Brittany Stickney, Medicare Insurance Broker

Answer: I want to be clear: I am not frustrated by the question, but I am frustrated at the misinformation that causes seniors to believe things that are not true. It only hurts the beneficiaries, and it's not right. However the biggest misconception in my 9 years of being a broker is that AEP is a time to switch your Medicare Supplement/Medigap plan without medical underwriting. This is simply NOT TRUE. The only time you can get a Medigap policy without a health review is when you are new to Part B (Open-Enrollment) or you have a GI Right (Guaranteed Issue) due to a qualifying life change. Most of these events require proof to the insurance company, but there are several GI cases: maybe you move, leave a group plan from work, or your MA plan stops covering your area. You can find more examples on the Medicare website. Few states also have a GI rule around your policy anniversary or birthday. If you are not in one of those states, and you do not have a GI right, you will ALWAYS have to answer medical questions to change your plan. Your eligibility and price of coverage will be determined by these answers. Most companies use a service like Milliman IntelliScript to get the Dx and Rx information they need. That said, I recommend applying for a new plan as soon as you decide you are unhappy or unable to afford your current one. Medigap plans are standardized, so you will receive the same coverage from each company.

Bonus misconception: "Everyone needs Medicare at 65". Also not true! Sometimes people save a lot of money by staying on a group insurance plan. They can see their same doctors without change, insure a spouse or dependents, and usually keep a larger face amount of life insurance--which is important if there are still liabilities to be paid. The same life policy outside of a group insurance plan would likely cost hundreds of dollars each month. As always, talk with a trusted agent early in the process to make sure you are getting honest answers from the start.

Answer: The very first step is deciding if one needs Medicare at 65. Some people spend months learning the program, only to find out they will continue working or be covered by a spouse under group insurance. This leads to a duplicate process happening years later when that individual needs to catch up on any changes and basically re-learn Medicare. Once we know the program is a good fit, it's simply a matter of explaining what the letters (A, B, C, and D) mean, what they cost, what they cover. When does one enroll? How does Social Security play into the picture? Do they have TRICARE, Medicaid, a retirement plan from the government or a past employer? What is their health and budget like, will it change down the road? Do they travel? 85% of Medicare is learning the program and how to stay protected from scams and "bad apples" while navigating it. About 15% is actually choosing coverage. A successful Medicare enrollment (and retirement) is all about education and advocacy. Unfortunately, there is a lot of misinformation. Make sure whomever you are getting advice from is trustworthy and up-to-date. Make sure they are "fact-finding" and asking enough about you to determine what you need--not just at 65--but well into retirement. A good broker should feel like a mentor, not a salesperson.

Answer: Food cards: due to a limited number of people qualifying for them, but agents are marketing them like crazy. OTC cards: Unless you really need help buying diabetes test strips, pain relievers, band-aids, etc., this shouldn't be a priority when deciding on a health plan. Part B Giveback: A lot of plans advertise this, however, common issues are $.60 - $1.00/month "Givebacks", OR the company offers more ($66 - $120), but a lot of times, it isn't paid, is overinflated, or you have to fight to get it--and it's likely going to be a contributing factor in that plan leaving the market the following year. Also, read the fine details on the dental, vision, and hearing benefits in the Summary of Benefits. I have many clients who were sold Medicare Advantage plans and had to purchase a standalone dental plan because the coverage wasn't what they were expecting--nor was it effective for their needs.

Get insurance for what it's made to do best. Who's got better meatballs: Golden Corral, or the small Italian restaurant down the street that's been open since the '70's? My point: There is no magic insurance plan that does everything well all in one package (unless you have TRICARE or Medicaid, but that's not the focus); make sure you can see your doctors. Make sure you can afford the co-pays and deductibles. Physical therapy is a common situation where people overlook how quickly those $40 - $55 copays add up. Make sure you're covered at a price you can afford, at doctors you are comfortable seeing. Then move on and get a dental plan... in network with your dentist, covering what YOU need. Supplemental or Cancer/Heart/Stroke coverage is an affordable option to add to help with MA copays, hospitalizations, outpatient surgeries, and catastrophic health situations. Get creative and ask questions, but don't buy insurance because you're going to get $35 to use at CVS every quarter. Buy insurance plans that make you feel genuinely protected.

Answer: Having "enough" coverage is 100% subjective. Every person is different: different resources, different health situations, different needs, etc. I am going to highlight the facts of how Part A works--then you can decide if that is enough coverage for your needs.

Part A has a deductible of $1,736 if you're admitted to the hospital. That isn't an annual deductible like most people are used to. It works on a 60-day benefit period--meaning if you are hospitalized in the spring, meet your deductible, and are re-admitted in the fall (or possibly summer), you will pay that deductible again. That means in the absolute worst-case scenario, you could be billed that deductible up to six times in a year. If your hospital stay is continuous past 60 days, you start to accrue copays over $400 per day. This is not including Skilled Nursing costs, if those may arise as well.

