By Deborah Jeanne Sergeant
Many people feel confused when choosing a Medicare plan.
The numerous options and industry jargon can make plan selection challenging.
Fortunately, area Medicare experts can help guide those new to medicare advantage or those changing plans during the current open enrollment period, which ends Dec. 7.
“This is the time to do it,” said Daniel Goetzmann, insurance agent and broker with Goetzmann & Associates in Syracuse. “This is the year where they should be talking with Medicare specialists and getting as much information as possible.”
Beyond the basic Medicare, the additional plans vary depending upon company and type of plan. Goetzmann recommends that clients shop around to find the plan that best fits with their health and prescription drug needs “because of the number of benefits being added this year. I’ve never seen it added to this much,” he said. “There are plans that give you a reduction of your part B premium so it’s a refund. Some are a $42 a month refund for Part B. Those plans have a $0 premium. They’d gone up $22 a month last year which is a shock to older people on fixed incomes.”
He has also seen improvements in dental, hearing and vision benefits, along with fitness membership discounts. The competition among healthcare benefits providers has grown so much that many have participated in open house events to educate Medicare policyholders — something that Goetzmann has not seen before.
Typically, HMOs will not cover routine issues addressed out of network; PPOs offer some coverage outside the network. Goetzmann encourages policyholders to consider how often they travel, as some networks offer benefits outside the area for nonemergency care and some do not.
“Medicare.gov has a provider listing you can follow for doctors, listing and facilities,” he said. “Every major insurance provider makes finding a provider accessible on their websites. It can be tough to call someone. You should attend a seminar and arrange a one-on-one meeting with an adviser. The cost of the Medicare plans is the same if you go direct or if you go to an adviser.”
How much people use their healthcare benefits also affects their decision. Frequent users with chronic conditions or who want to see a provider with every ailment will want a plan that supports that level of care.
“You’re not married to the choice forever,” said Maura O’Toole, Medicare adviser at FitzGibbons Agency, based in Oswego.
She said that sometimes, companies change which prescription drugs they cover or at what level they cover them. Or sometimes, policyholders’ health changes in ways that may make different coverage more appropriate.
“If things change and you’re put on a different prescription, you can look to change your plan,” O’Toole said.
Typically, that is during the open enrollment period. However, an adviser may be able to find a reason for special election period where the policyholder could change companies.
“If you find someone you can trust, you can discuss this,” O’Toole said.
She also encourages current clients to reach out to her during the open enrollment period to review their plans, as the companies sometimes offer improved plans that could provide clients with better coverage.
Some people are stuck on a certain company. Although brand loyalty may seem like a money-saver, often, it is not. Some companies’ prescription plans may not cover a policyholder’s medication at the same level as another’s for example.
“Find an adviser you trust instead of paying attention to the ads you hear on the news,” O’Toole said. “Some people get called about plans and are unsure of what they’re signing for and when they get it, they’re not happy. You can find someone who does this for a living and can guide them. That’s important. The longer I’m in this business, the more horror stories I hear. There’s no charge for the services of the consultants like myself. We get paid by the carrier if the plan is sold.”