Tuesday, June 27, 2017


Half truths about
Mediocare supplements

IT SEEMS EVERYDAY I hear an AARP advertisement for a United Healthcare Medicare Supplement plan.

I’m also told some Humana Medicare Advantage plans have zero monthly costs.

Neither tells the sheep the full story.

AARP, which gets a kick-back on every UHC Medicare Supplement plan bearing the AARP logo, cites the standard Supplement pitch: it’s portable; subscribers can pick their own doctors and hospitals, and no referrals are needed to see a specialist.

What all Medicare Supplement peddlers don’t advertise is that subscribers pay a surcharge, often a hefty one, for the plan.

They also don’t advertise the fact that the “free” (we’ll get to “free” shortly) Medicare Advantage plans cover subscribers even when they are out of their home area, even overseas. Granted, in some cases — mostly when outside the U.S. — the patient may have to pay the local providers and submit the receipts to the insurance company for reimbursement. True, Advantage plans typically limit the providers (hospitals, urgent care, physicians, laboratories) an insured can see.

Referrals There is an advantage to having referrals — the patient’s Primary Care Physician; in my day a GP — knows who the patient is seeing and can expect reports from specialists so the patient’s care can be coordinated. (I have a no referral plan, but I always make certain any specialists I see send their findings to my PCP.)

Nothing is free Medicare is NOT free. The “basic” rate is about $105-a-month. It can be higher; it can be lower. It can be paid as a Social Security deduction or with a check to the government every month. HOW it’s paid does not affect the fee.

It’s higher if the person applying for Medicare lacked pharmaceutical coverage before applying for Medicare. (Fortunately for me, my time in the Flyin’ Corps many, many years ago gave me access to VA pharmacies.) Once a higher rate is set, it’s fixed “forever.”

The monthly rate can be lower if the person has sub-standard income.

Capitation Some Medicare Advantage plans require referrals; some do not. Some Medicare Advantage plans “capitate” their PCPs. That means while the Plan may have hundreds of specialists on its rolls, the particular PCP may be able to refer patients to only a much reduced list.

As with all insurance coverages, I compare my options once a year; for Medicare, in October.

There are a number of things to consider with all Medicare plans, be they Advantage or Supplement. Selecting the right Medicare plan for you walks you through the major considerations.

Before paying a surcharge for a Medicare Supplement plan, compare it to a Medicare Advantage plan. Maybe putting the extra bucks into your pocket might be a good option . . . but then, it might not. Everyone has their own needs.

”Through the gap” The “gap” in Medicare terms refers to the time when you “max out” the pharmacy allowance (usually around $3,500/year) until you go into the reduced fee/no fee stage. It differs greatly from any “gap” that may have been included as “supplemental insurance” to a private (non-Medicare) health care plan.

The bottom line is not to be stampeded into signing up for any plan with any insurer until you have done your homework. If you regret your decision, you have until December 30 to sign up with a different plan.

Annual review All insurance plans of all types — medical, auto, home owners/renters — need to be reviewed annually to assure that you are getting what you need at a price you are willing to pay.

A note on companies that will research plans for you. Do it yourself. Some plans are not on the searcher’s lists. Start with http://www.medicare.gov . It’s free and includes ALL plans approved by the Centers for Medicare & Medicaid Services, a/k/a CMS. (The CMS site is http://www.cms.gov)

One final thought: Beware of “capitated” PCPs. When talking to a plan’s sales people, be certain to ask: “Are your PCP’s capitated? Can they refer to ANY specialist in the Plan?”

Where to start

Medicare supplement plans defined

Medicare Plan Finder

Both Medicare sites above are free and should be the place to start for all things Medicare.

If the links fail to work, see http://tinyurl.com/y82lye4d to learn how to find/access them. It's a Google problem.


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Comments: In my opinion

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