Mistake # 2: Choose a Medicare Advantage plan that requires you to get approval from the insurance company before performing a procedure / test.
SOLUTION # 2: If you are comparing plans, refer to the Summary of Benefits. All insurers must publish them and they must be the same and easy to compare.
ERROR # 3: Do not pay attention to the “maximum out of pocket” (MOOP) limit. All Medicare Advantage plans have a MOOP and many agents glaze over it and help you choose your plan. However, if there is a catastrophic medical problem (cancer, organ transplant, long stay in a qualified care facility, etc.), there is a good chance that you will meet your MOOP so you want to make sure it is as low as possible. The reason is that anti-rejection drugs and chemotherapy are considered part of ‘B’ outpatient drugs, not part ‘D’ prescription drugs and many plans only pay 80% of part B drugs. Therefore you would be hooked for 20% and they are very costly.
SOLUTION # 3: Compare, compare, compare and choose a plan with a lower MOOP.
Mistake # 4: Choose a plan just because the drug co-pays are a bit lower. Most smaller insurance firms will try to persuade you to choose a plan which they offer with very low co-pay on their drug formula, but have a smaller network of doctors / institutions in which to choose. The problem is that if you have a medical problem, you are locked up in the smaller network of doctors / institutions until the next enrollment period.
SOLUTION # 4: If you have difficulty paying for prescription drugs and your income / fortune is low, you may be eligible for additional social security assistance. A good insurance broker will list this and guide you, or go to https://secure.ssa.gov/i1020/start. By getting help with your medication, you can choose the best plan based on other options (additional optional benefits, the size of the network, authorization rules, doctor / institution, etc.).
Bug # 5: Choose a Humana advantage plan for 2019 at www.medicareadvantageplans2019.org/humana-medicare-advantage-plans-2019/ because you want a PPO plan, not an HMO.
SOLUTION # 5: Many people have the misunderstanding that they can take a PPO plan to any facility/doctor they choose. In reality, PPO plans still have a network of doctors / institutions that you need to stay in order to get lower cost. The biggest difference between a HMO and PPO is having a PPO, there is no need to get a “recommendation” to see a specialist. With an HMO you have to get a recommendation. To select EVERY doctor / institution in the country that accepts Medicare, you should consider a Medicare Supplement (MediGap) plan.
I’ve seen most solutions and mistakes when it has to do with the choice of Health Plans for Medicare Advantage. Outside of California there are additional variants of plans that can pose additional challenges.
What happened to my client, you may ask? Being in constant contact with my clients, in June I was overjoyed to hear the good news. Two physicians from a large medical group in Los Angeles identified the problem using the same test rejected by his former Medicare Advantage Plan. He slowly lost cerebrospinal fluid and was dangerously close to having no more. Now that he is healthy, we will review his coverage during Medicare’s annual open enrollment and decide whether to keep it in the supplement or switch to a Part C Medicare Advantage plan.