Part A is generally free monthly if you or your spouse have 40 quarters (10 years) working, paying FICA taxes. It seems unusual that one would pay for Part B, but not enroll in premium-free Part A. Original Medicare has no annual maximum out of pocket. There's no cap on the amount of medical bills you can receive. If the Medicare premiums are unaffordable, work with your local Social Security office to file an appeal. I would never recommend someone have Parts A and/or B by themselves. There are plenty of options to protect you from exhausting your retirement funds on medical expenses!

Answer: Most people regret choosing Medicare Advantage because it’s not well understood to them before signing up. Sometimes it’s because of the agent/broker, sometimes not. A lot of people aren’t aware of the network restrictions or high out of pocket cost potential. Most people don’t understand that Medicare Advantage replaces Original Medicare. When people truly understand MA plans and how they work, most will choose Original Medicare. Those that choose MA at this point—they are prepared, understand the coverage, and usually have no issue with the terms they agreed to. The “regret” comes from a faulty buying process and lack of understanding. People who get sold on “free insurance that covers dental” are likely going to regret that decision if their health declines and they need more support. Insurance is very personal and very confusing. Request physical materials about any plan you’re interested in—namely the SOB (summary of benefits). Ask all the questions all the time; they are never “dumb” questions, but they can save you a lot of money in retirement.

Answer: Medicare Advantage plans. I don’t say this because they are inherently bad, I say this because historically, they are not sold responsibly. Most people are only told the “cool” things: no premium, covers dental, includes a gym membership.

Most people aren’t told about constant plan/network changes, possibly losing coverage, high out of pocket costs (including paying 20% for chemo and dialysis). I have explained Medicare the same, non-biased way to every single person for 9 years. 100% of the time, my clients tell me they want Original Medicare. I have never had someone see both sides and choose Part C (Medicare Advantage) for any reason other than they can’t afford a supplement premium (or they have Medicaid).

That said, all you need is to understand your plan. You might be okay with a higher premium or deductible than your neighbor would be. As long as it works for you and you know how to use it, it’s effective.

Answer: A responsible advisor would use common sense to determine if a POA is a better method of communication, but there are plenty of folks who have dementia on paper, but still drive and take care of themselves. Everyone deserves help understanding Medicare, but brokers only know the information given to them. That said, there have been a few times where I have avoided doing an application until we can get a spouse, son, or daughter to give the green light. Unfortunately, this is up to the client being open and the broker having compassion and common sense. This is something I stay aware of and look for warning signs of before doing official business with someone.

Answer: This is really dependent on where you live. Approximately 14 states have a “Birthday rule” or “Anniversary rule”. This is a short timeframe around your birthday or policy anniversary that you can change supplement plans without answering health questions. Now, you HAVE to have a supplement to replace. You cannot use a Birthday Rule to go from Medicare Advantage to a Supplement. You also have you make your coverage effective within your timeframe.

If you do NOT live in one of those states, the guidance to “choose the cheapest plan” is quite dangerous. You want to look at how quickly a plan pays claims, how long they have been in the market, customer service, financial stability, and past rate increases. If you don’t do that homework and make your decision based on that information, you can end up in a plan that gets really expensive really fast, and you might not pass underwriting to get away from it. Medicare isn’y fun to learn, but if you do it right the first time, you’ll have a smooth and easy retirement—as far as healthcare is concerned.

Answer: It’s not allowed—and I’m so sorry you have to deal with this. Those benefits are available to certain Medicare beneficiaries, but the majority of them don’t qualify for the benefits outlined in the ads that make them call. It’s a tactic to get the phone to ring and to circumvent the compliant marketing processes. Grocery cards are only available for people who have Medicare and Medicaid (dual-enrollees). Part B giveback plans are NOT for folks on Medicaid (Medicaid beneficiaries don’t typically pay Part B, so a “giveback” does not benefit them). People on Medicaid have a vastly different experience with their Medicare Advantage plans than those without Medicaid. Do not take any calls about Medicare that you did not initiate. If you need help applying for Medicaid, reach out to DHHS. Don’t put your information into Facebook lead forms. If you need to talk about your Medicare coverage, find an experienced local broker you can meet with. Ask for license numbers. Tell the agents and brokers you are also recording the call. Fight back any way you can!

Answer: Medicare Advantage plans terminate or withdraw from a market for many reasons. Number one: cost. If the plan is not profitable or costing too much to administer, the company will pull it from its offerings in the coming year. Typically, it is replaced with a plan similar in structure. Service area and network changes causes plans to go away as well. Folks in rural areas have to be aware of MA plan changes more often than those in larger cities. If you’re interested in these plans, you really have to understand the mechanics behind them because plan changes can result in lack of medical care and/or high out of pocket costs.

Answer: Medicare does cover some blood thinners, but each one is different. Eliquis, for example, is covered but has a high co-pay. Plavix is usually not covered at all, however, the generic Clopidogrel is covered—and has very low copays. I recommend running medications through Medicare.gov to understand the costs. It’s easy to do on your own and you don’t have to worry about someone selling you something!