PLANNING AHEAD: Facts to consider during Medicare open enrollment [Column]

Once again in the Thanksgiving season it is time to evaluate — or not — your Medicare options if you are over age 65 or soon to turn 65 or are disabled receiving Social Security Disability benefits for the requisite period before qualifying. The deadline this year for the upcoming 2023 benefit year is Dec. 7.

To make matters simpler for you, if you currently are enrolled in Medicare, have a Medicare Supplement plan with which you are satisfied and are enrolled in a Medicare Part D drug plan that meets your needs, you might skip this discussion and move on.

On the other hand, if you currently have a Medicare Advantage (think HMO or PPO, for instance) or want to explore other options for a Medicare Part D drug plan, you might look further.

Changing from basic Medicare with a Medicare Supplement plan to Medicare Advantage carries with it some infrequently discussed hazards.

I have tried for years to describe the differences between Medicare with Medicare Supplement and Part D prescription benefits and Medicare Advantage. This is a venture made more complicated and difficult by the massive campaigns to try to sway applicants into Medicare Advantage.  After all, why not?

Television commercials for Medicare Advantage raise the enticements of zero premiums, extra benefits such as eyeglass coverage, physical fitness memberships, and so on.

An easy way to think of the difference between a Medicare Supplement plan and Medicare Advantage that a Medicare Supplement is like a dinner menu — you know what you are going to get. A Medicare Advantage plan is more like a buffet. You might or might not know.

A Medicare Supplement (also referred to as “Medigap”) is an add-on to basic Medicare. It is standardized so that, once you sign on to the plan you know exactly what services are covered. It will indicate a letter such as “F,” “K” or “N.” Regardless where you obtain your coverage all Plan “G” programs, regardless of companies, for instance will have the same benefits. Differences are in cost and service.

A Medicare Advantage plan on the other hand depends on the issuer. It can and often does change from year to year and might even change during the year. Changes to the plan could include premiums, provider networks, pharmacy networks, copays, coinsurances and deductibles.

The benefits can vary widely among plans. Therefore, to the extent that television commercials might imply without actually saying so that all of the benefits described are available with all of the plans this is not so and the benefits provided are not consistent. A plan could indicate it includes dental services but cover only preventive work. It might indicate vision but only pay a limited credit.

Some solicitations state you may receive funds “added” to your Social Security check. This is a deduction from Part B premium available only in some locations.

Here is what you should know.

• Zero premiums does not mean zero cost. You can still and probably will have co-pays, deductibles and other expenses.

• Medicare Advantage plans generally speaking are less expensive initially but may cost more later as other expenses arise. This is especially true when it comes to hospitalization. While Medicare Supplement plans fill in the gaps (hence the term “Medigap”) not covered by Medicare, Medicare Advantage plans can require additional payments that may be unknown until the need is there.

• Medicare Supplement plans must be accepted by any provider who accepts Medicare. This includes physicians and hospitals. Before signing with a Medicare Advantage plan make sure your preferred provider, whether physician or hospital, accepts that plan of coverage.

• Changing from Medicare Supplement to Medicare Advantage at a later date is easy. Changing from Medicare Advantage to Medicare Supplement is not. If you sign with a Medicare Supplement plan and wish to change to a Medicare Advantage you are not limited in doing so. If you sign with a Medicare Advantage plan and later want to switch to a Medicare Supplement you may be unable to do so. It requires medical underwriting and you may be sick at the time.

• Medicare Advantage plans do not “travel” in the same way Medicare Supplement plans do. If you move to another state, for instance, and are covered by a Medicare Advantage plan, you will likely need to locate another plan.

Just be aware and ask questions when it is time to decide.

Janet Colliton, Esq. is a Certified Elder Law Attorney from the National Elder Law Foundation and limits her practice, Colliton Elder Law Assocs, PC, to elder law, special needs, guardianships, estate planning and estate administration with offices at 790 East Market St., Ste. 250, West Chester, 610-436-6674, [email protected] She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, co-founder of Life Transition Services LLC, a service for families with long term care needs.

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