The AEP is almost upon us and most Medicare brokers are ready. In the next few weeks, the MAPD insurance carriers are preparing to ship out the new and updated plans for 2018. October 15 through December is the AEP so you can change your MAPD or drug plan as many times as you want during that period but once that period is over the last plan chosen will be the plan for 2018.
As in previous years, these carrier’s keep the Medicare brokers in suspense on what the new plan benefits. All the carriers are holding meetings in the near future to reveal the changes to their plans and what that means to the broker and more importantly, the Medicare recipient.
Let’s look at what are the Medicare recipient choices:
- They can have Original Medicare and buy a standalone drug plan. The benefit is they can see any Doctor or go to any Hospital anywhere in the US as long as they take Medicare. Great option. Here’s the downfall and why so many Medicare recipients choose a MAPD plan instead of Original Medicare. There is no maximum out of pocket with Original Medicare so the Medicare recipient will be paying 20% of all bills regardless of the amount of those bills. Lastly, the Doctor or facility has an option of taking Medicare Assignment of benefits or not taking it. If they do take it, they have to write off the 15% that Medicare doesn’t allow. If they don’t take Assignment of Benefits then they can bill the Medicare recipient the 15% that Medicare calls excess charges. So, the recipient ends up paying 35% of the bill instead of the 20%. Not good.
- Using a MAPD plan whether it is an HMO or PPO or in some states, a PFFS plan; all have a maximum out of pocket so the Medicare recipient has a stop loss on out of pocket expenses. Much better for the recipient especially if they have a fixed income. If they choose an HMO, the benefits are rich and the stop or max out of pocket is $1,900-$4,000 annually. I personally have not seen anyone reach the maximum out of pocket but suppose it has happened. Having said that, the recipient on an HMO must use Doctors and Hospitals in network unless it’s an emergency. They must also get referrals to specialists. Your typical HMO, senior sized. These plans have rich benefits and in Clark County Nevada there are five plans to choose from and all offer great benefits. These plans have no monthly premium and many have little if any out of pocket costs.
- The PPO plans work similarly to an underage PPO in that you don’t need a referral to see anyone on the provider list. The PPO’s have a higher maximum out of pocket in the range of $6,000-$6,700 annually. They also allow you to go out of network but you then have a deductible and a higher maximum out of pocket. To use out of networks providers all you have to be aware of the higher out of pocket costs. Then using a service out of Clark County you simply have to ask the provider if they take the MAPD PPO plans from the carrier. If they say yes, then you go as if you were in Clark County. These PPO plans offer more choices but you pay a slightly higher monthly premium and out of pocket costs. Pricing varies but most are under $100 per month.
- Medicare Supplements and separate drug plans. The supplement plans are not subject to the AEP and can be bought anytime with some caveats.
These plans offer all the benefits of Original Medicare without the limitations. These plans are in addition to Original Medicare so they fill in the gap created when on Original Medicare. What most Medicare recipients don’t realize is that these plans are designed by CMS and the premiums charged are decided by the carriers. To keep it simple there are 10 plans but in my opinion, only 4 of them make sense; the others not so much. The next blog will go into details about these supplement plans but suffice it to say that you can go to any Doctor, any Hospital that takes Medicare anywhere in the country. Since these plans don’t offer drug coverage, you need a separate drug plan along with the supplement. Again, these supplements are not subject to the AEP but once a
Medicare recipient is beyond the 6-month window after they go on Medicare Part B or turn 65 and go on Part B, they have to prove they are insurable. More to follow in the next blog.
The Barend Agency Inc. Len Barend, broker