Please be patient. I am going to fully explain this strategy but I need to give you the back story first. Believe me, it will be worth the wait.

I know I have been preaching this strategy for quite a long time but now I want to put it in clear, easy to understand words. So here goes.

There are many shortfalls with Medicare Advantage plans. These are the plans that people flock to because of much lower premiums and sometimes enticing extra benefits like dental cleanings and gym memberships. Don’t be fooled by all the bells and whistles.

These plans have so many holes, I don’t know where to begin. Take a look at this chart comparing Medicare Advantage to Medicare Supplements. Anyone with any sense can clearly see the difference.

  • Let’s go line by line. In Med Advantage plans you are ALWAYS restricted as to which Doctor or Hospital you can go to=>>ALWAYS! In HMO’s it’s much worse than PPO’s. In an HMO, if you do don’t stay In-Network, you WILL foot the whole bill. These could be many thousands of dollars. There is no cap in such a case!
  • Although minor, most Advantage plans have co-pays for Doctors and higher co-pays for specialists. Believe me, this is the least of your problems.
  • Up to $6700 Out-of-Pocket per year! But hold on…if you go Out-of-Network it could be off the charts if you have an HMO. PPO’s are usually capped at $10,000. And remember, this is EVERY YEAR. Imagine the pain if you have a really chronic condition requiring constant care.
  • The next one kills me ( and a lot of patients as well). Your Doctor(s) determines what protocols you can and cannot do for your health or condition. I don’t know about you but if I get really sick, I’ll be all over the internet researching possible treatments.
  • This is a big one. Did you know the Medicare Advantage plan can change and/or be completely cancelled at any time? Medicare Advantage sales agents love this because you have no choice but to find a new plan when this happens. As far as plans changing, my goodness, they change every year! I have to get re-certified EVERY year, on every plan being offered! Why? Because they ALL change every year. If you have been on Medicare for any amount of time you already have experienced this, right?
  • Most Medicare Advantage plans are local and their networks are local. You will have to get your wallet out in order to get coverage outside of the plan’s network. I hear these stories all the time.
  • This next one is like the one above. These plans all have treatment plans that THEY follow and approve for treatment. You must follow what they say or pay the whole bill yourself.
  • This last point won’t hit home until you or your loved ones get some really bad news about a health condition or disease. If you were told they had a treatment plan that has proven to have success with a life threatening aliment at the Mayo Clinic or Cleveland Clinic, would you want to go? Of course you would. Be prepared for a huge bill if you are in an Advantage plan.

So why doesn’t everyone just buy a Medicare Supplement F plan and be done with it? Total peace of mind, just pay your premium each month and you are all set.

Obviously, we know why. Medigap coverage costs too much, right? At least this is what I hear in my day to day business.

So what is the answer? ( I know if you are an existing client of mine, you already know what I am going to say)

Did you know that in NY and ONLY in NY, you can have the best of both worlds? It’s true, Let me explain.

Any one that earns under $75K as a single or $100,000 as a couple can sign up for EPIC in NY. EPIC is a Prescription Drug assistance program that has many benefits you should learn about by <CLICKING HERE> but we are only concerned with one benefit right here.

Anyone on EPIC can change plans at anytime (once) throughout the year with no questions asked. This means you have both AEP (10/5-12/7) and your EPIC Special Election Period to change plans. It doesn’t sound like much but it’s huge!

The strategy that I employ with my clients is pretty simple. First, get on EPIC if not already on.

The next step is the most important. Evaluate you health situation.

Are you healthy? Are you only going to the doctor a couple times a year? Do you require constant doctor visits? Are you being treated for chronic conditions that could require hospital stays at any time? Do you just want the best coverage possible because, you never know?

If you determine you are pretty darn healthy, you can elect a Medicare Advantage plan with little or know premium. I do suggest a PPO over an HMO. That’s a whole other topic. Read this Blog Post for more information.

As long as you are healthy, you can stay on an Advantage plan and save the monthly premium associated with have a Medicare Supplement plan. This could be $200-$300 a month or over $3000 a year!

Here’s the key to the strategy, if you get bad news from the Doctor or suddenly require chronic care go on the Supplement immediately. It’s really that simple. The only heath question in New York State pertains to End Stage Kidney disease. Other than that you can switch to a Supplement plan with no health questions.

It’s worth repeating because this blog post will come up all over the internet. You can only use this strategy in New York State.

The is one window of risk if you use this strategy that must be mentioned. When you want to switch using the EPIC Special Election your plan does not go into effect until the 1st day of the following month. It is for this reason that some prefer the peace of mind to just be on the Supplement from the get go and be done with it. The choice is yours.

I hope this was clear. If you have questions or would like further explanation, just let me know.

 

 

 

 

 

 

Attention!

Starting mid-August, you will likely begin to receive notices regarding changes in your Medicare coverage.
Please, do not wait until October 15th when Open Enrollment begins. Reach out as soon as you're able and have all your Medicare and AEP questions answered!