Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to Part 7 of the series, "New to Medicare," which I'm writing to help those who will be going on Medicare Part A, B, or both for the first time in the near future. QUESTION: What are the most important considerations when choosing an Advantage Plan? Which plans and companies are the best? ANSWER: Those going on Medicare Part Bfor the first time inpatient. A per stay co-pay in the $300 range is what my favorite plans have; A lower Maximum Out of Pocket (MOOP), which represents Chemo, injection therapy, or infusion therapy. Regardless if a plan has a premium of $0 or $300, the cost of all three of those treatments is 20% of the billable amount to the insurance company need to make sure they understand the differences between both Supplements and Advantage Plans as well the most money one could as the pros and cons of each, be billed in a calander year. which I have discussed in earlier editions of the series. to $T,550, Generous ancillary It's my opinion that Advan- Failure of educating oneself makes it much more difficult sive dental, a free routing to choose the plan or plans that offer the greatest value. If you're new to the series, I suggest going to our website allowance to spend on items and reading the first six. You that can generally be found can also listen or watch the podcast and webcast ver sions. MOOP's range from $4.000 benefits such as comprehen- tage Plans could use a few more regulations. If I were eye exam and allowances for in charge of creating them, eyeglasses of at least $150, OTC benefits that provide an is that no plan can have a the first I would implement premium higher than $100 per month. Insuurance com- panies know there are plenty of Medicare bemeficiaries, especially the elderly who will not change plans, even on the shelf at a drug store. Choosing an Advantage Plan can be a much more complicated than a Sup- plement because there are eight companies that offer them in Western PA and approximately 80 total plans to choose from vs only nine available Supplement op tions. Another important consid- eration is the network of doctors and hospitals that are after premiums have gone available. Not all eight com- panies that sell Advantage Plans in our area provide ac cess to both Allegheny Health result in tens of thousands of Networks and UPMC. In addition, insulin dependent diabetics may need choose a plan that participates in the Senior Savings Model which guarantees no more than a $35 co-pay for insulin that is up as much as 500% over the years. They fear changing to a lower priced plan could dollars in bills in the event of a heart attack or hospitaliza- tion. I find it very troubling that some companies have gotten away with charging exorbitant rates over the years. And unlike Supplements where every plan of the same on a plan's formulary. Only letter has identical ben- efits and out of pocket costs regardless of what company clients participates. sells it, that's not the case with Advantage Plans. Co pays and out of pocket costs can vary quite widely among to Advantage Plans, paying plans and companies. For example, one might have a co-pay for a 6-day or longer hospítal stay as low as $300, while another $1,800. Two people who needed the same ly premiums doesn't provide clients choose a company type and amount of chemo- therapy could pay as much as most of the higher priced $3,500 more or less than one another. one of the companies we normally recommend to our As far as the best plans, those that meet the criteria I listed previously are in my profes- sional opínion. We typically I've mentioned this in previ- only write plans with three ous columns. When it comes companies, which per regula- tion, I can't mention by name in any column, podcast, webcast, or Facebook post. more doesn't at all guaran- tee lower co-pays or out of pocket costs. Except on a rare When all things are equal as occasion, it's my opinion that far as benefits and premiums paying $50 or more in month- are concerned, we prefer our that provides the best cus- tomer service, In that regard as well, not all are created any additional value. In fact, plans don't even provide the lowest MOOPs. And some, in equal. fact, have the highest! I find it unexplainable that in some Remember that these col- cases companies can charge more and provide less protec substitute for working with tions and benefits. Once someone has de- termined they prefer the Advantage Plan option, the most important considera- tions and what we want in an HMO or PPO for our clients are the following Premiums of why paying more than as low as $0 and but not to exceed $50 per month; A per stay hospital co-pay. In other likely ways someone on an words, a flat fee no matter how many days one is an umns are not meant to be a a licensed, experienced, and quailed agent like those at The Health Insurance Store. Consultation at one of our of fice locations, over the phone, or via Zoom are always free of charge. Here's another example S50 for a plan almost never makes sense. The two most Advantage Plan could meet their MOOP is if they needed 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to