Today is 12/2/2019. Last call to change your Part D plan is midnight 12/7/2019. I am using one 12 minute video to cover two topics of great importance.

Medicare Advantage Push

• Medicare and Medicare Advantage carriers are still heavily advertising $0 premium plans like there is no tomorrow. 
• Be aware, if you DO enroll in an Advantage plan you may never be able to pass underwriting for a new Medicare supplement plan.
• With original Medicare you can use any doctor or hospital anywhere in the country
• Advantage plans require you to use their “approved” providers who agree to accept their reimbursement level

Why is Medicare Pushing Advantage Plans?

• Money
• The pitch is Advantage plans save taxpayer dollars
• Those dollars are saved because YOU (the patient) pay MORE for your health care when you use the plan
• Big companies like IBM, Coke, ATT and more terminated their retiree health plans to save THEM money
• Retirees get a stipend, usually around $1500, and are told to buy their OWN plan
• Medicare wants to do the same thing so they don’t have to administer benefits and pay claims

Why are Carriers and Agents Pushing Advantage Plans?

• Carriers make more money because Medicare pays THEM to handle your benefits
• They increase their profits by LIMITING the doctors and hospitals you can use, RAISING your cost sharing copay’s, and DENYING claims then expecting you won’t APPEAL their denial
• Every claim denied is more money in THEIR pocket and less in YOURS

Inspector General Report on Claim Denials

A new report by federal investigators finds that Advantage plans have a pattern of inappropriately denying patient claims.

"widespread and persistent problems related to denials of care and payment in Medicare Advantage" plans, which usually are managed-care HMO or PPO plans. The Advantage payment model reimburses plans a pre-set amount per patient, and this may be incentivizing plans "to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits,"

The good news is that those denials are frequently overturned if people bother to appeal.

https://www.reuters.com/article/us-column-miller-medicare/column-u-s-probe-shines-light-on-medicare-advantage-claims-denials-idUSKCN1MS2XG

Medicare Plan Finder STILL Broken

• Default sort option is lowest PREMIUM
• Often the lowest premium plan generates the highest COPAY’s
• Paying a few dollars more per month in premium can save you hundreds or thousands in prescription drug copay’s
• Copay’s listed on Plan Finder may not match with those listed on the carrier site
• High cost drugs may be on only one or two carriers formulary
• Using the LOWEST DRUG + PREMIUM COST is the ONLY WAY to find your absolute LOWEST annual drug cost
• Formulary’s on Plan Finder may not MATCH with the carrier information

Shocking details about issues and challenges with the Plan Finder https://www.advisory.com/daily-briefing/2019/11/27/medicare-tool