The Champion of Medicare
Building a Strong Medicare Plan Foundation
Like human health, the health industry can change rapidly. Year in and year out, there's changes in the Medicare health care in the US. It can be from providers going bankrupt, providers becoming out of network with a specific insurer, drug formularies changing, to plan contract benefits changing. With all these changes, this is a risk to the beneficiary. It’s important when choosing a health plan at 65 to look for stability in the overall plan. Here are the top characteristics you should look for:
Guaranteed Issue Coverage:
When a beneficiary becomes eligible for Medicare, they have a one time guaranteed opportunity to enroll in a Medicare Supplement Medigap plan. Why is this important? Because, this a guaranteed enrollment without being underwritten and being excluded because of prior conditions. This is HUGE!! This 6 month time frame allows you to enroll in a highly sought after plan without being denied. Once the 6 months end, you will be underwritten and priced accordingly or not for a Supplement plan. Its beneficial to enroll because you can always downgrade to a lower class plan, but you can't necessarily upgrade to a Supplement plan G or N. If you change your mind, you can downgrade to a Medicare Advantage plan. So, always start at the top.
2. Guaranteed Renewable:
Why a Supplement Medigap plans? Unlike Medicare Advantage plans, the benefits of Supplement Medigap plan are guaranteed and unchangeable every year. Medicare Advantage plan benefits can change yearly without future plan benefit guarantees. That means coverage can change every year whenever the carrier has unforeseen costs. If their loss ratio increases then benefits decrease. We see this in 2024 with Humana1 with increased Medicare Advantage expenses. McKinsey & Company has an article “The Future of Medicare Advantage”2 March 13, 2024 which summarizes “The winning strategies of the past five years are unlikely to be sufficient to meet members’ evolving needs and preferences.” Why be in an uncertain Medicare Advantage plan with yearly changing benefits?
Choose Your Doctors and Hospitals:
Options are good. In urban areas there’s lots of options. But, as you move further away from metropolis areas, the providers may be more strict on accepting Medicare Advantage or none available. What we see is a trend of providers not accepting Medicare Advantage plans3 such as Scripps in San Diego. In less populated rural areas, there may be no Medicare Advantage plans available regardless of the low amounts of providers. Medicare Supplement Medigap plans offer options anywhere in the US with providers that accept Medicare. This is important because if you decide to move or move out of state, you will want a plan that can provide full coverage for any unexpected health issues as you age.
Low Out of Pocket Costs:
Depending on the Medicare Supplement Medigap plan you choose, the pricing is very low when you visit doctors or hospitals. This is a different story with a Medicare Advantage. Medicare Advantage plans can change the contract every year to benefit them, not you. This can mean higher out of pocket costs to you or less coverage. Medicare Advantage plans are 3 times more likely to have problems paying medical bills compared to enrollees with Medicare Supplement Medigap plans according to AHIP 2024 report “The State of Medicare Supplement Coverage”.4 With a Medicare Supplement Medigap plan, you can be sure that your benefits will not decrease.
Medicare is very complex. With it’s complexities and moving parts, it’s important to get a plan that gives you the most options going forward. You can always downgrade a Medicare plan, but after the age of 65, you can’t necessarily upgrade your plan. Always choose the best most suitable plan with options when you turn 65. An important factor is the plan contract changing yearly or is it by law unchangeable? Make sure you choose a plan that allows you the flexibility to visit your doctors wherever Medicare is accepted in the US. Contracts with providers change yearly, and you don’t want to get stuck in a billing battle. Choose a plan based on unchangeable benefits instead of $0 cost premiums. Because Medicare is so complex, it’s important to start your Medicare journey with a strong foundation. Talk to our licensed agents to help you find a suitable plan HERE. Our Medicare services are no cost to you.
https://press.humana.com/news/news-details/2024/Humana-Reports-Fourth-Quarter-2023-Financial-Results-Provides-Initial-Full-Year-2024-Financial-Guidance
https://www.mckinsey.com/industries/healthcare/our-insights/the-future-of-medicare-advantage
https://www.reuters.com/business/healthcare-pharmaceuticals/california-healthcare-providers-move-shows-pitfalls-medicare-advantage-2023-11-02
https://www.ahip.org/news/press-releases/ahip-report-understanding-the-value-of-medicare-supplement-coverage-for-nearly-14-million-americans