Medicare.gov - Doesn't Tell You Everything - Important Info for Consumers

Medicare.gov – Things To Know

Medicare.gov is an outstanding resource. We are the first to gladly admit that. But it can be overwhelming. And, there are some important things the government doesn’t tell you.

For example, your Medicare plan choice today may be irrevocable.

Selecting the right Medicare plan is NOT easy (especially the first time when you turn 65). A most important point that Medicare.gov fails to tell you is that making a mistake can wind up being very costly for you.

And while it’s logical to think that ‘buying directly’ is going to be better and save you money, IT’S SIMPLY NOT TRUE. There are some very significant reasons to speak to a local Medicare insurance professional. We’ll share some. But the real reason is because your needs are unique to you. You don’t benefit from a simple cookie-cutter solution.

You Are Buying Today – BUT YOU NEED TO THINK ABOUT TOMORROW. A ‘Free Plan’ sounds great when you currently have few health issues or needs. But the ‘wrong’ Medicare plan choice can end up being much more expensive if a serious health condition arises.

SAME PLAN — SAME COST (if any) — PLUS FREE ADVICE FROM A LOCAL PROFESSIONAL
A local Medicare insurance agent can help you learn about ALL plan options in your area. He or she does NOT charge (they can’t). You benefit from their knowledge and experience. You can still buy directly via Medicare.gov. BUT WHY NOT AT LEAST HEAR WHAT THEY HAVE TO SAY.

Click here to find Medicare Brokers Near You

To access a directory of Local Medicare Insurance agents, click the link or the image.

The directory shows agent information. NO information is entered to see and use the directory.

MEDICARE.GOV: THINGS TO KNOW BEFORE MAKING WHAT COULD BE AN IRREVOCABLE DECISION

Medicare.gov is much easier to use for Medicare Advantage (MA) plans. But that is just ONE of the options available to you. It may or may NOT be your best option. Want to see any doctor or specialist (Medigap does that). Do you travel or spend time in another state (Medicare Advantage might NOT cover you). Are you on an insulin pump (understand costs before choosing).
Medicare.gov doesn’t make it easy to understand things that matter such as in-network, out-of-pocket costs, drug plan coverage, coordination with Veteran’s coverage, Medicaid.
“In Network” matters if you decide a Medicare Advantage plan is best for you. Knowing which local doctors, hospitals and especially specialists participate (and can be tricky to find on your own).
Medicare.gov’s Plan Comparisons seem very detailed. But they miss some important information that’s vital (we explain some more below).
VERY IMPORTANT FOR THOSE TURNING 65. The decision you make could be irrevocable. Switching Medicare plans is NOT always possible. Medicare.gov does not tell you what’s possible if you don’t like your choice (or when your chosen plan changes). All very important things to know before locking in a choice.
Medicare.gov’s Plan Finder prescription drug search can be confusing for those taking multiple medications. See our example below regarding insulin coverage.
Medicare.gov lists Medicare Advantage plan ancillary benefits (vision, dental, etc.). There’s little detail of specifically what’s covered in terms of benefits and service providers.
Medicare.gov provides insurance company connections. That’s valuable but know that you will likely be talking to a captive/employed agent who typically represents ONLY their one plan.
Medicare.gov offers NO savings or better plan availability . You can buy the same insurance policy for the same cost through an independent insurance professional (who is appointed with the insurance company).
WANT MORE INFO ABOUT WHAT’S MISSING AND MISTAKES TO AVOID? Below we share 18 important things consumers don’t know (but need to) about Medicare Advantage and Medicare Supplement insurance options. Facts shared by top local Medicare agents.

Reasons to work with a local Medicare insurance agent

Many Medicare-focused insurance agents offer ALL Medicare options (Medicare Advantage & Medicare Supplement aka Medigap). They can help you compare and find the best option for you today and likely in the future.
You may be new to Medicare – but many agents have been focused on Medicare for YEARS. They know which plans have changed (rates, service quality) and which plans local doctors complain about.
An experienced agent can help you navigate Medicare’s nuances – important things you might not even think about (like plan changes, their history of rate increases, changes in service providers).
To offer Medicare Advantage plans, agents MUST undergo yearly Medicare-mandated training and certification.
There is NO COST to tap into the expertise of a licensed independent Medicare insurance agent. Where else can you get free expertise with no obligation to buy anything?
Plan coverage and costs are identical (there is NO savings by buying direct or through an insurer contacted via Medicare.gov).
You’ll have ONE PERSON to call when you have questions or have CLAIMS ISSUES. You’ll never get one person consistently from a toll free customer assistance number.
Year-to-Year Consistency. Medicare changes … Medicare plans change. Just like having a trusted doctor or electrician, having a local Medicare insurance pro can be of enormous value and peace of mind.

How does an insurance agent get paid for the time they spend with me? The agent is compensated from the insurance company (via a commission) that is factored into the cost of each policy. The commission does NOT add to what you pay for insurance. You pay the same cost for the identical plan. You get the added benefit from their knowledge, support and assistance.

local Medicare insurance agent directory

Click here to access the Association’s directory of local Medicare insurance agents.

18 POINTS ABOUT MEDICARE.GOV & BUYING DIRECT:
WHAT’S MISSING & WHAT MISTAKES CAN YOU AVOID?

We turned to Medicare insurance agents listed on the Association’s directory to share some of the things Medicare.gov fails to point out … and that consumers need to think about. Note, Medicare options are complex and vary. The following represent items denoted by top local Medicare insurance agents.

1. Medicare Advantage Plans Vary (Medicare’s Alphabet Soup): MAPD (MA with prescription drug benefits) plans can vary greatly with limited HMO, HMO-POS, RPPO, LPPO etc. The average person usually does not make the best decisions for themselves unless they are willing to invest about 40 hours reading the Medicare and You guide ( very few people do).

