We often get questions relating to the enrollment of Medicare eligible veterans outside of the Annual Election Period. In short, veterans are treated just as any other Medicare eligible person. There are a few things to note, however, when working with a veteran who is Medicare eligible. Here’s a short list of things to consider when helping veterans make an informed decision about Medicare Advantage enrollment:
As I have indicated in the past my wife and I went onto Part A and enrolled in Part B of Medicare this year. I started on May 1st and my wife February 1st. Just some background, the past eight years I have had a high deductible plan with Life Wise of Washington state. We had a $6000 family deductible plan and was paying about $700 per month the last year we had the plan. I had also enrolled in an HSA eight years ago as well so today the balance of my HSA account is over $50,000. As most of you know this fund can be used for co-pays for doctors visits as well as prescription drugs.
My wife and I both chose the $0 premium MA only PFFS plan available in Washington state. (My wife does take some prescription drugs so I enrolled her in Humana’s WalMart standalone PDP, as I do not take any drugs, I chose not to enroll in a PDP.) This is a Medicare look alike plan meaning I am responsible for the Part A hospital deductible and 20% of the Part B outpatient expenses, however, there is no Part B deductible, I pay 20% from the first dollar of charges.
I have used this plan three times so far, twice at the ophthalmologists and once at the dermatologists. I could not be happier with how the plan works. First of all, I am not paying for my healthcare in advance in the form of a premium. Not for a high deductible plan like I did before going onto Medicare or for a traditional Medicare supplement. I am only paying for 20% of the Medicare approved charge and that is a lot less the than the $8400 in premium I paid for Pat and I last year. If I had chosen a traditional Plan F my premium would have been around $200 per month for me and $200 for Pat or about $4800 per year.
I have my annual physical scheduled for the fist week of August with the doctor I have had the past several years. In past her office accepted Life Wise. Before going onto Medicare I called my doctors office to explain I was planning on enrolling in Humana’s MA only PFFS plan. The office manager explained they did not officially accept Humana but as I was currently a patient, the office would accept Humana’s terms and conditions and bill them directly so I could continue to keep my current doctor.
So far I could not be happier with the choices I have made. I now go to the downtown YMCA using Silver Sneakers and no longer pay $55 per month to OZ fitness. The best part is on October 15th I can look at all the options available for 2014 and make a new choice if I find a better option with no pre-existing conditions or waiting periods. The new choices today really are a win win situation for Medicare beneficiaries like me.
Over the last several months I had heard it all. Medicare Advantage is going away. The days of the Balanced Budget Act are back. Time to call in the dogs and put out the fires. But wait, a 3.3% increase to reimbursement rates? What happened to the 8% reduction? Looks like all the anxiety over Medicare Health Plans was for not.
Time and time again we have seen this play out in similar fashion. Government programs are introduced or adjusted, and instead of detracting from the potential of the market, it creates more opportunity than ever before. This phenomenon goes all the way back to the inception of the Medicare trust fund, to the standardization of Medicare supplements, to the MMA, and now Health Reform known as the Patient Protection and Affordable Care Act. Contrary to initial reactions, history shows us that these laws have created enormous opportunities for agents and agencies who are prepared.
We can’t forget the importance of service, ethics, and compassion for clients in our roles as insurance professionals. I was reminded of this when I fielded a call last week from a plan member, who had some legitimate concerns. I rarely speak with the members themselves, so this caught me off guard at first. The lady on the line was noticeably upset, a bit frightened even, and looking for someone that would help her. She had just received notification that her Medigap plan was going to experience a significant rate hike for both she and her husband, and while she never came out and said it, I could sense that affordability of this new premium was a major challenge. She shared that it was very difficult to reach her agent, and after several attempts, was told that there was nothing that could be done, and that the reason for the increase was “Obamacare”. Her husband, also an older gentlemen, struggles with hearing on the phone, so she was stepping up to the challenge of finding solutions on behalf of them both. This woman was very sharp, and perceptive, but obviously needed someone with the expertise to advise her of any and all options available to reduce their cost of coverage. Having recently celebrated a birthday, her research revealed that there may be some favorable rules within this time period that might allow their to select another plan in their state of residency. Her existing agent had already written this option off.