Open Enrollment for Medicare Advantage plans - what they are, how to shop and are they for everyone. Pat MacKinnon from MMAP, Inc. discusses what beneficiaries need to know about them and encourages everyone to know what the coverages are before committing to one.
Open Enrollment for Medicare Advantage plans - what they are, how to shop and are they for everyone. Pat MacKinnon from MMAP, Inc. discusses what beneficiaries need to know about them and encourages everyone to know what the coverages are before committing to one.
Good morning. This is Kitty Glomski along with
Brooke:my cohost Brooke Mainville
Kitty Glomski:from Region 9 Area Agency and Aging and another episode of Let's Talk About Aging. Good morning. This is Kitty Glomski, and I have the pleasure of talking to Pat McKinnon from the MMAP office in Lansing. Good morning, Pat!
Pat MacKinnon:Good morning, Kitty.
Kitty Glomski:We finished one exciting open enrollment and we're starting a new exciting season for our Medicare Medicaid Assistance Program. Pat, do you want to talk about open enrollment?
Pat MacKinnon:Sure, yeah. Throughout the year, there are different enrollment periods for folks who are either new to Medicare or thinking about changing their Medicare plans. The January 1st through March 31st is a special enrollment period for folks who have a Medicare advantage plan.
Kitty Glomski:Yes, it is. We get lots of advertising, TV and mail and unwanted phone calls about this program, don't we?
Pat MacKinnon:About the Advantage plans? Yes. They're very active. They've got a product to sell and they work hard at it.
Kitty Glomski:So, so what's different about the Advantage Plan? Why would somebody be interested in an Advantage plan?
Pat MacKinnon:Well, an advantage plan is what is called managed care. Folks might be familiar with the initials H M O or P P O. It's a private plan there's a network of providers: doctors and hospital networks, therapists, the whole range of healthcare providers. They agree to work with this plan, accept payment at a certain rate and the idea is that you have a network of doctors who are there to coordinate your care.
Kitty Glomski:So let me just recap that because the plan itself, the insurance company, negotiates its rates with the doctors and hospitals and labs and clinics and all of the providers. Is that correct?
Pat MacKinnon:That's right.
Kitty Glomski:So each plan is a little different. Correct? Correct. They little different in their network. Some providers will work with a variety of different plans. Others are more specific. Each plan is a little different in its structure. Absolutely. So that means that our beneficiaries have to shop, don't they?
Pat MacKinnon:Yes. That's, that's very important. Folks wanna make sure that their care providers are a part of that plan's network. That's very important. Yeah.
Kitty Glomski:Was there anything else that you wanted to say about the Advantage Plan program?
Pat MacKinnon:it's a different option for receiving your Medicare benefits. You'll receive all the same benefits you would get with what's called original Medicare. The studies have shown that the quality of care is essentially the same as if you had original Medicare. It's just a different way of receiving your healthcare coverage insurance.
Kitty Glomski:So Medicare though, original Medicare, that's Part A hospital, Part B, medical covers 80% of the bills and so that 20% part of it is picked up with the Advantage plan.
Pat MacKinnon:Right. you don't have that gap, if you have original Medicare, some folks will purchase an additional policy called a Medigap policy or a Medicare supplemental. With an advantage plan you don't need that. It's structured in a way that folks may not see those gaps in coverage. With a managed care plan, you may see more copays than you would with original Medicare. It depends on the plan you choose and your monthly premium. Some folks will elect for a very low monthly premium, but then when they go to see the doctors, there may be higher copay. Others may go with a higher monthly premium, but then when they're going in to see the doctor there may be no copay that's involved. So you kind of wanna look at it. It may appear to be very cost effective on the front end, but if you're somebody who sees the doctor very often, those copays may add up so that you're paying more than what you thought.
Kitty Glomski:These plans have what they call a maximum out-of-pocket spending cap per year, a cutoff that you only co-pay up to a certain level and then the plan kicks in and will pay everything over and above.
Pat MacKinnon:Right. That's not uncommon for insurance plans. You have your annual deductible once you re reach a certain point then different benefits kick in, and then at another point you pay more. Then you're not paying anything, but it's insurance. That's what we're talking about- healthcare insurance and whether it's original Medicare or Medicare Advantage plan, these are all insurance plans and the rules and practices are the same.
