Errors To Avoid When Choosing A Medicare Advantage Policy Pt. 2

Errors To Avoid When Choosing A Medicare Advantage Policy Pt. 2

Error #. 2: Choose a Medicare Advantage policy that requires the approval of the insurance company before proceeding to a test/procedure.

SOLUTION # 2: If you are comparing diets, refer to the Benefits Summary. All insurers must publish them and must be identical and easy to compare.

ERROR # 3: Do not pay attention to the (MOOP) “maximum pocket” limit. There is a MOOP for every Medicare Advantage policies, and many agents freeze it and help you choose your policy. However, if there is a catastrophic medical problem (organ transplant, cancer, long-term stay in a qualified care facility, etc.), there is a huge possibility that you will meet the MOOP; hence make sure it is as low as possible. This is because chemotherapy and anti-rejection drugs are considered part of outpatient “B” drugs, not prescription “D” medications, and many diets only pay for 80% of Part B medications. So you will have to pay the rest 20 percent and they are costly.

SOLUTION # 3: compare, again and again; and choose a policy with a lower MOOP.

Error # 4: Choose a policy just because the drug co-pays is a little lower. Most small insurance companies will try to persuade you to choose a policy they offer with very little cost-sharing for their drug policy, but they have a smaller network of doctors / institutions. The challenge is that if you have a health condition, you will be locked in the smallest network of institutions/doctors till the following registration period.

SOLUTION # 4: Peradventure you have a challenge with payment for prescription drugs and your income / wealth is low, you may be eligible for additional social assistance. A sound insurance broker will draw up a list and guide you. When you get help with medications, you can choose the best policy based on other options (network size, additional optional benefits, doctor / institute, authorization rules, etc.).

Error # 5: Choose a policy because you want a PPO policy, and not an HMO.

SOLUTION # 5: So many have an erroneous impression that they can take an OPP policy for any doctor/facility of their choice. In fact, OPP policies still have a network of doctors / institutions that need to be maintained to reduce costs. The greatest distinction between a PPO and a HMO is that with a PPO, no need to obtain a “recommendation” for consulting a specialist. For an HMO, you must get a recommendation. To select EACH physician / institution from the country that accepts Medicare, a Medicare supplement program (Medigap) should be considered.

I have seen many of the errors and solutions and in choosing health policies for Medicare Advantage plan. There are other variations of diets outside of California that can pose additional problems. What happened to my client, one might ask? While in constant contact with my clients, I was very happy to learn the good news in June. Two doctors in Los Angeles, from a large medical group identified the problem by using the same test that was rejected by their previous Medicare health policy. He slowly lost the cerebrospinal fluid and was about not to have any more. Now that she is in good health, we will review her insurance at Medicare’s annual open enrollment and decide whether to keep her in the supplement or upgrade to a Medicare Advantage policy in Part C.