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Medicare Supplement

Diabetes and Medicare Advantage

Differences between Original Medicare vs. Medicare Advantage

If I have diabetes, should I choose Original Medicare or Medicare Advantage?

The answer to this question depends on how important individualized care is to you.

Medicare Advantage plans are typically bundled, all-in-one plans that are made as a ‘one size fits all’, with a prescription drug plan included.

However, Original Medicare is set up for you to choose a supplement plan along with a prescription drug plan tailored to your individual needs.

The American Journal of Managed Care published a study pertaining to the difference in treatment of diabetes between Original Medicare and Medicare Advantage.

In the study, they concluded that in order to achieve savings, Medicare Advantage enrollees are more likely to be treated with cheaper medications, such as Metformin and Sulfonylureas, rather than receive costly, newer medications, compared to Original Medicare. This means Original Medicare affords you the opportunity to have the drugs that might best suit you.

In this video, we review the study and explain some of the differences between Original Medicare and Medicare Advantage. We also discuss why this decision is so important if you or someone you know has diabetes and are searching for the best plan.

If you would like help finding the best Medicare plan for you, please reach out. Our help is 100% FREE to you.

How to Leave a Medicare Advantage Plan

In the first quarter of every year, seniors often discover that the plan they signed up for during the Annual Enrollment Period does not suit them.
Their doctors may have already left the network. Hospitals they thought participated might have dropped out already.

Still, some seniors have now had the time to review the Summary of Benefits and looked closely at how chemotherapy is covered by Medicare Advantage.

This is often quite a shock, when, not only must they use only network providers (in the case of the HMO), but the plans typically only pay 80% of the cancer treatment costs.

That’s the “Advantage” they’ve been sold for the often-zero premium.

Regardless of the reason, Medicare says that the first quarter is the opportunity to go back to original Medicare or change to a more-appropriate Medicare Advantage plan.

Steps to Cancel a Medicare Advantage Plan

From January 1 to March 1, Medicare now calls this the “Open Enrollment Period.”

A more appropriate name would be the “Disenrollment Period“. Those without a plan cannot obtain one, so it is not open by any stretch.

If you wish to go from Medicare Advantage to a Medicare Supplement, here are the steps:

  1. Apply for a Medicare Supplement
  2. Wait for the Underwriting Approval from the Supplement company
  3. When approved, make an application for a Part D plan.
  4. When the Part D plan starts, it automatically cancels the Advantage plan

This process ensures that you do not prematurely cancel the only insurance you may be able to qualify for. By using an independent Medicare broker, like the Senior Savings Network, you can find out what Medicare Supplement companies will likely approve your application and guarantee that you will not be paying too much for the same coverage that is offered by all of the Medicare Supplement companies.

Careful: Do Not Act in Haste!

Far too often, we get calls from seniors telling us that they became angry with the details of their Medicare Advantage plan and have already called their company and told them to cancel it. This is the wrong move.

In a worst-case scenario, that Advantage plan MAY be the only insurance you can have and, having something is better than nothing at all. So let an independent professional advise you on which plans are available in the market and which ones are most likely to approve you.

We would be happy to help with this process.


You can contact us securely here or by calling us at 1-800-729-9590.

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2021 Medicare and You Book

The 2021 Medicare & You Guidebook is available and you can download it here.

When downloading the digital version, it will open in your Acrobat document reader, or in your browser. A tip for finding what you want, instantly, is to hit the Control and F button at the same time on your keyboard. This will bring up the FIND feature in your reader. 

Then, type in a word or phrase you are looking for. The reader should show you how many instances of that word or phrase exist in the entire book and you can click the down arrow to move from the first to the second, and so on.

This is how we zero in on things such as the Special Election Periods, Trial Right scenarios, Guarantee Issue Periods, and more. 

The 2021 Medicare & You book is slightly less controversial than those in the past. CMS (Center for Medicare and Medicaid Services) has been leaning more and more toward promoting Medicare Advantage plans and this bias has started to come through in their Medicare guide book.

In 2018, the non-profit Medicare Rights Center, in a joint letter with the Center for Medicare Advocacy and Justice in Aging, wrote a letter to the Administrator of CMS urging corrections in the proposed guidebook for 2019. 

