Tuesday, September 3, 2013

IBM Medicare Extend Health Pre-Call Research

I was talking to a colleague today and he asked me why he had to fill out information about his doctors, the conditions he has or the drugs he takes in his profile before he talks to an advisor.  The truth is you don't need to provide any of that information.

The reason they want to know about your doctors is because they will look for Medicare Advantage private plans that have those doctors in the group when they are advising you.  So, that is information you only need to supply if you want them to talk to you about a Medicare Advantage plan.  The reason they want to know about your drugs is so they can look for a private insurance plan that will cover those drugs.

I highly recommend you decide before you make you call in October what structure of Medicare insurance you want. It will save you and the advisor from wasting time on products you don't want. So, let me remind you of a few things about Medicare.

  1. Original Medicare is the federal government insurance pool and the federal government is the payer.  There are no networks and it is not zip code based.  If a doctor takes Medicare you can go to that doctor.  If you decide to spend time in different states during the year this is the best kind of insurance to have since you are covered where ever you go.  If you decide you want to go to a specialty clinic (like Sloan Kettering) - if the clinic takes Medicare you can go.  It is easy to remember your copays and deductibles.  They do not vary from service to service whether it is an ambulance ride or a visit to a specialty doctor.  Any part B procedure always has between a 20% and 35% copay depending on whether or not the doctor takes assignment.
  2. Original Medicare copays and deductibles can be covered by secondary private insurance called medigaps.  If you buy a medigap you pay the insurance premium directly to the medigap insurance company.  Again, there is no network.  If the doctor takes Medicare then the doctor takes your medigap because the Medicare claim that is filed is automatically sent to the medigap insurance company. If you want a medigap plan decide what kind of medigap plan you want. The plan types are described on www.medicare.gov and they will tell you what insurance companies sell those plans.  There is also general info at the following link:  http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=231 
  3. Original Medicare and medigaps do not include prescription drug coverage.  If you want prescription drug coverage that is another type of private insurance. Do list the drugs you take in your profile so your advisor can find a part D plan that covers those drugs.  If you don't buy prescription drug coverage and then decide some years later you actually should have there will be a penalty on the premium of 1% per month of the average premium for every month you were without insurance. Look on www.medicare.gov for part D plans in your zip code that cover your drugs so that you have a comparison to any part D plan offered by Extend Health.
  4. Medicare Advantage plans are a substitute to original Medicare and are offered by private insurance companies but must conform to government rules.  If you use an MA plan that private insurance company becomes your payer.  There will  be a group of doctors associated with the plan and a doctor can decide at any time to not be part of the group. How much doctors charge depend on whether they are "in network" or "out of network" - for the latter your copay will be higher.   The plans are zip code based so you must use the doctors that are part of their group.  If you move to another area you must get a new MA plan. These plans must cover all the procedures that original Medicare covers but they can vary copays from service to service.  So, an ambulance ride might have a 50% copay. Most MA plans do not include use of specialty clinics. MA plans can also include prescription drug insurance. They might also require an additional premium over an above the part B premium you pay out of Social Security.  Look on www.medicare.gov to see what MA plans are sold in your zip code so that you have a comparison to plans offered by Extend Health.  Reminder - MA plans are sold by profit and loss institutions. The federal government insurance pool obviously is not. 
 Decide what insurance structure you want BEFORE you talk to an advisor.  It will save a lot of time and let the advisor focus on plans that fit the structure you want. Also, I highly recommend you directly pay any premiums to private insurance companies the old fashion way.  Don't let them suck money from you automatically because if you switch insurance policies from year to year you'll get a major headache trying to disconnect direct paying to the old company.

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