Medicare Advantage Plan: Mistakes to Avoid When Selecting One. Pt 2

Medicare Advantage Plan: Mistakes to Avoid When Selecting One. Pt 2

Error #2: Select a Medicare Advantage plan that requires approval from the insurance company before proceeding with a test/procedure.

SOLUTION #2: If you are making diet comparisons, see the Summary of benefits. All insurers must publish them and they must be identical and easy to compare.

ERROR # 3: Do not pay attention to the “MOOP” “maximum out-of-pocket” limit. There is a MOOP for all Medicare Advantage plans, and many agents freeze and help you choose your plan. Meanwhile, if there is a disastrous medical situation (, cancer, organ transplant, long-term stay in a qualified care center, and so on, there is a good chance that you may know about MOOP; Therefore, ensure that it is as low as possible. Now, this occurs because anti-rejection medications and chemotherapy are considered part of ambulatory “B” drugs, and not prescription drugs “D, and most diets pay only for 80% of the Part B drugs. Then you will have to pay the remaining 20% ​​and they are expensive.

SOLUTION # 3: compare, again and again; and select a plan with a lower MOOP.

Mistake # 4: choose a plan only because the co-pay medication is a bit lower. Most small insurers will try to persuade you to choose a plan they offer with very little cost sharing for their drug plans, but they have a smaller network of doctors/institutions. The challenge is that, if you have a health problem, you will be locked in the smallest network of institutions/doctors until the registration period to follow. SOLUTION # 4: Why you have a challenge with the payment of 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 it. When you receive help with medications, you can choose the best plan based on other options (network size, additional optional benefits, doctor/institute, authorization rules, etc.).

Error # 5: choose a plan because you want a PPO plan and not an HMO.

SOLUTION 5: Many have the mistaken impression that they can adopt an OPP plan for any doctor/facility of their choice. In fact, OPP plans still have a network of doctors/institutions that need to be maintained to reduce costs. The biggest distinction between a PPO and an HMO is that, with a PPO, there is no need to obtain a “recommendation” to consult a specialist. For an HMO, you must obtain a recommendation. To select EVERY doctor/institution in the country that accepts Medicare, a supplemental Medicare program (Medigap) must be considered. I have seen many of the errors and solutions and the choice of health plans for the Medicare Advantage plan. There are other variations of diets outside of California that can cause additional problems.

What happened to my client, could someone ask? While in constant contact with my clients, I felt very happy to know the good news in June. Two doctors in Los Angeles, from a large medical group, identified the problem using the same test that was rejected by their previous Medicare health plan. He slowly lost the cerebrospinal fluid and was about to have no more. Now that you are in good health, we will review your insurance at the annual open Medicare enrollment and decide to keep it in the supplement or update to a Medicare Advantage plans 2020 in Part C.