They stated, “First, in several places, the Handbook suggests that Medicare Advantage is the less expensive alternative for beneficiaries. This is an overstatement. There are many variables determining whether enrollment in a Medicare Advantage plan may be more or less expensive for any particular Medicare beneficiary…. The repeated suggestion that Medicare Advantage can save beneficiaries money does not fairly represent these realities.”

The letter went on to point out that various descriptions throughout the book give the false impression that the benefits of Original Medicare are the same as the benefits in Medicare Advantage.

When the guidebook was first read by many of our clients, they found it to be confusing, contradictory, and inaccurate to their experience with Medicare. This again points to the benefit of using an independent Medicare professional who can interpret the realities of Medicare and how it works in the real world. This only comes from experience.

We are here to help and our service is always free.
1-800-729-9590

Does the Mayo Clinic Accept Medicare Supplement Plans?

Can you use your Medicare Supplement plan at the Mayo Clinic? Yes.
Depending on which Medicare Supplement plan letter you have, you may or may not be responsible for paying “Excess Charges”.

The most important question, then, is not whether or not they accept Medicare, as we cover in the video, but whether the specific procedure that you wish to have done is covered by Medicare.

Medicare Supplement plans only supplement what is APPROVED by original Medicare. If Medicare approves the procedure and pays their 80%, the Supplement plan, also known as Medigap, will fill in the remaining portion, subject to your deductible and possible co-payment, depending again on which Medicare Supplement plan letter you signed up for.

In this video, we go over the details of how Medicare and Medicare Supplements are accepted at the Mayo Clinic. Also, for those on a Medicare Advantage plan, you must look very closely at your plan and communicate with Mayo on it, as these private plans are most often not accepted at centers of excellence like the Mayo Clinic.

See the video:

What are Excess Charges with Medicare?

Are you concerned with how excess charges might impact your Medicare plan? This video answers that:

Important to note, in addition to this video, that Medicare Advantage plans have nothing at all to do with these billing scenarios. The scenarios, including everything having to do with Excess Charges, only apply to original Medicare and/or Medicare with a Medicare Supplement policy. Medicare Advantage participants are not free to see any original Medicare provider and have restrictions, exclusions, co-pays, etc. in addition to original Medicare.

Mentioned in the video:
https://www.kff.org/medicare/issue-brief/paying-a-visit-to-the-doctor-current-financial-protections-for-medicare-patients-when-receiving-physician-services/

Physician Compare at Medicare:
https://www.medicare.gov/physiciancompare/

Getting the most out of Physician Compare tool:
https://www.youtube.com/watch?v=lI91Cp2Xwu4

We help folks with supplemental Medicare benefits, from coast to coast, and our service is completely free.

 To reach us for Medicare-related benefits help, call toll-free 1-800-729-9590

Can I Keep Plan F?

🙄 𝗖𝗮𝗻 𝗜 𝗞𝗲𝗲𝗽 𝗣𝗹𝗮𝗻 𝗙? 🙄

Many agents are wrongly telling seniors right now that they MUST get out of Plan F Medicare Supplement plan.

𝗧𝗵𝗮𝘁 𝗶𝘀 𝗻𝗼𝘁 𝗮𝗰𝗰𝘂𝗿𝗮𝘁𝗲 and is sometimes being communicated as a fear tactic.

The truth is that you CAN keep your Plan F, if you have it, past the January 1, 2020 date after which no one new to Medicare can get Plan F.

The question is, do you want to keep a plan where the average age will be increasing daily and whose rates will start to climb even faster than they have in the past.

Plan F covers everything, and Congress did not like this. They say it causes seniors to go to the doctor far too often, so they have eliminated it being available to new Medicare folks after January 1, 2020.

So yes, you can keep your Plan F if you have it, but in this video, I explain why you should strongly consider NOT keeping it, and now would be the best time to take action.

At least see what’s going on in this enlightening video. – Chris Westfall 1-800-729-9590

What’s Covered App for Medicare

It is now easier than ever before to find out what is covered on original Medicare by using a free app for your smartphone. While this app is not perfect, it is continually being updated by Medicare.

It is important to note that this application will not work for anyone on a Medicare Advantage, otherwise known as a Part C plan. Why? Because Medicare Advantage plans are not “original Medicare” but are private insurance whereby original Medicare is waived for the period that you are on the “Advantage” plan. 

