Reasons Why Your Friend Told You Not To Get an Advantage Plan
Recently I was tagged in a comment on a Facebook post related to an unhappy customer (not mine) of an Advantage Plan. He had simply stated that Advantage Plans are bad and advised the world of Medicare Beneficiaries NOT to elect one. This person, like so many that post negative things on social media, likely had a bad personal experience and is in no way an expert on Medicare Advantage Plans or any other area of Medicare. So, rather than respond on social media, I decided to respond here – with a blog for my clients and followers to help them understand this unfortunate myth surrounding what could be excellent coverage. Here is a short breakdown of why someone may have had a bad experience.
Your Friend Didn’t Use an Independent Agent
I will always point out first and foremost how beneficial it is for you to use an expert – a Licensed Independent Insurance Agent. I know I sound like a broken record, and yes, this is my business. But seriously, do not go it alone when it comes to Medicare or really any other type of insurance coverage. I understand that there is so much information now at everyone’s fingertips with Google and Yelp Reviews, however, that can make an important decision like your healthcare worse. Go ahead and use Google and social media for decisions like the best dishwasher, but please be more careful in matters related to your healthcare. I would encourage you to get personal recommendations on agents with whom someone has had a good experience and is local. Our services are free to clients, so if someone is charging you, that is a red flag. Most likely, the individual on Facebook did not use a local agent, and thus was enrolled in an Advantage Plan that didn’t work well for him. He likely called an 800 number and reached an agent five states away that didn’t find out about his health, personal needs, network preferences, medications, etc.
Your Friend Takes Drugs
This is obviously a play on words. Truly, no one plan is right for everyone. Original Medicare with a Supplement [or Medigap] and a Part D plan is a great combination of coverage for some. Others do very well and love their Advantage Plans. How do we begin to decipher what is best? We start with the medications. Every plan, be it Part D alone or an Advantage Plan, has a different formulary, pharmacy contract and drug category selection. One of the main reasons someone is unhappy with their plan is that their drugs were not considered. In other words, their drug list was not quoted and researched. In addition, their preferred pharmacy must be taken into account to get the best pricing. ** See again ‘Your Friend Didn’t Use an Independent Agent’
Your Friend’s Doctors Were Not Checked
The second biggest reason someone may be unhappy with their Advantage Plan is that no one checked all their doctors to ensure they were in network prior to enrolling them in a plan. I will usually review the top two or three plans based on the lowest annual drug costs, and then proceed to check all doctors, preferred lab, nearby skilled nursing facilities, hospital systems, etc. prior to final selection. Even though PPOs have out of network coverage, the Max Out of Pocket and Copays will be higher, and that will leave people very unhappy. This is especially true if they are not made aware of it or prepared for it.
Your Friend Was Sold on the Perks
Advantage Plans do come with a lot of perks that Original Medicare doesn’t have. For example, they come with dental, vision, and hearing. Many have OTC benefits, transportation, gym memberships, etc. Some of the plans have even added some minimal Part B premium reduction. However, depending on an individual’s health status and needs, some of the perks aren’t useful if medical coverage is sacrificed. In other words, Advantage Plans are designed with only a certain amount of total benefit dollars. The more dollars allocated to ancillary perks sometimes means less dollars are put into medical coverage. If the gentleman on Facebook had a serious medical issue that ended in a large coinsurance but he didn’t necessarily need the extra transportation, then he could be very unhappy overall.
Advantage Plans can be excellent coverage, and many are very happy with them. The question I get asked most frequently after ‘How do you get paid?’ is ‘Which is better, a Supplement or an Advantage Plan?’ My answer is always, ‘That depends on you.’ And then I begin to obtain a health history, list of medications, doctors, preferred labs, pharmacies, and hospitals. Even within the Advantage Plan world, there are many different options. There are HMOs, PPOs, MSAs and plans with no drug coverage at all. The moral of the story is to use a good local agent to help you wade through all the clutter and find your gem!
As always, if you would like assistance from someone local who is passionate about serving Medicare Beneficiaries, let me know! My guidance and assistance cost you nothing. For more information, email me at carrie@cdi-cares.com or check me out on www.cdi-cares.com
n “You life does not get better by chance. It gets better by change.”
o Jim Rohn