Sometimes I Feel Like a Piece of Bologna

Monday, December 11, 2006

Medicare Soup - A, B, C, D

I’ve spent the evening on the Internet and still have few answers. A salesman from Mom’s HMO visited her last week. Apparently they are now offering a PPO option. Mom mailed me the materials, which don’t tell me a lot. This plan seems to have no premium, but doesn’t list the Part B premiums and is unclear on the Part D premiums.

I called the salesman, who knew almost nothing. He said this is a Medicare Part C plan. I didn’t realize there was a Plan C. My research tonight showed me that Part C is the Medicare Advantage Plan, which is what their HMO plan is, which is different from a Medigap plan. I thought the HMO was a Medigap plan.

I asked for a side-by-side comparison between the HMO and PPO. That seems reasonable, since the same company is offering both plans to the same clients. It would make sense to offer a comparison so seniors can make an informed choice. Well, the salesman didn’t have or know of any such comparison, but assured me that the PPO plan is better. It has to be. “They can’t offer a plan unless it’s better. There are insurance laws, right?” Right…

This plan seems to have higher co-payments for many services, but also has an annual out-of-pocket maximum of $3,200. So depending on utilization, you might come out ahead. Or not. And there’s still no provision for coverage in the donut hole.

I finally found a side-by-side on the company’s website, about six layers deep. It gives me more information than I had before, but is still lacking. I continue to be amazed at how confusing all this Medicare stuff is. And I have a degree in hospital administration! There’s no way any of the seniors I know would be able to figure it out.

So tomorrow, in the midst of my workday, I need to find time to call the company and ask more questions. I hope I don’t have to sit on hold for 20 minutes, which is what usually happens. And so far, I’ve not been impressed with the knowledge (or lack thereof) of the employees I’ve spoken to. When I was trying to get information on Part D, it took three calls to find an employee who even understood my questions, which were clearly not part of their memorized scripts. So I hope I can find someone who can help me so I can get back to work.

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3 comment(s):

It is, I believe, a national scandal that the insurance industry is allowed to offer so-called comparison data in a format of such impenetrable complexity. Insurance marketing material is clear enough.

The fog settles in here only when you are trying to figure out how to file a claim or to determine exactly what it is you are buying. I can't see that anything will change until a major consumer/voter revolt shakes up the insurance industry and the politicians who permit the industry's status quo to go unchallenged.

By Anonymous psampson, at 12:09 PM  

I am an insurance agent in the Medicare market which includes part c (advantage plans) and medigap or supplement plans as well as part d prescription drug cards. I will sum it up as best i can and hope I can help and leave me email open to any questions. Part C is part of the market because it makes healthcare costs more predictable for medicare beneficiaries. This being said, you need more than just a salesperson, you need that plus a teacher. I have felt like i was back in school in preparing for the medicare selling season and I feel I have a grasp on how these work. With part c you will have a smaller premium than your medigap, but you will have copayments. If you enroll in a plan and don't know what these are it can be disasterous(and you need to fire your agent). I would also advise that a family member be present when one of these plans is presented to clear up any confusion before it starts. Also, make sure that a summary of your benefits is reviewed with you and left with you. And if the cost of your medicare supplement is not causing financial hardship, stay with it because with most of them you have no copays but just a higher premium. As far as part d drug plans if there is a plan that has donut hole coverage out there I am not aware of it(although there are some that offer generic discounts through the gap). I cannot stress enough that when you take out a plan or help your parent(s) select one to have an agent that takes time and guides you through every detail before the meeting is over. NEVER enroll in anything you don't understand because it is our job not just to close sales, but to educate the public. Unfortunately because of greed or ignorance some agents fall short. Also, I know we all love our pharmacists and trust them, but they are not (in most cases) insurance professionals and just because they paint a plan to be great, remember they are in the drug selling business! There are people in our business with the heart of a teacher that want to help you and it is in everyone's best interest to seek those individuals out. Hope this helps! Feel free to email me with any concerns I help people every day whether it benefits me or not because I believe in the business and I want it to help people and be around for years to come.

By Anonymous syoung, at 7:42 PM  

Thanks. I appreciate your insights and your willingness to help. Looks like Congress is messing with Medicare again so now even what we know will change!

By Anonymous Pat, at 11:08 PM  

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