Medicare is notoriously complicated, so we heard from some of our clients. Some of them used to work in healthcare admin themselves, but that does not prevent them from drowning in the complexity that is Medicare. It is not just keeping tabs on your deductibles, copays, coinsurance, and enrollment periods; for new Medicare beneficiaries, now you have the new job of understanding your Part A, Part B, Part D, and supplemental insurance. Sure, more and more seniors now are internet savvy and are empowered to do their research online. This is a great development for the consumer, and the trend will surely continue this way. But despite being current and savvy, it may still pay for you to sit down with a licensed agent when it comes to learning your Medicare options, either by good old fashioned face to face meeting, or by simply discussing things with someone over the phone, and here are the reasons why.
Narrowing It Down.
On average, each Medicare beneficiary has 24 different Medicare Advantage plans being offered to them in their county, and in big cities, such as NYC, the number goes up to 49. That is 49 mind-numbing Medicare Advantage plans to compare, narrow down, decide, and you haven’t even started to look at Medicare supplement plans yet, which are an entirely different category.
The idea of Medicare Advantage usually means you are working with an HMO/PPO network or HMO-POS plans. If you do not use your plan’s in-network doctors and hospitals, you may be responsible for 100% of the costs. So, the first order of business if you’re looking at Medicare Advantage plans: look up your doctors and hospitals in the plan network, see if you’d be able to keep them under the plan. You do not want the surprise of finding you have to change your doctors down the road, especially for seniors with multiple specialists, or those that use a specialty hospital. When one company has a couple of different MAPD plans, it does not mean the network is the same. Agents in our company know the ins and outs of each plan network. Some plans may have special hospitals in-network; some are not. From our experience, we heard our clients say: “I called my Dr, he said he takes A Company.” That is great; you can ask your Dr for advice on Medicare plan, but we need to take a look at each plan specific company network.
Next, you have to look up your medications and inform yourself how the plan classifies your drugs into Tiers. Tiers are meant to make it easier for you to see how expensive your drugs are, in terms of deductibles and copayments. If you take a lot of high-tier medications, the out of pocket may be significant. Different companies may have the same medication in different tires.
So, you did the impossible of narrowing down the 49 plans into 3, whose costs seem agreeable to you–but you’re only halfway done. Now you must go through the exercise of looking up your providers and meds, one by one, on each carrier’s website. Not the worst thing in the world, but wouldn’t you like to know there is a more natural way?
As licensed agents at our brokerage, we do ALL that work for you. And because we do this every day, we are efficient and informed and can tell you right off the bat, what plan works, and what doesn’t, based on who you see and where you’d like to go.
The World Is Ever-Changing, and So Are Insurance Plans.
So, you did all the hard work, now you’re all set and can take it easy. The bad news is, you’re never set. Choosing a Medicare plan is not a one and done process. The good news is, your licensed agent is there to save you sweat and tears.
With any plan you choose, the review should be ongoing. The reality is your health may not stay the same, and unexpected incidents could happen. That is why every year, from October 7 – December 15, Medicare beneficiaries have a chance to change their plans for the coming year during the Annual Enrollment Period (AEP).
And even if your year went by with no incidents occurring, and your health is still in great shape – your insurance plan could change.
Every October, each Medicare beneficiary receives an Annual Notice of Changes (ANOC) in the mail from their insurance carrier, as mandated by Centers for Medicare & Medicaid Services (CMS) to let them know of changes to their plan for the coming year. Each year, premiums and copays tend to inch up with inflation, out of pocket costs could be adjusted, and provider participation could also change from year to year.
That is why you need to sit with your licensed agent during AEP to review plan changes and your health changes quickly, to see whether your current plan would still serve you well.
You Will not Pay Extra.
Licensed agents and brokers get paid by the insurance company you sign up with. Because we get paid a commission, we do not charge you a fee for your enrollment, reviews of benefits, or we can even look at the mail you receive. If you have a bill and have a question, we are there for you. You would not incur any extra costs for having an agent, and your premium rates and copays are 100% uniform, whether you work with an agent.
At First Manhattan Financial, we are contracted with almost all major carriers in the region. As a result, we can offer our clients all of the most established and creditable companies on the market. Because all plans pay us the same (as established by CMS), we would only recommend plans based on suitability for the client, not on our paycheck.
You May Save Extra.
Other bonuses when you work with an agent: we can help you identify and apply for subsidies you may qualify for, including the federal Low-Income Subsidy (LIS) and State Pharmaceutical Assistance Programs (SPAP). Each subsidy has unique requirements for income and assets. Licensed agents at First Manhattan Financial can quickly identify subsidies for you based on your income and asset levels.
When you enroll with the call center, they are licensed in all 50 states and do not know the specifics of plans in your area. You do not know who you speak with, and you will not be able to talk with them again.
Our consultation is always FREE!