Kitty Glomski:I always tell people look at the different parts and pieces of an advantage plan because you have to really compare each part to consider your healthcare needs when you're looking at one. You have the healthcare part, but they cover prescriptions too.
Pat MacKinnon:That is right. Many of the Medicare Advantage plans will have both your healthcare as well as a prescription drug benefit. If you're with original Medicare, you would have your original Medicare, which covers the healthcare costs, and then you would choose what's called a part D, prescription drug plan. But with many of your Medicare Advantage plans, it's all bundled together, so, If you're looking at an advantage plan that has that part D prescription drug coverage, you'd want to make sure that that prescription coverage covers your medications. Each plan has what is called a formulary. It's a list of medications that they cover and that they pay for. The government requires them to carry certain types of medications, but it can vary between plan to plan. So that's also very important to look at. You talked about the different parts of Medicare Advantage plans, some Advantage plans add some additional benefits that you don't normally get with original Medicare. Silver Sneakers is a very popular one in my neighborhood. It'll help cover the costs of health clubs or gym memberships. Some will have dental coverage, some may have some vision coverage, and you'll want to look at those as well. Does it make sense for me? What is being covered? Am I paying for something that I'll really need or it may be worth it to me to look at a separate vision plan that really covers what I need or a separate dental plan if that is something that's outside of the advantage plan. So is the benefit that that advantage plan offering, is the benefit, really a benefit? Is it affordable? Is it worth it? Those few extra dollars for that coverage. So it can be very time consuming, but it's something you really want to think about and look at. It's not something you want to make a quick decision about. So doing homework ahead of time, going online to look at the various plans, talking with a certified MMAP counselor 1-800-803-7174. Highly recommended.
Kitty Glomski:We help people and we have a whole network of counselors throughout the State of Michigan. Basically, every county has access to a MMAP counselor. We're educators. We give beneficiaries the information so that they can make an informed decision, and advantage plans. There's different types of advantage plans, aren't there? There's HMOs PPOs, et cetera, et cetera. Do you wanna talk about some of those and the differences?
Pat MacKinnon:The Alphabet Soup of Advantage plans. An HMO Healthcare Maintenance organization. It may be the most familiar to people maybe through an employer. Many employer plans are HMO plans, and for those plans there's a network of providers and the expectation is that you will use that network of providers. If you use somebody who's not in that network, you may be saddled with the extra cost. The plan won't cover it. So it's very specific. If you're looking at an HMO, you really want to look at that network of providers to make sure that your doctors and other healthcare providers. We talk about maybe the doctors, it's also hospital networks as well as possibly hospice, skilled nursing facilities. All those are part of the network and that's something else that folks may want to consider. Does this plan work with the hospital network that's in my community? So the H M O, it has a network, a very specific network, and you use the providers in that network. If you don't the cost comes back to you, to the beneficiary. The other type of plan is a PPO, a preferred provider organization. Again, there is a network of providers, but if you use somebody outside the network the plan will pick up some of the cost. But you'll still be responsible for some additional costs there.
Kitty Glomski:You need to have a prior authorization though, don't you? The plan has to give you, basically its permission to go outside of the network of authorized providers.
Pat MacKinnon:Right. So that's something else you want to look at. Do I need to get permission? Some plans have gotten a little more lenient in that over the years. It used to be one of the concerns and criticisms about managed care. But in some cases that prior authorization is still there, especially if you're working with a specialist. If you've got a special health condition.
Kitty Glomski:Your family doctor loves these plans, don't they? And all the extra paperwork.
Pat MacKinnon:Oh, I think they're getting used to them, it's kind of a fact of life.
Kitty Glomski:Then there's also plans geared for people who have Medicaid and Medicare. Aren't there?
Pat MacKinnon:Yeah. The special needs plans and sometimes they're referred to as D SNPs. D for dual, and they're a plan that has been approved by the State of Michigan. They're the Medicaid office in Michigan, as well as being an approved Medicare plan. They can't call themselves a dual special needs plan unless they have that approval from the State as well. Their client base are Medicare beneficiaries who are also eligible for and receiving Medicaid benefits. Medicaid is another insurance program. So for folks who are low income and have high medical needs, it coordinates the two insurance plans, but it's still, Medicare and Medicaid insurance. And they are directed at individuals who have special healthcare needs and low income.