Part 7 of the series, "New to Medicare," which I'm writing to help those who will be going on Medicare Part A, B, or both for the first time in the near future. QUESTION: What are the most important considerations when choosing an Advantage Plan? Which plans and companies are the best? ANSWER: Those going on Medicare Part Bfor the first time inpatient. A per stay co-pay in the $300 range is what my favorite plans have; A lower Maximum Out of Pocket (MOOP), which represents Chemo, injection therapy, or infusion therapy. Regardless if a plan has a premium of $0 or $300, the cost of all three of those treatments is 20% of the billable amount to the insurance company need to make sure they understand the differences between both Supplements and Advantage Plans as well the most money one could as the pros and cons of each, be billed in a calander year. which I have discussed in earlier editions of the series. to $T,550, Generous ancillary It's my opinion that Advan- Failure of educating oneself makes it much more difficult sive dental, a free routing to choose the plan or plans that offer the greatest value. If you're new to the series, I suggest going to our website allowance to spend on items and reading the first six. You that can generally be found can also listen or watch the podcast and webcast ver sions. MOOP's range from $4.000 benefits such as comprehen- tage Plans could use a few more regulations. If I were eye exam and allowances for in charge of creating them, eyeglasses of at least $150, OTC benefits that provide an is that no plan can have a the first I would implement premium higher than $100 per month. Insuurance com- panies know there are plenty of Medicare bemeficiaries, especially the elderly who will not change plans, even on the shelf at a drug store. Choosing an Advantage Plan can be a much more complicated than a Sup- plement because there are eight companies that offer them in Western PA and approximately 80 total plans to choose from vs only nine available Supplement op tions. Another important consid- eration is the network of doctors and hospitals that are after premiums have gone available. Not all eight com- panies that sell Advantage Plans in our area provide ac cess to both Allegheny Health result in tens of thousands of Networks and UPMC. In addition, insulin dependent diabetics may need choose a plan that participates in the Senior Savings Model which guarantees no more than a $35 co-pay for insulin that is up as much as 500% over the years. They fear changing to a lower priced plan could dollars in bills in the event of a heart attack or hospitaliza- tion. I find it very troubling that some companies have gotten away with charging exorbitant rates over the years. And unlike Supplements where every plan of the same on a plan's formulary. Only letter has identical ben- efits and out of pocket costs regardless of what company clients participates. sells it, that's not the case with Advantage Plans. Co pays and out of pocket costs can vary quite widely among to Advantage Plans, paying plans and companies. For example, one might have a co-pay for a 6-day or longer hospítal stay as low as $300, while another $1,800. Two people who needed the same ly premiums doesn't provide clients choose a company type and amount of chemo- therapy could pay as much as most of the higher priced $3,500 more or less than one another. one of the companies we normally recommend to our As far as the best plans, those that meet the criteria I listed previously are in my profes- sional opínion. We typically I've mentioned this in previ- only write plans with three ous columns. When it comes companies, which per regula- tion, I can't mention by name in any column, podcast, webcast, or Facebook post. more doesn't at all guaran- tee lower co-pays or out of pocket costs. Except on a rare When all things are equal as occasion, it's my opinion that far as benefits and premiums paying $50 or more in month- are concerned, we prefer our that provides the best cus- tomer service, In that regard as well, not all are created any additional value. In fact, plans don't even provide the lowest MOOPs. And some, in equal. fact, have the highest! I find it unexplainable that in some Remember that these col- cases companies can charge more and provide less protec substitute for working with tions and benefits. Once someone has de- termined they prefer the Advantage Plan option, the most important considera- tions and what we want in an HMO or PPO for our clients are the following Premiums of why paying more than as low as $0 and but not to exceed $50 per month; A per stay hospital co-pay. In other likely ways someone on an words, a flat fee no matter how many days one is an umns are not meant to be a a licensed, experienced, and quailed agent like those at The Health Insurance Store. Consultation at one of our of fice locations, over the phone, or via Zoom are always free of charge. Here's another example S50 for a plan almost never makes sense. The two most Advantage Plan could meet their MOOP is if they needed 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents