Deadline looms for chance to pick a Medicare Advantage plan

Dec. 3—If you watch much TV these days you probably have seen the likes of Joe Namath, William Shatner and Jimmy "J.J." Walker — and one age-insulting stereotype about a cranky woman named "Martha" — urging you to call an 800 number and see what new Medicare options are available to you. But don't delay, the deadline is Dec. 7.

Well, the deadline is real — and real close, coming next Tuesday. And taking time to check out options makes a good bit of sense because they can change every year. But while calling those 800 numbers is one choice, it probably isn't the best one, Ellen Galardy of Highmark Health suggested.

Those TV pitches are for "insurance brokers that sell plans from a variety of carriers all over the nation, probably through a big call center," the senior vice president of consumer markets advised. "People hear things like 'I can get these benefits.' Well, yes, but it may be in one county in Florida where they offer that one. We all trust local folks. I like to hear advice for plan options locally."

Galardy recommends either contacting insurance companies that offer Medicare Advantage plans directly, or finding a local insurance broker you trust to help you see what's available that fits your situation.

What is an Advantage plan? Galardy gave a quick breakdown of the "ABCs of Medicare."

Medicare is a government health insurance plan. Once old enough, you are automatically eligible for parts A and B, which cover most of your basic medical costs: A is for hospitalization, B is for other services and equipment. But they don't cover the full cost, typically leaving you to pay about 20%.

Medicare Part D, known as Medigap of Medicare supplement, helps offset the cost of drug prescriptions, though you have to opt into it, it's not automatic. An important side note: If you don't get Part D when you first enroll in Medicare, there will likely be a penalty if you enroll several years later, increasing the cost. This is done, Galardy said, because "you don't want people to wait until they need the coverage to buy the coverage."

Medigap programs can help pay for some or all of what Medicare alone doesn't cover, but still works within the restrictions of original Medicare.

A Medicare Advantage plan — technically Medicare Part C — is a different animal. In a nutshell, rather than getting the red, white and blue Medicare card, "The government says, we're going to let Highmark issue that card, and give Highmark a budget." Galardy explained. "They give Highmark a pot of money to make sure patients stay healthy."

So each year an insurance company that decides to offer Advantage Plans has considerable flexibility in how that "pot of money" is spent covering the insured person's needs. That lets each company craft its own Advantage options, usually offering more than one, in an attempt to tailor coverage to better suit your needs.

"The minimum we have to cover is what Medicare does," she said. "Where we have flexibility is to put more of those dollars into, say, primary care visits." So one plan may allow you to go to any doctor of your choice anywhere, while another may do a better job of covering specific drugs you may be taking now that you weren't taking when you first enrolled.

"That is why there are multiple Medicare Advantage plans," Galardy said. "I think the flexibility creates plans that may best meet your needs. Some may look at it and say "I don't go to the doctor very often, but I want full coverage for a gym membership, or want benefits directed to the cost of eyeglasses."

"That's where this time period is important. You may have shopped for your first Medicare plan five or ten years ago, and you might have different drug needs, different health needs. The time is now to make that comparison."

And for those who are turning 65 next year, no, you don't have to enroll by the deadline this year. You can make comparisons of plans anytime, but you generally can't enroll in Medicare until 90 days before you turn 65. You also have 30 days after that to change your mind.

Insurance companies like Highmark can make Advantage plans more economical than traditional Medicare by emphasizing preventive care, Galardy said. "Advantage can have more robust coverage, let you seek care early, do all the health care screenings we encourage people to get to stay health." That, in turn, can mean the insurance company spends less than the "pot of money" assigned for a patient, and that savings can be used to increase your social security check.

Galardy concedes her bias in believing Highmark offers the best plans around. You can check online at medicare.highmark.com or call for direct access at 888-409-3641. But if you are already with another provider, you can start your review by checking their newest plans. If you are just considering Medicare Advantage for the first time, the federal government has a website that can help look at all plans available in your area at medicare.gov.

According to medicare.gov, along with Highmark, Advantage plans are offered locally by Geisinger (geisinger.org) Aetna (aetnamedicare.com), Humana (humana-medicareadvantage.com), Vibra (vibrahealthplan.com), Wellcare (wellcare.com/medicare), AARP (through United Health Care, www.aarpmedicareplans.com), and Lasso Healthcare (lassohealthcare.com)

The important thing, Galardy stressed, is that it's not to late to review some options and make changes if you find a plan that better suits you. She said Highmark is operating extended hours and can talk with you over the phone or meet in person. "We'll be open until midnight on Dec. 7."

Reach Mark Guydish at 570-991-6112 or on Twitter @TLMarkGuydish