Joanne (00:00):

Are you looking to enroll in a Medicare Advantage plan, but you're worried about making a crucial mistake? Well, in today's episode, we will break down some of the biggest mistakes that we see when people try to choose a Medicare Advantage Plan so that you can avoid them.

Cameron (00:10):

But before we start, my name is Cameron Giardini, and together with my co-host Joanne Giardini Russell, we operate Giardini Medicare, which is an independent insurance agency based out of Southeast Michigan. Although we are based in Michigan, we do work virtually over the phone to directly help consumers in about 13 states to find the right Medicare coverage for them. If we do not work in your state, we will connect you with another trusted independent agent that will be able to help you find the right coverage that you want. And even if you choose not to work with us, we know that the information in today's podcast will help you have a successful and stress-free transition to Medicare. Joanne already mentioned that this episode is all about Medicare Advantage and potential mistakes you can make when you're enrolling in them or choosing a plan. So a brief overview of what we'll talk about, we will go into detail about what are Medicare Advantage plans, or at least give an overview of it.

Cameron (01:04):

We will talk about the top five mistakes we see people make when choosing Medicare Advantage coverage, and we'll talk about what impacts these mistakes can have. Of course, we will talk about how to avoid these mistakes, which is probably what matters to you. And we will do a recap of everything at the end. Now, just remember that this episode, it's only about potential Medicare Advantage mistakes. We do have another episode solely focused on the top five Medicare supplement mistakes. If you are also interested in that, make sure you tune into that episode as well. And you should always compare Medicare Advantage and Medigap. So might as well listen. First, Joanne can talk about what are Medicare Advantage plans.

Joanne (01:44):

All right, diving right in, what are Medicare Advantage plans? Well, Medicare Advantage plans are also referred to sometimes as “Part C”, and these are private alternatives to Original Medicare. What happens is a plan will bundle all the benefits from Part A, Part B, and typically Part D into one package. These are technically managed care programs, and again, they're offered by private insurance companies. They'll often come in the form of an HMO or a PPO. They often require the use of a specific network of providers and hospitals. They may require prior authorization before getting medical care. Medicare Advantage plans often will have a very low monthly premium (usually zero), and they will often provide extra benefits such as dental, vision, and hearing, but potentially they can have higher out-of-pocket medical costs when you use the coverage. While you are enrolled in a Medicare Advantage plan, you're going to get most of your services for Part A and Part B coverage through your Medicare Advantage plan instead of Original Medicare. This means that you can put your red, white, and blue Medicare card in a safe place in your house. When you're going to get your medical care, you're going to be presenting that Medicare Advantage card from that insurance company that you enrolled with and not your Original Medicare card. Because your Medicare Advantage plan is now your primary coverage. Medicare Advantage plans must follow rules that are set by Medicare, and they must cover the same services that are covered by Original Medicare. Keep that in mind.

Cameron (03:12):

Yep, and that's true. They do have to cover the same services, but as Joanne talked about, how they cover them is typically different, and that's where the fun comes into play. Now that we've done an overview, let's talk about mistake number one and that mistake is not considering all parts of the plan. Joanne already briefly mentioned that Medicare Advantage plans are bundled alternatives to Original Medicare. “Bundling” means that the coverage typically includes, medical coverage, prescription coverage, and extra benefits that are not covered by Original Medicare like dental, vision, hearing, and more. So, a common mistake that we see is that consumers tend to pick one portion of the Medicare Advantage plan and focus on that instead of the total package or that total bundled plan. For example, you may find a plan that has all your doctors and network, but it doesn't cover your prescriptions very well.

Cameron (04:08):

Or you may find a plan that covers your prescriptions, but some of your important doctors are not in the plan's network. Perhaps the biggest mistake when not considering all parts of the plan is you just get drawn into the advertisements and all the extra benefits, whether it's a flex card or high levels of dental coverage. And then when you later go to use the plan, you might realize that the medical and prescription coverage is lacking what you need. And this is hard to, it's just really hard to navigate. There is so much out there, it's very easy to get caught up with one of the benefits. You know, dental is important, so if that is a big factor for you, you can use that when thinking about the plan, but don't fixate just on the dental and neglect the other parts of the coverage.

