Expert Offers Help Understanding ‘Ins And Outs’ Of Medicare

By: John Grimaldi

Understanding the machinations of Medicare is not easy; researchers figure that as many as 75% of seniors eligible for Medicare wind up confused. Carl Hohsfield, vice president of the Medicare Advisory Service at the Association of Mature American Citizens, has been immersed in the task of explaining and advising as regards the ins and outs of Medicare for more than a decade. In an interview with Rebecca Weber, AMAC CEO and host of the Better For America podcast, noted that in the space of those ten years, Hohsfield and his team have helped hundreds of thousands of AMAC members and non-members understand the nuances of Medicare.

One of the most common misconceptions is that you can change your Medicare plan just once a year during the annual election period from October 15 to January 1. As Hohsfield explained it, “that’s a myth. We’re talking about Medicare Supplement or Medigap plans, very different than Medicare Advantage. You can review and shop your Medicare Supplement plan outside of your open enrollment period, which starts six months from your part B effective date. After that, depending on the state you live in and different eligibility rights, you can switch that plan and speak to an agent about plans in your area and see if the price is right for you every year. But if you’re comfortable, you could stay on it for a couple of years and then work with your agent and switch again. But the point is we highly suggest you work with us to determine, am I on the right plan and am I on a competitive plan in the market that I live in?”

He explained that the annual election period, beginning October 15 through January 1st, doesn’t necessarily apply to Medicare Supplement plans. “That applies to Medicare Advantage and prescription drug plans or what’s known as part C and Part D of Medicare.”

Another myth is that a Medicare Supplement plan and a Medicare Advantage plan are virtually the same thing, Hohsfield noted. “These words, phrases and acronyms get thrown around very easily. Medicare Advantage plan is also referred to as Part C. A Medicare Supplement, also known as a Medigap plan, is a private health plan sold by a private insurance carrier run by a state’s Department of Insurance. It comes in the form of plan letters like Plan G, as in George or Plan F, as and Frank, it’s not to be confused with Medicare parts A, B, C, and D, but a Medicare Supplement plan is exactly what it sounds like. It supplements or fills in the gaps of what original Medicare parts A and B do not cover. For example, Medicare Supplement Plan G covers everything except for the Part B deductible that Medicare doesn’t cover. You have no networks, so you can see any doctor that accepts Medicare in any state in the country. It typically comes with a monthly premium. It does not include prescription drug coverage. So somebody who enrolls in a Medigap plan can then choose his or her’s own separate Part D plan that suits their needs. And a big key, again, no networks. You can see any doctor that accepts Medicare. On the other side of the fence, you have Medicare Advantage or Part C, also sold by a private insurance company, often at a lower or zero premium.  But it comes in network form like an HMO or a PPO. Typically, it means you have to see doctors in that insurance company’s network and that Medicare Advantage plans network. If it’s an HMO, you can only see doctors in that network. If it’s a PPO, typically you can go outside the network but pay higher cost share. And unlike a Medicare Supplement plan, you have out-of-pocket expenses like co-pays, co-insurance and shared dollar amounts for a variety of Medicare covered services. So those are the key differences — out-of-pocket costs and networks. Most Medicare Advantage plans include drug coverage. So that’s a benefit of an advantage plan.  A benefit of a Medicare Supplement plan is that you can choose whatever drug plan you would like and see any doctor that you would like.”

Hohsfield pointed out that “if anyone’s ever been on an employer plan or an under 65 health insurance plan, you typically have deductibles and co-pays for things like urgent care, emergency room doctor visits. That’s similar to how a Medicare Advantage plan works, whereas a Medicare Supplement plan covers everything that Medicare parts A and B does not except for the annual part B deductible. What that basically means is every time you go to the doctor, every time you need service of some sort, you’re not taking out your wallet and using your credit card and paying out of pocket co-pays for all those different services.”

He says the annual election period “allows anybody who is currently enrolled in a Medicare Advantage plan or not, who is enrolled in Medicare Part A and B between October 15th to December 7th can make a choice, see what plans are available in their service area, and make a change to their plan, keep their plan or drop their plan and go back to original Medicare. Those are the choices they have for Medicare Advantage and prescription drug plans during that annual election period, October 15 to December 7th.  Other than certain special enrollment periods like somebody moving out of a plan service area to a new service area. For example, if somebody moves from New York to Florida, they’re going to automatically lose their Medicare Advantage plan in New York and they’ll have to look to a new plan in Florida. But that would be a special enrollment period outside of those steps. We call them special enrollment periods. You cannot switch your Medicare Advantage plan whenever you like. That’s what the annual election period is for. And these plans are guaranteed for one calendar year at a time, January 1st to December 31st.”