In this article, I will outline some scenarios in which we see people rationally or logically choosing Medicare Advantage plans as a viable option. After helping thousands of Medicare beneficiaries and building a team of agents that have helped hundreds of thousands, I have a pretty good grasp of the different Medicare beneficiary scenarios. Every day during the annual enrollment period, we are sent a new Facebook post or article written by someone with a negative spin on Medicare Advantage. For the first half of my career, it wasn’t feasible for most of my clients. We were force-fed the narrative that the turning point on offering it was compensation, but short of a few call centers owned by people who aren’t even licensed agents or brokers, I do not believe that is the case. Medicare Advantage plans have improved their networks (many more PPOs than there used to be), prior authorization processes (most major carriers are again decreasing Prior Authorization requests by 20-25% in 2024), and premium and out-of-pocket cost combinations (Maximum Out of Pocket also known as MOOPs are getting lower in a ton of areas.
Still, the articles that come out latch on to anecdotal evidence or the stories of a few, then fund narrative-driven research performed by research groups with an agenda to trash Medicare Advantage. The truth is, the program is helping a ton of people that used to be forgotten. Considering we serve many different client avatars, we will showcase the traits of each group we’re helping by naming them and explaining why they might consider Medicare Advantage as a solution. The names are fictitious, but like Law and Order, their stories are real!
Group Retiree Medicare Advantage
Steve and Janet Austen are retiring at 67. They both married within weeks of their 19th birthdays and became school teachers at around 25. They have had a long and fulfilling career as educators. Still, they’re having to deal for the first time in 42 years with personal health insurance coverage options. Their employer is offering them a retiree Medicare Advantage Plan, but their friends told them it should be called “Medicare Disadvantage.” Still, they are looking at all options with an agent they were referred to. This agent works for a brokerage that offers all major carriers in the Medicare Advantage and Medicare Supplement space and has been licensed for ten years. They’ve helped over 1,000 people through similar scenarios. After looking at the group Medicare Advantage Plan, the only alternative to present is a Medicare Supplement option.
The group, Medicare Advantage benefits, require Steve and Janet to keep their Medicare Parts A and B active. Their Part A is free, but their Part B in 2023 is $164.90. The Advantage plan the state offers has a $900 Maximum out-of-pocket in-network and is with Aetna. It is also a PPO where they can use any provider in the PPO network nationwide. The network touts over 1,000,000 providers participating. It also included $1,500 worth of no-cost dental coverage each year for each of them, and their drug expenses on the plan look to be minuscule. There is no premium, and after checking, all of their hospitals and providers are in the network. It also includes a $250,000 foreign travel benefit, which will come in handy on some of the upcoming mission trips they’ve been putting off until after retirement.
The Medicare Supplement Plan G option is going to cost them roughly $350 per month on top of their Part B premium, and to get dental, they’d have to pay an additional $56 per month per person. This brings the Medicare Supplement option to a whopping $452 per month, with probably annual rate increases being a factor. They’d still have to pay their $240 annual Part B deductible, and there is only $50,000 of emergency foreign travel benefit included.
Steve and Janet have done well with their retirement, but they finished building a house six years ago and still have a mortgage that won’t be paid off for another six years at their current trajectory. The extra $452 a month in premium savings feels to them like it will go a long way towards helping pay that off faster and/or allowing them to take advantage of more travel opportunities, not to mention the fact that the out-of-pocket potential differential is just the difference between $240 and $900 per person per year.
This seems like a no-brainer to the Austens, and the experienced agent must admit that though he’d like them to become a client of theirs, this plan is very appealing, and not all people have access to something quite like this. The Austens go with the Group Medicare Advantage Plan and then ask the agent for a follow-up appointment with him regarding their 401K rollover, considering he was so honest with them about what was in their best interest.