Kitty Glomski:I want to jump into the Senior Medicare Patrol, and we're members of Senior Medicare Patrol, aren't we?
Pat MacKinnon:Yes, we are. You want to talk about that a little bit? The Senior Medicare Patrol is a program that helps educate Medicare beneficiaries about potential fraud and scams. We work with the SHIP programs to educate people about their benefits, but then letting them know how to protect themselves from fraud, how to identify potential fraud, and then help them report it to an appropriate entity that can investigate it. Reviewing the monthly or quarterly statements you get from your healthcare plan about what services you've received, your Medicare summary notice or explanation of benefit. If we're talking about Medicare Advantage plans you get a notice monthly or quarterly about what services you received, what the plan has paid, what you may owe. Reviewing those and making sure that the services listed are services that you actually received.
Kitty Glomski:That's an excellent point because most people will mark on their calendar doctor appointment and if you get your Medicare summary notice you can check, and that notice will include every single thing that's been billed to your Medicare. So if it looks funny and dates are not quite right, or the service doesn't look right, what should a person do?
Pat MacKinnon:They should call 1-800-803-7174 and talk with one of Kitty's Marvelous MMAP counselors, and review it with them. Sometimes we don't see all the providers that are helping us out. If you have to go in for an x-ray, there's the technician that helps you out, and then there's a doctor in another room somewhere, who you may never see, who actually reviews the film. They're allowed to bill Medicare as well, even though you don't see them. So you may see some doctor on there. Who was that? I never saw that doctor. I don't know who that is. And a MMAP counselor can help walk you through that. But on the other hand, there could be a charge on there to Medicare that has absolutely nothing to do with you, and the MMAP counselor can help review that, call the 1-800-MEDICARE line with you or on your behalf to report it, and then you'll want to keep checking your notices to see if the charge has been removed. All that's important part of the process. Reviewing those summary notices protecting your Medicare number. A few years ago CMS went through the whole process of changing everybody's Medicare number so that it no longer included your Social Security number. Great move! But that Medicare number, you need to protect it. It's like a credit card number that if somebody gets a hold of it, they can start charging Medicare for all sorts of stuff, using your number and your name.
Kitty Glomski:Well, and when you have an advantage plan, you don't need to even show that red, white, and blue Medicare card do you?
Pat MacKinnon:You usually don't. You can just kind of tuck it away, and typically if you use the same providers all the time, once they get a copy of your plan card, they should be set. if you're somebody who changes a plan every year or so, it's a good idea to review your Medicare coverage every year. Once your providers have a copy of the card, you really don't need to be carrying it around with you everywhere you go.
Kitty Glomski:Advantage plan programs though, include the Medicare benefits. It's all in one. In other words, you have Medicare, you have additional coverages that are beyond Medicare, and then if the plan includes it, you also have a Part D drug plan. So you only have to have the one card. A lot of folks think like, oh, but I should get some additional benefits if I show more cards. Right?
Pat MacKinnon:Nope. Nope. That's an advantage, just one card.
Kitty Glomski:One card, one size fits all. One thing I wanted to touch on, because you mentioned you have Silver Sneakers and you're down in the Lansing area, Southern Michigan. Northern Michigan is a little more rural. I always recommend that if people are interested in specific benefits, whether it's the Silver Sneakers, if it's dental, vision, anything that is specific as an additional benefit, that you do some homework and find out if there are providers in your area that accept that plan, because there's not always a specialist, there's not always a dentist. There's not always a gym in Northern Michigan that accepts this plan. It sounds great. Oh boy. I get to go to an exercise class.
Pat MacKinnon:Sometimes not. That provider network, that is very, very important. Not only your local doctor that you see but the hospital network, the gyms. Is there a health, health club gym that I can go and use this benefit? If there's a vision benefit, are there actual eye doctors in my community? Are there dentists that work with this plan? Investigating that network that is associated with the plan is very important.
Kitty Glomski:With the healthcare benefit, you would want to investigate if your doctor and all your specialists, your hospital, and those providers are all in your network. Then the extra benefits you're gonna want to investigate your dentist and your ophthalmologist and any other benefit that, is it available? Right. Right. That helps you make that decision. The biggest thing is, is your healthcare going to be covered? And then next, are your drugs gonna be covered. So that's where we can step in as educators and counselors, and we get to use Medicare's database, don't we? We get to look at the actual benefits, don't we?