Medicare Advantage plans can have more restrictions and limitations and require referrals and plan approval before many procedures can be approved. So, if you are on original Medicare, or using original Medicare with a Medicare Supplement, or Medigap plan, this app will come in handy, should you wish to check to see which procedures are covered by Medicare.

At the Senior Savings Network, we help seniors with their Medicare plan choices from coast to coast with our free broker services. 

If you would like help picking the best Medicare insurance plan for you, call us at 1-800-729-9590.

 
Try the “What’s covered” mobile app!

 


   Downland What's covered on app store  Downland What's covered on play store

The app is an official program from Medicare. This website, the Senior Savings Network, and its employees, are a private organization not employed by Medicare and offer licensed advice and support for seniors in 46 states.

Cheapest Medicare Supplement Plan

Important Video, please watch:

As my mother always said, "Sometimes you get what you pay for."

When a new carrier enters a new market, such as many of these smaller companies that you have never heard of before, they are allowed to have rates that are too low and cannot compete, over time.
They are allowed to make projections on their expected losses, and those projections are just that, projections. When they are new, the state insurance departments allow them to do this, until they have real data, which takes up to 2 years.

During this timeframe, they will very often undercut the entire market with rates that are not justifiable. This means that they cannot sustain those low rates but hope, as they often to, that they will get so many customers during the first year or two, based on super-low rates, that their customers will stay with them when they spring out the REAL rates. These rate increases have been seen to be up to 15% per year, once the “honeymoon” phase has worn off with the Department of Insurance, and they need to go from “buying business” with super low rates, to actually becoming profitable by raising rates.

What is sad to see, is where a senior goes on their own rate sheet, or advice from a brand new agent who does not know better, and gets the “cheapest” plan in the market from an off-brand insurance company that has virtually no experience in the market. When they have been in the market less than 2 years, and they are offering what we call a “teaser” rate, this is a recipe for disaster.

WHY IS THIS IMPORTANT?

If you plan on being on Medicare longer than two years, the long term viability of the insurance company you pick should be very important to you. The rate stability is absolutely critical because, in most all states, you must qualify with health underwriting in order to change companies. When doing this, if you have suffered a catastrophic or progressively worsening condition that might last your entire life, as we see far too often, you are then STUCK with the insurance company you are with. Being with a “cheap” carrier right off the bat might very well mean that you are stuck with a company that:

1) Got you in with below-justified rates that they cannot sustain; and
2) Have too small an insured base to spread that risk among tens of thousands of other seniors in your state, like the larger insurance companies can do.

What happens in this case is that the small carrier can then go back to the Department of Insurance and get large, double-digit rate increases approved. 

Now, if you can predict what your health will be with certainty, in the next two years – great – take that teaser rate and switch companies when you get that first massive rate increase. It is sound advice to take a slightly higher cost company from the beginning of your Medicare journey. Preferrably, one with possibly millions of covered lives throughout the entire country, not just coverage in one state or one very small region. This is how you spread your risk and have rate stability throughout your entire time on Medicare.

While no agent can predict the future and see what rate increases will come from what company with certainty, what I have experienced in 25 years of the insurance business is that experience in the industry matters. Anyone can offer a super cheap rate. What do they do after that super cheap rate is the question.

How is their customer service with a small startup insurer?
How good are they at paying claims, with a small cheap company new to the market?

These are just but a few reasons why our clients are happy with our recommendations. We choose long term quality over short term cheap.

– Christopher Westfall, Sr. RFC

Ways and Means Committee Report on AARP Removed From Site

According to the internet archive, the last time the Ways and Means Committee report on AARP was available at its location on the congressional website was December 25, 2018. Some time shortly thereafter, before the new year of 2019, the file has been removed.

A Google search of the file name will show that it has been referenced in thousands of other websites and news reports, however, a click on those links, pointing back to the Ways and Means Committee website now shows, “FILE NOT FOUND.”


As the original report from 2011 was newsworthy and enlightening, the Senior Savings Network has decided to post the original report here, in its entirety. 
See the original report:

Until it is removed, too, here is the video talking about the report, from the Ways and Means Committee’s Youtube channel:

Feel free to share this page.

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