Throughout the year and especially during AEP (Annual Enrollment Period), my Medicare clients ask if Medicare Advantage is right for them. And every time I’m asked I reply the same way – depends on your health!

In many cases, Medicare Advantage plans offer $0 premiums and feature additional benefits. When faced with paying upwards of $250+ per month for a Plan F/G Medicare Supplement, Medicare Advantage looks like a great bargain. But it’s only a bargain if it saves you money vis a vis original Medicare and an F/G supplement.

My agency promotes the view that if you can’t leave your client in a better place then leave what they have in place.

Here are 3 scenarios I encountered this past AEP.

Client One

Widowed male, age 82, resides in Florida but lives half the year in a
northern state. He has heart problems, currently on original Medicare with an F Plan supplement.

Reason for Contact: Wanted to go on a Medicare Advantage Plan because of the $0 monthly premium and additional benefits.
Due Diligence: Found that only one of his doctors in Florida was covered on any of the MAPD HMO or PPO networks. His doctors in the other state were also out-of-network. His 7 prescriptions were Tier 4 & 5 in the formularies. Also, because of previously diagnosed heart issues, he did not qualify for a hospital indemnity plan. (I do not enroll clients based on premium, so I rarely ask what they pay for their current coverage.) I found out he was paying $152.xx per month for his current F Plan which was significantly lower than any of my clients of the same demographic. He insisted it wasn’t a high deductible F plan.
Solution: Advised the client to keep their current F Plan supplement and enroll in a PDP plan to stop the penalty from continuing to increase. Offered a cancer plan.

Client Two

Married female, age 73, resides fulltime in Florida. Great health, no prescription drugs. She is currently on original Medicare with an F Plan supplement.

Reason for Contact: Wanted to go on a Medicare Advantage Plan because of the $0 monthly premium and additional benefits.
Due Diligence: She has had no hospitalizations in the past 5 years, never any major illnesses. She does have sporadic back problems that send her to the doctor about 6 times per year. Her monthly premium for her F Plan supplement was $230.xx.
Solution: Advised the client to name her back doctor as her primary care physician and enrolled her into an MAPD with a $0 PCP copay. Mitigated any unforeseen hospital stays with a hospital indemnity plan and cancer, heart attack, stroke plan. Saving her over $80 per month!

Client Three

Married male, age 75, resides fulltime in Florida. Great health, no prescriptions. Hasn’t seen a hospital in 15 years.

Reason for Contact: Wanted to go on a Medicare Advantage Plan because of the $0 monthly premium and additional benefits.
Due Diligence: This guy is in better health than I was ten years ago!!! Had original Medicare with F Plan supplement paying $261.xx monthly premium. Didn’t care who his doctors were.
Solution: Advised him to enroll in MAPD PPO and add a hospital indemnity plan. He’s saving almost $185 per month. Couldn’t get him on the major illness, but his wife is aging in this year so
that’s likely to change!

To me, Medicare Advantage is a reward for being healthy. As long as out of pocket costs for unexpected things such as hospital stay, ambulatory, etc. copays can be mitigated.

Resources

Centers for Medicare and Medicaid Services – CMS | Medicare

Disclosure: I only enroll my clients in Medicare Advantage w/ prescription drug (MAPD) coverage if they qualify for a hospital indemnity plan which will mitigate most if not all unforeseen hospital, lab, ambulatory & rehab copays. I also only enroll my clients in the G Plan supplement unless their income and net worth make the N Plan an option.