Cameron (04:50):

It's okay to fixate on certain benefits, but you still want to think of it as a total bundled package. The reason this is important as well as you cannot typically change Medicare Advantage plans just at any time of the year. There are some cases, of course, you can make a switch, but you don't want to be stuck with the wrong coverage and then suddenly realize that you're stuck for a certain period. So again, consider all aspects of the plan. These are package plans. You can't just choose your favorite benefits from one plan and then pair it with plan benefits from another Advantage plan. It's all or nothing.

Joanne (05:23):

And just to throw something in there. Again, not considering all parts of the plant, when you're talking to a neighbor or a friend or a cousin in another state, et cetera, and they're saying, well, I have this plan that has X amount of dollars in dental, it's the best thing in the planet. Understand that their medications are different than yours, and their doctors are not yours. So, it kind of falls along that line of just don't get focused on the wrong thing.

Cameron (05:47):

Yeah, absolutely. And talking about different providers, you can go right into mistake number two.

Joanne (05:53):

The second mistake we see often is not checking plan provider networks. Medicare Advantage plans, again, are going to work very differently than Original Medicare. One of the main ways that they work differently is by being a managed care plan and they have a network of medical providers that they contract with the insurance company that is providing the Medicare Advantage plan that you enrolled into. This network can go beyond just doctors, and will also include hospitals, durable medical equipment, home healthcare agencies, skilled nursing facilities, and the dental networks that these offer their perks with. So, be aware of the overall network, but focus on the networks for the services that you plan on using soon. We brought up with dental the most important thing is to make sure that the dental network is going to work with your dental provider. So doctors, hospitals, and dentists tend to be the biggest things people look at.

Cameron (06:42):

And quick, again, what Joanne just said, don't focus too much on the perfection of the networks. There's always going to be some area that they are lacking as far as coverage goes, but if you don't necessarily need skilled nursing soon, understand that that is going to require networks in the future, but just fixate on what is typically most important soon. Of course, unexpected things happen, but you can only do so much when you're first choosing an advantage plan.

Joanne (07:07):

Look at what you're using today. Exactly. So, enrolling in a plan, if you don't check your providers, may result in you having to pay more out-of-pocket to get care, or even worse, not being able to be treated by a doctor that you have been seeing or have your heart set on seeing. Many people think a PPO plan is the solution to Medicare Advantage network issues because they do provide out-of-network coverage. However, a PPO is not a “free-for-all” to see any provider that you want. Even with a PPO out-of-network providers are under no obligation to treat you outside of an emergency. Don't forget to consider if you plan on traveling or getting treatment outside of your planned service area. Are you okay with emergency-only coverage or do you prefer a national network of providers to work with?

Cameron (07:54):

Yeah, that's also really important. I just talked to somebody yesterday and they said, “Hey, is it true Medicare Advantage if we travel, we have no coverage?” And it's not true. There are plans that have small networks that are just a small region and there are plenty of them that have national networks. So just go back to check networks and put that in your overall consideration with your Medicare Advantage plan. Now, I know we talked about the fact that this episode is only about Medicare Advantage, and that's mostly true, but mistake number three does involve Medicare Supplements. Mistake number three is not considering both Medicare Advantage plans and Medicare Supplements when you're first eligible for Medicare, no matter how you choose to get your coverage, once you do enroll in Medicare, it's always good to know that your Medigap Open Enrollment Period, the period that lasts for six months and begins on the first day of the month, you're both 65 or older and enrolled in Part B.

