By Mary Jo Heins, Medicare Insurance Help, CMS Partner in Medicine

In my 15 years of doing Medicare, this is unprecedented. Insurance companies are reeling and terminating/discontinuing Medicare Advantage plans.

Medicare Advantage plans have a service area based on the county in which a patient lives. Patients are now receiving Service Area Reductions (SAR) letters from three insurers that are terminating plans in Colorado, including Denver Metro.  Yes – unprecedented!

Here is how your Medicare patients should evaluate their new options for Open Enrollment that begins October 15:

If you don’t go to the doctor often, the best match for your health, lifestyle and finances is still most likely a Medicare Advantage plan. You can use a Medicare agent to help you with this or go to medicare.gov.

If you have chronic medical problems, your best match may be a supplement. This SAR opens up a guaranteed issue (no medical underwriting required) to move to a supplement. The premium cost per month is around $225 (varies based on age, gender, zip code and smoking status.) This is on top of your Part B premium.

The reasons why people who do a lot of “doctoring” should look at a supplement are:

• Super low medical out of pocket. ($300/year vs $4000/year on Med Adv). If you are maxxing out your Med Adv out of pocket, the total costs (premium + copays) are likely to be lower on a supplement.
• Few, if any, prior authorizations needed
• No Med Adv network. You can go to any provider in the U.S. who accepts Medicare A&B. No more worries about the Med Adv insurer getting into a dispute with your doctors and having your doctors go out of network.
• This window to get a supplement without medical underwriting really is a “once in a lifetime” opportunity for someone with ongoing, expensive medical concerns.

Downside, of course, is a $225/month premium vs $0 for Medicare Advantage.

Mary Jo Heins

720.484.6946 (voice only – no text)

Medicare Insurance Help

Colorado Medical Society Partner in Medicine