The Dual Eligible
Mattie Stegall is 72 and has been on Medicare and Medicaid for over ten years. She sees a commercial about dual plans through Blue Cross Blue Shield for people with Medicare and Medicaid cards and decides to call in. She gets an agent on the phone and starts asking questions about the pros and cons of a Dual Special Needs plan designed for someone in her shoes. The agent explains to her that in her area, she is eligible for a DSNP PPO, meaning she can get the plan and go in and out of the network. The agent asks for a list of her medications and providers to check if they are in the formulary and network. They are, and afterward, they start to go over the coverage and benefits. The plan would continue to have $0 out of pocket and would cost her $0 in premiums, but she’s already used to that. The benefit of this plan, however, is that it has a whopping $5,000 a year dental benefit and a grocery card that will help Mattie pay for $200 a quarter in groceries. This will be massively helpful to Mattie, considering she’s struggling to make ends meet.
She later reads a post on Facebook saying the Medicare Advantage plans are very bad. She is confused. Her experience has been good for over a year now. She becomes afraid and calls her agent. The agent has to spend additional time talking to her about why people might say this and how it can be anecdotal or even, in some cases, self-serving advice. Mattie ultimately agrees, but once a quarter or so, the agent has to have this conversation with them due to them being heavily solicited and disproportionately subject to a mountain of misinformation.
High Medicare Supplement Premiums
John Mattox is 77 and in exceptional health. He gets a premium increase notice in the mail for his Mutual of Omaha Plan F, and it is going up to $389 a month. He waits and also gets his Annual Notice of Change for his Part D plan with Humana, and it is also going up to $67 per month. He has had it. He cannot take the increases anymore and is struggling to get by on his $1,800 a month income. He doesn’t qualify for any extra help because he’s barely over the limits. He calls his agent to see what can be done, but the agent says he has to stay with the Mutual of Omaha because he was prescribed Ropinirole for Restless Leg Syndrome and also has pre-diabetes with heart surgery in his history nine years earlier. John is livid, but he waits another year. The next increase comes, and the premium is now $432 per month, and his Part D plan goes up again to $69 per month. This time, he decides to call around to some other agencies, and he gets Lucy. Lucy has been an agent for four years and asks if he has considered Medicare Advantage. He responds with, “I heard they don’t pay anything.” “Well,” she replies, “that’s definitely something someone who didn’t understand their plan probably said.”
Medicare Advantage plans are required by the Center for Medicare and Medicaid Services to cover all of the same services as Parts A and B of Medicare, which is precisely what your supplement will cover right now. The difference is you’d have a much lower (potentially $0) premium amount to pay, and if you have a Medical service done, there will be a corresponding copay. “What about a deductible?” John says. Lucy lets him know that there is no medical deductible on most Medicare Advantage plans. So he lets her search for plans available in his area. She finds one with a $3,900 maximum out-of-pocket, which is a PPO with Humana. It also includes some benefits he isn’t getting, like Dental, Vision, Hearing, and even an over-the-counter monetary benefit he can use to pay for vitamins and ibuprofen. John is very irritated that no one has explained this to him before. Lucy also knows that other topics like Prior Authorization might come into play down the road, and so she prepares him for the fact that if he enters a state where he might have to go into a skilled nursing facility, he’d have to go to one in network and would be subject to prior authorization. He decides that the risk associated with that is minimal to his overall health and that the options of continuing to pay ever-increasing Medigap premiums or going with Medicare only and being subjected to the unlimited Hospital daily copays, deductibles, and Part B 20% coinsurance are less viable options than this Medicare Advantage Plan. He signs up, and Lucy becomes his advisor for the foreseeable future.
These are just some of the pictures we see painted daily in quality agent/broker and client interactions. Medicare Advantage is not one size fits all, and Medicare Supplements are not either. It is most helpful to talk to a broker with experience offering both in your area. We have brokers all over the country that we partner with and train, as well as an entire office of experienced agents we teach to help people over the phone anywhere in the country. Two days ago, I helped two people shop their drug plans and get Allstate Plan Gs in Alaska. Last week, I helped clients with Medicare Advantage Plans in New York City and Sacramento. No matter where you are, we have someone that can help.