2. One Company – 5 Choices: In my area, United Healthcare has 5 different plans . One has no drug coverage and was designed for Veterans, one is for individuals with Medicare/Med-Cal, one is for people who live in the County but want to cross county lines to see doctors, and the other two have different benefits. How would someone new to Medicare know let alone understand the nuances?

3. Network Parameters. The majority of MAPD’s are HMOs. Since the enrollee’s Medicare funds are now contractually bound to the Medical Group with which the health plan contracts, access to desired providers is critical. While the Primary Care Physician availability can be found by the moderately online-savvy senior consumer, getting Specialist information requires true detective skills. To be locked away from a needed specialist for a year, or perhaps, due to pre-existing conditions and supplement underwriting, to permanently give up access to needed specialists is a clear and present danger for the online shopper.

4. Free Changes During The Annual Enrollment Period (AEP). NOT COMPLETELY TRUE! Many mistakenly think they can change everything during AEP but there are restrictions and limits. You might be able to change from a Medicare Advantage to a Medicare Supplement plan IF you can meet health eligibility. If not … that’s why we say some people make an irreversible choice.

The Next 4 Points About Medicare.gov

5. The Cost Of Moving: Seniors move. Medicare Advantage plans can be ‘county-specific’ (that’s COUNTY … not COUNTRY). If you move from one county to another, you may be involuntarily dis-enrolled from the plan and have to re-enroll in whatever plan is available.

6. Doctors Not “In Network”: A major Medicare Advantage insurance company noted this is the #1 reason people who signed up for their Medicare Advantage plan subsequently dis-enrolled (often within a few months). The RISK is that their GUARANTEED INSURABILITY for another Medicare option might have expired.

7. Right Doctor – Wrong Plan: You spoke with their doctor’s receptionist who told you, “yes, we do take XYZ insurance company” only to find out they don’t take the specific Medicare plan you signed up for. Doing the research is more complicated than many people understand.

8. NOT All Networks are Equal: Some networks (consumers pay more for out of network services) are very small and regional, while others will let people cross county/city lines and still be in network – state-wide as an example. (Awaiting clarity) One carrier, one of the larger ones, has a specific provider, but National network on their MA plan.

Additional Considerations About Medicare.gov

9. Co-Pays Matter: Consumers don’t look carefully at in hospital co-pays for each day. Some plans in the area have daily co-pays up to $350 for up to 5 days vs Medicare plus a supplement $0 out of pocket. Some plans are lowering co-pays to 250 per day next year but still higher than some realize.

10. Sorry, You Are Now DIS-Enrolled: Some Medicare Advantage (MA) plans do not have drug coverage, and of those plans some will allow you to enroll in a stand-alone Prescription Drug Plan (PDP) while others won’t. If they enroll in the MA plan then try to enroll in the PDP they’ll be dis-enrolled from the MA plan and might not find out until after AEP is over.

11. Ancillary Offerings. All MAPD plans offer ancillary products through other companies and networks such as optometry, dental, non-emergency transportation, fitness memberships. These benefits are becoming more competitive and richer, with greater variance between companies. Very little information on ancillary programs is included on the health plan websites.

12. Failure To Prescribe: When signing up for Medicare (at age 65) you may think it is okay to go without the the Prescription Drug Coverage or select a MAPD plan only to learn at a future time, that the penalties are worse than they may or may not have calculated and there is no appeal process to stop the excess charge on the premiums for the rest of your life. That’s the happy version. The other version is when you need that $2,000 medication for intestinal health or that $75,000 medication (month after month) that may save your life.

13. Prescription Drug Comparison: Drugs can be very deceiving and Medicare.gov does not provide you will all of your options to buy prescription drugs. One drug can lead to a plan selection that would be wrong. Azelastine: 1%. 2 squirts each nostril 2x/day was on a list that my client provided me yesterday. The cheapest plan listed on Plan Finder was tier 3 with a deductible of $90. This meant that the client would have to pay $90 before they reach a co–pay of $47 per refill. Good Rx had the drug for less than $20 at multiple pharmacies. This is a very common occurrence.

14. Are You ‘Dual Eligible’? Simply that means you receive both Medicare and Medicaid benefits. Some dual eligibles who are beginning Part A and Part B will be automatically enrolled in a plan that CMS (the government agency) selects. But the government doesn’t know who your doctors are. You might have to change doctors and pharmacies or change the plan AFTER learning your doctor isn’t in Network.

The Final 4 Points About Medicare.gov

15. Limits on Skilled Nursing Care: Typically 20 days coverage with an MAPD plan vs original Medicare plus a Supplement plan offering a total of 100 days. Cost of ‘durable medical equipment’, client pays 20% on most MAPDs. It may be covered under a Medigap plan after limits.

16. Insulin Coverage: A woman with diabetes was convinced by one of the 1-800 numbers to select a Medicare Advantage (MA) plan. The phone agent never took into consideration that she had an insulin pump and the MA plan only covered 80% of the insulin for the pump. A Medicare Supplement plan would have covered it all after the Part B deductible – ultimately saving her money every year.

17. Star Ratings: Medicare.gov shows last year’s Star ratings A local insurance agent with many clients on Medicare may have a better sense of which physicians and practices seniors on Medicare complain about.

18. Veteran’s Coverage: I had a client whose husband was a Veteran and covered by both the VA and Medicare A and B. As such he could get a MA plan (doesn’t need drugs as a Veteran) which costs $0 and has numerous benefits attached that he does not have as a Veteran. Meals in case of hospital, transportation, $40 a month freebies from CVS, Silver Sneakers (gym membership), etc. These are very valuable and costs him nothing.