Cameron (08:51):

That time period allows you to enroll in a Medigap plan without being denied coverage based on your health at the time or based on pre-existing conditions. In most states, once your Medigap open enrollment period has passed, you will have to qualify for a Medigap plan based on your health and you could potentially be denied that coverage. So again, we're not saying you must enroll in a Medigap plan right when you're 65 or during your open enrollment period. But you do have to understand that this time period exists. And if you choose a Medicare Advantage plan, going to a Medicare supplement in the future will require you to qualify for that in most circumstances. And we've seen this before where some consumers, mistakenly think, oh, I'll just choose Medicare Advantage while I'm healthy, and then I'll just change to Medigap once something comes up. And then, unfortunately, you realize it may be too late at that point. So, the takeaway here is to always compare both Medigap and Medicare Advantage plans before you begin Medicare. The worst thing we see is people don't know that both options exist. You may only know Medigap exists or you may only know Medicare Advantage exists. Now if you just listen to this, you can't say that's the case anymore, but now you should just look at both. That's the moral of the story here.

Joanne (10:07):

You really do. You must know they exist to make a good choice.

Cameron (10:11):

Yep. Get the pricing for it. Just say, “Hey, what would a Medigap look like for me?” then compare it to your Medicare Advantage options. Even if you're dead set on one or the other, it doesn’t matter.

Joanne (10:19):

Exactly. It's good to understand both for sure.

Cameron (10:21):

And the easy way to compare options is what Joanne will talk about in mistake number four.

Joanne (10:25):

Mistake number four is not using a broker and not comparing companies. So, you might be sick of hearing us say this, but a good independent broker can make all the difference when you're making that transition to Medicare and enrolling into that Medicare Advantage plan.

Cameron (10:39):

We know we're biased, but it's true

Joanne (10:42):

Even if you don't want to use a broker, you can find another source of independent information such as your state's SHIP counselors (they're called different things in different states), or you can find your Area Agency on Aging. If you don't want to talk to anyone and you want to do everything on your own, you can at least take the time to compare all of the Medicare Advantage plans offered in your area by using the Plan Finder tool on Medicare.gov which is a really good tool for Medicare Advantage plans. Now mistakes will tend to happen when someone just goes off directly to one insurance company that you're familiar with. This might be a company you had your health insurance with prior to turning 65 years old. So you're familiar with that company. Maybe it's a Medicare Advantage plan that a family member or a friend has, but Medicare Advantage plans are very specific to your individual needs and want. Don't just pick a company based on the name. The last point here is there are many Medicare Advantage plans that are offered in counties across the United States. So not using an independent source of information can really cost you a lot of valuable time trying to compare plans. For example, right in our backyard, Metro Detroit, one county here has over 60 Medicare Advantage plans being offered. That is very difficult to weed down on your own.

Cameron (11:53):

Yeah. And just to reiterate what Joanne said there, we're not saying don't listen to recommendations from friends or family. If you've had a company in the past for health insurance and you really enjoyed the experience for whatever reason, or if you know a family member or a friend has a good Medicare Advantage plan company that they like, you can certainly use that recommendation and add them to your list of options. They might even be top of the list but get a couple of other options for different companies to compare them to. Of course, use recommendations, but don't focus on them so much to where you don't consider other Medicare Advantage plans since there are so many of them now available.

Joanne (12:28):

One of my favorite things there, Cameron, is just to get a notebook out. I always tell people, to grab a notebook, and start writing down the questions. Sally told me this, what does this really mean? So, you've got all, you've got 15 questions to go talk to a broker or SHIP counselor or anybody about, but then you are taking that into consideration so you're not just dismissing what Sally said, but you're trying to understand what she really meant. And then somebody that really knows Medicare can kind of talk you through that.

Cameron (12:52):

Yeah. Or if you say, my brother has a really good plan, instead of saying, I want that plan, just say, is that also right for me? That's where the broker comes in. Now, mistake number five is not using the benefits provided by your plan. Again, Medicare Advantage plans, have become famous for extra benefits that they provide that are not covered by original Medicare. Of course, at this point, you have probably seen Joe Namath on your TV in the fall, and if you have seen that, you're already well aware of the extra benefits that you supposedly may be entitled to with Medicare Advantage. Now, these extra benefits, they do commonly include some of the following, dental, vision, hearing, gym memberships, over-the-counter benefits, groceries, meals, transportation, even paying for some of your home utilities, and more. These benefits are not provided by all plans, but pretty much all of them are 100% real and they do exist in some capacity with at least one plan in most places

