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Protecting against unexpected risks in Medicare insurance Thumbnail

Protecting against unexpected risks in Medicare insurance

When you become eligible for Medicare, getting some supplemental health insurance to fill in the gaps in Medicare is often a good idea. What many people do not know, however, is that insurance companies often change their costs and what they cover without making a point to let you know. And once the enrollment period is over and a new year has started you are stuck with that policy for the year. To help us understand how you can protect yourself from unexpected changes in your coverage, we invited Helen Pleszewicz to speak with us about it. 

If you want to know more about the different kinds of Medicare supplemental coverages and how you can make sure you get the best deal, you can reach Helen at Century Benefits Group,    (585) 224-8138 x 205 or helen@aboutcentury.com.

Steve: So, Helen Pleszewicz, thanks for joining us on the blog here. We have a lot of clients, as I was telling you, who are near retirement or in retirement. And, of course, one of the many things that changes when you get into retirement is health coverage. And it's a significant concern for a lot of people who are retiring and a big part of that is the role that Medicare plays. And you're a specialist at that. So, let me ask you a little bit about that generally.

So, when people get to be Medicare eligible, what kinds of decisions do they have to make about Medicare insurance specifically, but other kinds of insurance as well?

Helen Pleszewic...: Well, there's a lot of things that come into play when you become Medicare eligible. And I'm glad that we're talking about this because a lot of people don't think forward and then they're left with all these unanswered questions. And they just say, "I didn't know this." And it could be kind of scary transitioning into a Medicare. It's another milestone that we all have to face.

One of the things that they really should be thinking about, are they going to be continuing to work? They may decide not to transition into Medicare and continue to work and stay on a group plan. You can do that. What I would suggest is look into your choices. What are the benefits? What are the costs staying on the group plan versus going onto Medicare? You also would like to know, or have to know, are you looking for a supplement plan or an advantage plan? There are differences. And there's original Medicare.

There's also the thought pattern where you would have to know who's on the group plan with me? It's not just about the beneficiary. You may have a spouse that's on your plan. You don't want to transition into Medicare and then leave your spouse hanging and not have insurance. That's really, really important.

Steve: Yeah. So, you mentioned a couple of things in there. First, let's sort of break down Medicare, and then I want to ask you about those two things that you just mentioned. So, Medicare has different parts?

Helen Pleszewic...: Correct. Well, there's the normal parts that everybody hears about. They might see commercials on TV, A, B, D, and C.

A is generally your hospitalization. B [inaudible 00:02:37] your doctor's outpatient, lab works. D is your prescription drug. And then there's C, which a lot of people don't realize is A, B and D combined, bundled sort of together. So, that's something that may help people and be beneficial to them as C usually includes your drugs, your hospital, your doctors, and may give you some perks, like dental and vision, where original Medicare doesn't.

Steve: Okay. And so, B is kind of automatic when you're eligible?

Helen Pleszewic...:  A is automatic.

Steve: A is automatic, okay.

Helen Pleszewic...:  And paying into the system, if you've worked 40 quarters throughout your lifetime, and it's up to about 10 years. You've been contributing, when you look at your check, you see that FICA or FICA, however you say it. So, you've been contributing. So, when we tell people A is free, there's no cost, but you've been contributing to that.

Your B there is a premium, right now it's 148.50. It can change from year to year. Part D is usually you get that through a plan, that is a private plan.

Steve: Okay. And then, you also mentioned supplemental, or Medicare Supplement and Medicare Advantage. What are those two things?

Helen Pleszewic...:  When we talk about supplements, it's original Medicare, and then if you ever heard of Medigap. Supplements fill in those gaps, things that Medicare may not cover.

Steve: Okay. Like what kinds of things would those be?

Helen Pleszewic...: Well, copays, co-insurances.

Steve:  Oh, I see.

Helen Pleszewic...: Original Medicare has large deductibles and co-insurances where the Medigap plans may fill in those areas. They're a little higher cost, but they usually will take care of those extras.

Steve: I see, okay.And that was the Advantage or the Supplement.

Helen Pleszewic...: The Supplement Plan.

Steve: Okay. And then what's an advantage plan.

Helen Pleszewic...: Advantage Plan is those C plans, the ones that take the A, the B, and the D and put them all together. So, that when you have a supplement plan, you have to have an extra part D plan. So, supplement plans don't include your drugs, where when you have an advantage plan it's all included. So, you don't have to think about that portion.

Steve: Oh, I see, okay.

Now, one thing that I know confuses a lot of people is that if you have Medicare supplement coverage of some sort or another, it's a good idea to review that maybe even every year, is that true?

Helen Pleszewic...: Most definitely. Plans change every year, costs change every year. A big piece of that is that all important prescription drug coverage. As we all know, drug costs are skyrocketing. Every year, the formularies change so you have coverage for a drug this year, but you may not next. So, we definitely need to go over that every year, especially if the drug changes.

Steve: Okay. And from what I've heard, if they change their formulary, or change something significant about their coverage, they don't necessarily make a lot of noise about that, right?

Helen Pleszewic...:  They do not. And then, you go to the pharmacy and here you are, it's like, "Wow." And I've had people call me up and say, "Helen, oh my gosh, I didn't pay anything for this drug. And now they're telling me it's not covered." So, it's really a good idea.

And you can't change plans throughout the year. We have our annual enrollment, and that's when we go over things in we change plans. There are some exceptions to that, but that's where you would want to come and talk to one of us about that.

Steve: Yeah. And when is the enrollment period?

Helen Pleszewic...: It's from October 15th to December 7th every year.

Steve: And so, that's the time you have to sign up for the subsequent year?

Helen Pleszewic...: Correct.

Steve: And so, well, once after you get after that December date. But once January starts, you're in that new plan and there's nothing you can do about it for that year?

Helen Pleszewic...: Pretty much. There are some cases where you can change plans. There's actually a January, February and March timeframe where you are allowed to change advantage plans from one advantage plan to another one time. That's kind of new, it's not always there. But so far, the last few years we've been able to do that.

Steve: Okay. And so, a Medicare coverage broker, it sounds like helps people select those things. So, what does a broker do? And, and what does it cost to utilize one?

Helen Pleszewic...: Well, the great thing is that it doesn't cost any money to come and talk to us. We are paid by the insurance companies. Here at Century Benefits Group, we sell all plans. So, our allegiance is not to the insurance company, it's to the beneficiary itself. We will analyze your drugs. We will talk about who your doctors are. Another thing that's important is to make sure that your doctors are a network. You may end up on a plan and your doctor's not in network, and we get used to our doctors. That's really hard, if you need to change doctors.

Steve: Right, okay. And so, people can find you at Century Benefits Group, if they want to review their Medicare coverage and see if they should change next enrollment period?

Helen Pleszewic...:  Absolutely. Even during the year, if they have a question, they can give us a call. I can answer questions. We could prepare for the annual enrollment. And even if they're having a problem, we may be able to direct them to whoever they need to speak with.

Steve: Okay, well, great.

Well, Helen, thank you so much for joining us. That's really helpful information. I appreciate your sharing some time with us.

Helen Pleszewic...: Thank you for having me.