or bonuses) or working with an independent career agent; (1099 contractor with carrier and wired). The last term is very confusing to me. They are classified as independent, but if they write an application with another carrier, since this is a right for the beneficiary, their contract can be terminated. What incentive agent should be absurd if they lose their source of lead?
** Another mistake is working with an agent who is not certified to sell all types of Medicare medical plans. They can only sell MediGap add-on plans without certification.
*** Go directly to the insurance agent. If something goes sideways, it will be useful for you to have a defender on your side, especially one that you can see and live / work in your community.
SOLUTION number 1:
* Choose an independent insurance agent who represents more than one insurance agent. What for? Because independent agents will know the pros and cons of ALL Plans and will be able to transmit this information so that you can make a choice for EDUCATION. They receive compensation from insurance companies, but do not have the loyalty of any particular company. Also be attentive to carriers who force their independent agents to sign an exclusive agreement. I saw this happen with the “Double Plans” (Medicaid / Medicare Plans). Again, how can an agent be "partially"? if they are contractually obligated to sell only one Plan?
** Choose certified & # 39; Medicare insurance agent able to sell Parts C, Parts D and MediGap Plans. They have additional training and supervision.
*** When you go directly to the carrier, you eliminate a valuable person who will fix problems if they arise and provide you with additional peace of mind in the process.
MISTAKE # 2: Choose a Medicare Advantage plan that requires you to get approval from an insurance company before conducting a procedure / test.
SOLUTION № 2: When comparing plans, go to Summary of Benefits. All media must publish them, and they must be the same and easily comparable.
MISTAKE # 3: Ignoring the "out of pocket max" (MOOP). All Medicare Advantage plans have a MOOP, and many agents glaze over it, helping you choose your Plan. However, if a catastrophic medical problem arises (cancer, organ transplantation, prolonged stay in a qualified medical institution, etc.), there is a good chance that you will get into your MOOP so you can be sure that this is Reason: chemotherapy and anti-negative medicines are considered parts. outpatient drugs, not part D & prescription drugs, and many Planners pay only 80% of part B. So you’ll be hooked by 20% and they’re very expensive.
SOLUTION number 3: Compare, compare, compare and select the Plan with a lower MOOP.
MISTAKE # 4: Choosing a plan just because the co-pays drugs are somewhat lower. Many smaller insurance companies lure you into their plan with very low co-options on their dosage forms, but have a smaller network of doctors / institutions where you can choose. The problem is that if a medical problem arises, you can be locked into a smaller network of doctors / institutions before the annual open registration of Medicare.
SOLUTION № 4: If you have problems with your prescription drug payments and your income / assets are low enough, you can get additional help through social security. A good insurance agent will bring it out and direct you, or go to https://secure.ssa.gov/i1020/start. After receiving mediation assistance, you can choose the best plan based on other parameters (size of their network, authorization rules, convenience for the doctor / facility, additional additional benefits, etc.).
MISTAKE # 5: Choose a plan because you want a PPO plan, not a HMO.
SOLUTION number 5: Many people are mistaken that they can turn to any doctor / institution they choose with the PPO plan. In fact, the PPO plans still have a network of doctors / institutions where you have to stay in order to get lower costs. The biggest difference between PPO and HMO is related to PPO, you will not need to receive a referral & # 39; to see a specialist. With the HMO you should get a referral. To be able to choose ANY DOCTOR / facility in a country that accepts Medicare, you must consider the Medicare Supplement Plan (MediGap).
I have seen most of the mistakes and solutions when it comes to choosing Medicare Advantage Health Plans. Outside of California, there are additional variations of Plans and there may be additional problems.
What happened to my client, you ask? Since I constantly keep in touch with my clients, in June I was very happy to hear him exclaim about the great news. With the same test that was rejected by his previous Medicare Advantage plan, two doctors from a large medical group in Los Angeles identified this problem. He slowly flowed cerebrospinal fluid and was dangerously close to absence. Thanks to a fast outpatient procedure, they basically laser-glued the flowing area, replaced the cerebrospinal fluid, and it was healthier, happier, and better than ever! Since it’s good now, we’ll review its coverage during Medicare’s Annual Open Registration (October 15 to December 7, 2012) and decide whether to keep it in the Supplement or switch it to Medicare Part C Benefit Plan.
As an insurance agent for many years, I have stories like this and many others. With compassion, our profession helps to navigate in the best options, to explain the pros and cons on the basis of our clients. individual needs and offer peace of mind. Plans change every year, and your health / financial situation may also change, so it's a good habit to compare each year. In conclusion, choose a good, local, independent insurance agent, get an education and be well informed!