Pat MacKinnon:That's right. the Medicare plan finder, it's online on the medicare.gov website, and it's open to the public so anybody can go in there and use it. But for first time users especially, it can be a little daunting. So, working with a MMAP counselor we can go through it with you, show you how it works, explain what it's telling you, and maybe the first time it's a learning experience. Every year we highly recommend that you review your plans and your coverage and look at different options. But we are also here year after year. If every year you want to review your plan options with one of the counselors, we are here to do that. Sometimes it's nice having a little hand holding going through the process, so...
Kitty Glomski:You're right. I have several people that I call returned beneficiaries that look forward to their open enrollment time. And we do the review. They've tried to do it online too. And as counselors, we know the resources and some of the tricks to get you, maybe cheaper drugs or other services if you're eligible for a subsidy like there's one called Extra Help. Low income folks, and if you qualify by both income and assets, you might be able to get reduced rates for your prescriptions. So we're aware of all this additional information.
Pat MacKinnon:Reviewing every year is helpful. Life can go along just beautifully, and then all of a sudden you have a change in circumstance, change in your health condition, change in the family finances, so reviewing your plans, thinking about your needs, sitting down, taking some time to review your options is really important.
Kitty Glomski:We just came off from Part D Open Enrollment. Do you want to talk about the difference between October 15th through December 7th versus January, February and March?
Pat MacKinnon:Well, the, the annual election period, the October 15th through December 7th period, folks can review their Medicare coverage and their prescription drug coverage. So whether they wanna stay with original Medicare and a separate prescription drug coverage plan, or they can make a shift to a Medicare advantage plan, a managed care situation where they have different drug coverage. So that's something that happens every year whether you're in original Medicare or in a Medicare Advantage plan, you get that option every year to review what you have, and what you may need.
Kitty Glomski:October 15th through December 7th is primarily focused on your drug plan. That's standalone part D drug plans, and advantage plans that include drug plans.
Pat MacKinnon:For Medicare Advantage, January 1st through March 31st is when you can change to another Medicare Advantage plan, or you can leave the Advantage Plan and return to original Medicare.
Kitty Glomski:If you've been in an advantage plan and you decide to drop it and go back to original Medicare, then can you pick up your part D a separate part D along with that?
Pat MacKinnon:Right. You'll need to, you'll want to do that.
Kitty Glomski:And there's another program that goes with that called the Medigap or the supplemental program. And that's not actually a part of Medicare. It's an option.
Pat MacKinnon:It's another private insurance plan. It's intended to fill those gaps if you're returning to original Medicare.
Kitty Glomski:This is really an important time that you can consider changing to save money, and make sure your drugs are covered and make sure your healthcare is covered. It's an opportunity to discuss what's happening with your plan, and then we discuss what those other possibilities might be for you. Lots of Folks will tell me, oh, I've had this plan forever. I really don't want to change it. I also tell them, don't get married to your plan. Be open for savings. That money is better in your pocket. Anything else about Advantage Plans before I go on to the next topic?
Pat MacKinnon:We've got it covered, Kitty.
Kitty Glomski:This is the time of year that our beneficiaries are hit hard with advertising, phone calls, sometimes in-person knocks on doors. Medicare has rules though about what insurance agents can do and can't do. Do you want to talk about that?