Cameron (13:50):

However, these benefits are offered by the Medicare Advantage insurance companies often with them knowing that most people enrolled in the plan, won't even use them. They have a budget or a set amount of dollars they spend on all these extra benefits. So, they must allocate them in different ways. They have to say, okay, what looks good, but what are people going to use? Because they want you to enroll in the plan. They don't necessarily want you to use all of the extra benefits. It's not that they don't want you to get dental or anything, but just keep in mind that they're putting these out there for advertisement purposes and not always for usage purposes. But to avoid the mistake of not using the benefits we talked about, make sure you understand all of the extra benefits that your plan does offer and know how to use them.

Cameron (14:33):

More importantly, make sure that you follow through and that you actually do use them. If you have an over-the-counter benefit, make sure that you're using the full allowance, even if it means you must overstock on band-aids or toothpaste, whatever it may be. If your plan gives you a free gym membership, make sure you use it. Even if you're in Michigan and you want to get to a hot tub in the winter, you know, just go once a week if you have a free membership. You might as well use it now. To find all the extra benefits that your plan does offer and how to use them. Of course, you can ask your broker, they should know that information, or you can look at your plan's evidence of coverage document. This document is the legal master source that contains all of the information that you will ever need to know about your Medicare Advantage plan. It will tell you every benefit you have and it will say, here's how you use over-the-counter benefits, dental, whatever it might be. So, always take a look at that.

Joanne (15:26):

Be prepared. They're 200 to 300 pages long.

Cameron (15:29):

Yeah, I would say pull it up electronically and search it on your computer because if you're flipping through it, it will drive you crazy

Joanne (15:36):

Control F

Cameron (15:37):

Control F. Yep. So, I did lie again. We do have a bonus mistake, which Joanne will talk about, and we'll finish things up.

Joanne (15:44):

Here's your bonus mistake. It is not reviewing your Medicare Advantage coverage yearly. So, if you listen to this episode and others of ours and have taken the precautions to avoid the mistakes that we're talking about, then you're well on your way to getting the right Medicare Advantage coverage. However, there is still one more common mistake that can occur after you have enrolled in that plan. Once you've enrolled, the biggest mistake that you can make is not reviewing that coverage annually. Remember that Medicare Advantage plans are yearly contracts and the benefits they provide can and often will change on a yearly basis with the new calendar year. This can include things such as medical copays, drug copays, dental, vision, and hearing providers, the amounts of coverage, and more. In recent years plans seem to have smaller changes from one year to the next, but it's always good to look.

Joanne (16:33):

You'll also receive (and this is important), in September an annual notice of change from your insurance company. It's going to highlight your plan and some of the changes for the upcoming year. Please pay attention to that document. Please, please, please, it's very important for you to come in January. Luckily, if you do miss that change in the fall, you can use what we call the Medicare Advantage Open Enrollment period, which is from January 1st to March 31st, and you can possibly find a plan that suits you better. You can make one plan change during that window.

Cameron (17:07):

Yeah, we talked about that more in our Medicare enrollment period episode. 

Cameron (17:13):

After everything you've heard in today's episode and other episodes, you may realize that choosing a Medicare Advantage plan can seem like a daunting task. And you have likely heard horror stories from acquaintances that made a mistake when choosing a plan. Luckily, now you know at least some of the most common mistakes, what they are, and more importantly, how to avoid them. If you work with a good independent broker or anyone who's an independent source for Medicare information and you take the time to look at all of the details of your Medicare Advantage plan, we know that you will find the right plan that fits what you're looking for. As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can also find more Medicare content from us by going to YouTube and searching Giardini Medicare. If you want to schedule a one-on-one phone call with one of our licensed brokers, you can do so by going online to gmedicareteam.com. And lastly, if you want to send us any feedback or questions about this episode or anything about Medicare, you can send that email to info@gmedicareteam.com. So, thanks for listening, and have a good day.