For best results with Medicare, consult an expert

Kristan Dael
50plus Magazine

While some people are skilled and comfortable “learning by googling,” when it comes to learning about Medicare, it doesn’t get any better than wisdom and expertise from an experienced agent. Their help doesn’t cost a dime, and can save substantial money, time and stress.

In line with this, we spoke with Jason Stubbs of Oregon Insurance in Eugene. Following are his thoughts on many key questions about Medicare plans and benefits.

Concerns or Complaints
When asked what concerns or complaints he most often hears, Jason said, “The big issue for everybody everywhere is prescription coverage. The biggest complaint is that it can change, catching many by surprise. They either didn’t know about it, or they don’t know how to look into it; so, they end up, ‘Now what do I do.’”

The best next step, Jason says, is to “get ahold of your agent.”

“While everyone does receive written notice of any benefit changes around September 30th or October 1st, the notice doesn’t specifically list your medications; rather, it simply identifies changes to tiers. You have the responsibility as a consumer to see whether the medications you need will continue to be covered by your existing plan.”

In the event your medication benefits change, Jason says there are two main things to look at: “Sometimes you need a change in plan; sometimes it’s changing your pharmacy.”

For example, he says, a client with coverage that costs $20 per month or $900 per year at one pharmacy may be able to change his or her plan and get their cost down to $560 per year. Or, changing pharmacies might reduce the annual cost to as low as $120.

“It’s about the pharmacy and the plan,” he says. “If a client has a preferred pharmacy and they don’t want to change, perfect! Let’s look at the plan available with that pharmacy.” If the plan is the most important constant for a client, then the search can widen dramatically to include any number of national medication providers.

About Benefits
When it comes to the myriad benefits to consider when enrolling or changing coverage, Jason says by far the most confusing are fitness, dental and over the counter (OTC) medications. “People seeking specific benefits like alternative care, acupuncture or chiropractic tend to gravitate to the plans that cover such things. The most misunderstood benefit, fitness, is because not every company subscribes to all plans, so you have to figure out what your
plan covers.”

Most missed detail about dental coverage? “You may have this benefit added to your Advantage Plan,” Jason says, “but your dentist must be in the network.”

The most misunderstood feature about OTC benefits, which cover pain relievers, bandages and the like, is that the benefit is funded quarterly. For example, “If you signed up in March and have $40 in OTC coverage and don’t use it during that quarter, it doesn’t roll over but resets — so you again have $40 starting the next quarter.”

Top Tip for First-time enrollers
“If you are new to Medicare, signing up for the first time, do your research,” Jason says. “Get familiar with Medicare Advantage and Medigap plans — there is a night and day difference between the two.” The key difference, he says, is that starting with a Medigap plan offers greater flexibility than starting with an Advantage plan. For most, it comes down to budget, physician preference and health.

“If you choose an Advantage plan and two years later you want Medigap you are now subject to being screened for eligibility. If you start with a Medigap plan and later want to change to Advantage, you can — no health questions asked.”

It’s a matter of planning for the future, Jason says, versus trying to figure things out based on where you are today. “So many people get input from a spouse, friend or neighbor and just follow their example. “Neighbor Joe does this so I will, too.”

“The problem with that is neighbor Joe’s plan may have extra benefits for congestive heart failure or diabetes, but in choosing your plan you may not get those benefits. If you and your spouse need different medications, you need different plans — plans tailored to meet each of your unique needs.” Bottom line, Jason says, “Just because a plan works for your spouse or your neighbor doesn’t mean it’s the best plan for you.”

That’s surprising!
What many people don’t quite understand, according to Jason, is that Medicare coverage costs. “They’ve paid into the Medicare system all their lives, and now they have to pay for their premiums,” Jason explains. “This is insurance. There are monthly premiums, co-pays and co-insurance.”

Finding an Agent that Fits
Just as important as finding a plan that fits your needs is finding an agent that fits you. “It’s important that your agent is somebody you know and like and trust,” Jason says. “This is an advisor to you. You need them to be knowledgeable and to provide options.

If an agent has only one or two plan options, that’s not the person you want to see — they have limited access to plans.” Further, he explains, “If an agent shows you only plans he thinks you should choose, that’s not the same as exploring various options.”

Jason emphasizes that “You should never be sold on a plan. You always have a choice and should be given multiple options to choose from.”

Some agencies might present as many as 37 possible plans. From there, Jason says, choices can be narrowed based on your lifestyle, travel, alternative care desires, etc. “That’s when it becomes more of a conversation,” he says, “where your agent is trying to help you versus selling you something. If you’re being told, ‘I think this is the best plan,’ that’s not what you want to hear. You want options and the opportunity to ask questions.”

“Keep in mind,” he notes: “If you make a mistake, there is a one-time opportunity to change during the special enrollment period January 1st through March 31st. Once that change is made, however, it is final for the rest of the year.”

In closing, Jason says, for those who need help sorting it all out, “Go to a health fair and find an agent. They’re happy to run those lists, provide plenty of options and walk through your questions, concerns and unique needs.”