Pat MacKinnon:We talked a little bit about the October December time period, and that is also when people find that their mailbox has suddenly exploded with advertising and their phone is just ringing off the hook or they're getting text messages. That'll continue January through March with Medicare Advantage plans. Salespeople, they're good at their job and whether you're looking at buying a new car or a new insurance plan, whoever's selling it to you is going to try and highlight the things that make it sound good. But you always need to be cautious and you always need to take everything with a little bit of salt, and think about it. We get a lot of phone calls from people. I am very leery of, doing business over the phone with people. You need to be careful and mindful. Most insurance agents and salesmen are good reputable people. They don't want to steer you wrong. They want you to have a good experience. But unfortunately there are a class of folks out there that just want to sell a product. So folks need to be careful about what they're doing. Do their homework ahead of time, don't feel rushed, don't let somebody rush you. You've got time to think about it. And if you want a second opinion, get a hold of a MMAP counselor and talk through. They shouldn't be calling you unless they represent a plan that you are involved with. So if you are a current member of the A B C Health Network Plan, they could call you to talk about other A B C health network plan options that are available to you. One of the biggest things, if you have nothing to do with this plan, folks shouldn't be calling you just out of the blue. They shouldn't be stopping by your home or apartment and knocking on the door, hanging out in parking lots, tracking you down. Lobbys or meeting rooms either. They can send emails and text messages, but there must be an opt out or unsubscribe option that must be there so that you can say, no, I don't want to receive these emails anymore. If you're getting messages like that and there isn't that option, please get ahold of, Kitty and one of her counselors and share that information so that we can report it to the Centers for Medicare and Medicare Services. That is one of the roles that the Senior Medicare P atrol does. We try and get information to folks that need to know about it. If folks are calling you or stopping by your house uninvited, try and get a name so that we can help you report those to the Michigan Department of Insurance. They regulate agent behaviors and they want to know about marketing practices. The plans that they represent don't want to be associated with people who aren't following the rules. We can get that information to the plans and make sure that they're aware of it. Folks are reporting a lot of phone calls. If you don't sign up for this or you, you don't give me your Medicare number you're in danger of losing your benefits. They're using scare tactics.
Kitty Glomski:Yeah. I always tell beneficiaries, unless you know who you're talking to, you never, never, never, never give out your Medicare number or your social security number. Don't give out banking information. That's the latest thing around here are people that are asking for banking information. They have no business asking for it.
Pat MacKinnon:Medicare will never ask you for your Medicare number. Social Security Administration will never ask you for your Social Security number. They know what it is. If they need to get ahold of you, if they need to get ahold of you, they will. If you're still suspicious, contact Kitty and one of her counselors and, and talk it through. But Medicare will never ask you for your number.
Kitty Glomski:Pat, thank you for helping us to understand more about the Medicare Advantage open enrollment. I look forward to talking to you about other topics that we're involved in in our SHIP network. SHIP is State Health Insurance Program and the MMAP, M M A P is Medicare Medicaid Assistance Program and that magic number that they can call Pat is:
Pat MacKinnon:+1 800-803-7174.
Kitty Glomski:Thank you very much, pat, for joining us. Well, thank you Kitty. This is Kitty Glomski and Brooke Mainville, with the Calendar of Events. On February 8th, that's the second Wednesday of February, the MMAP program has a New to Medicare presentation starting at 10 o'clock on Zoom. This is a virtual presentation. This is information for anyone that is new to Medicare, is starting Medicare due to disability or has questions and wants to know how Medicare works. Then afterwards you get to meet one on one with a counselor and talk about your personal situation. To register, you can call 1-800-803-7174 or contact your local Senior Center, your Commission or Council on Aging, and they can make the appointment for you. On February 10th from one to two o'clock is the first of the Virtual Caregiver webinar series called Navigating Difficult Conversations. A panel of persons that are living with dementia will explore strategies to approach difficult conversations. For more information or to register, contact Brooke at 989-358-4616. On February 21st, begins the chronic pain PATH class. PATH is personal action toward health. The chronic pain PATH class, is held on Tuesdays, from February 21st through March 28th from nine to 11 o'clock, and this is a virtual presentation.
Brooke Mainville:You could register for both of these items through contacting me. That's 989-358-4616. Again, that was 989-358-4616 or you can email me at mainvilleb@nemcsa.org. My information is on our website in our Facebook page So we would love to have you, and those are my two events.
Kitty Glomski:So this is Kitty Glomski and Brooke Mainville asking you to join us again next time on Let's Talk About Aging.
Carla:Let's Talk About Aging is a production of the Region 9 Area Agency on Aging, 2569 US 23 South, Alpena, Michigan 4 9 7 0 7. This Podcast was supported, in part, by grant number 90MPPG0039 from the US Administration for Community Living, Department of Health and Human Services, Washington, DC. Podcast music provided by Groove Music, selection titled"Modern Logo," created by Vadym Kuznietsov and can be found at https://elements.envato.com/modern-logo-ZVHFBJ6