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Complexities in MA options discourage seniors from comparing plans

Insurance Forums Staff

Medicare Advantage Open Enrollment Period (MAOEP), Jan. 1-March 31, is a time when seniors can potentially save a lot of money and gain benefits.

Unfortunately, many seniors will do neither. But why is the Open Enrollment Period ignored by seniors? As Dave Rich CEO, Ensurem LLC, puts it, “The Medicare Advantage market is constantly changing, making better plans available to seniors every year during the fall Annual Election Period. This is crunch time for most seniors, but what they don’t usually realize is they also have a chance to make one additional change to their MA coverage for the year during the OEP. Additionally, insurance companies and brokers aren’t legally allowed to market this period or its benefits to consumers. So oftentimes, they’re left feeling stuck with the choices they made during a hectic AEP season.”

The MAOEP is the time when a beneficiary with Medicare Advantage can either:

  1. change from one Medicare Advantage plan to a different MA plan, or
  2. drop their MA plan and return to Original Medicare, Part A and Part B (and subsequently apply for Medigap or Part D, if they choose)

For those who do decide to drop their MA policy and return to Original Medicare they often don’t understand that there is an increase in patient medical costs for Original Medicare holders, while MA costs are on the decline.

Original Medicare, which covers the basic hospital and medical expenses that the government provides at age 65, does not cover all healthcare expenses however (such as Prescription Drug Plans) and it leaves the senior with out-of-pocket expenses that can sometimes be crippling.

Medicare Advantage, or Medicare Part C is coverage provided by private insurance companies that contract with Medicare. These plans will sometimes include additional coverage for things like dental and vision care, prescription drugs, rehabilitation services, diagnostic services or even fitness programs.

MA benefits better in 2020

If a senior has Medicare Advantage they may want to shop during the MAOEP because the MA markets are getting more competitive as more entrants continue to break in. To stay competitive, insurance companies are always adding new services and benefits.

For example, hundreds of MA companies are rolling out new homecare benefits in 2020. This is because the Centers for Medicare & Medicaid Services (CMS) is giving Medicare Advantage plans the most flexibility they’ve ever had in terms of covering non-medical, in-home supplemental benefits.

Additionally, the steps the Trump Administration has taken to improve and drive competition in Medicare Advantage means more savings, more benefits, and lower costs for seniors. Nevertheless, many seniors will likely not take advantage of these benefits.

Only 6-11% of seniors voluntarily switched from Original Medicare to Medicare Advantage during the 2006 to 2017 enrollment periods. In addition, more than one in three Medicare beneficiaries reported difficulty comparing the Medicare Advantage plan options.

Seniors would rather get a colonoscopy?

Another survey, from AARP, found that 23% of seniors said they found reviewing their Medicare plan to be one of the most unpleasant tasks they do among a list provided to them by pollsters. Other choices they said they’d rather confront before Medicaid included “getting a colonoscopy” and “going to the dentist.”

According to Ensurem’s Rich, neither reviewing a Medicare program or shopping for a new Medicare Advantage program has to be confusing or painful. After years dealing in international insurance, Rich says he became a passionate believer in the use of technology and the need to fundamentally change how insurance is sold so that more Americans can enjoy the benefits of these products.

“What is needed,” Rich says, “is a user-friendly online platform serving as an insurance broker on one side and a provider of tailored Medicare solutions information and purchasing opportunities on the other.”

He says Ensurem has designed such a platform. It has carrier relationships with Aetna, Humana, Ameritas, and other major health insurers where the senior can fill out a few forms and get straight, non-complicated answers as to which MA plan will work best for him or her.

Medicare Advantage beneficiaries still have a chance to make changes to their 2020 coverage during the Medicare Advantage Open Enrollment Period, which ends March 31. According to Rich, an investment of a few minutes of time may well be worth it for any senior.

About Ensurem: Ensurem, headquartered in Clearwater, Fla., is a technology and product distribution company serving carriers and consumers within the U.S. senior market. For more information, visit http://www.Ensurem.com



10 thoughts on “Complexities in MA options discourage seniors from comparing plans”

  1. “they’d rather confront before MEDICAID included “getting a colonoscopy” and “going to the dentist.”

    How did MediCAID get into the picture?

    “What is needed,” Rich says, “is a user-friendly online platform serving as an insurance broker on one side and a provider of tailored Medicare solutions information and purchasing opportunities on the other.”

    Sounds like he is advocating the elimination of agents.

    The NEW Medicare Plan Finder was supposed to be easy for seniors to use. Even the stakeholders that “tested” the platform before it rolled out praised the new design.

    But when AGENTS took it out for a spin it fell flat. And to make matters worse, it STILL is hopelessly broken even after last minute patches.

    The infamous healthcare.gov was pitched as being as simple as ordering an airline ticket. Five years later it is still a mess.

  2. I’d like to see him explain how a $6,700 out-of-pocket exposure for a Part C plan saves money vs. Original Medicare plus a Supplemental plan. Oh, and what about network requirements for Part C? Can’t tell you how many people I speak with who didn’t understand you can’t have a Part C plan AND Original Medicare; they are two different systems.

    That said, Part C plans can be very effective for Dual Eligibles or others in Special Needs Plans (SNPs) or others not capable of managing their own care. I’d also like to see Part C plans make a comeback as an employer-group alternative for active employees who are Medicare-eligible. The ACA made staying on small group plans (under 20 lives) post-age 65 a bad deal for most. About half of my Medicare business comes from folks still working but eager to escape expensive, high-deductible group plans. Aetna used to write a special small group Part C plan in my state that was attractive, but withdrew the plan several years ago. Group Part C plans solve the thorny tax issues invited by an employer paying premiums for individual Medicare plans for active employees.

  3. This article is geared to MA plans which can be cost savings if one doesn’t need the plan. If a person ends up with cancer, The best cancer center in the world doesn’t take MA’s. MA”s saves the Medicare program money simply because the consumer takes on more risk during the aging years when they may need good care the most.

  4. Higru

    If a person ends up with cancer, The best cancer center in the world doesn't take MA's.

    Same can be said for heart conditions.

    Places like Cleveland Clinic may accept SOME MA plans as long as they are not HMO. You may be balance billed if you use a PPO plan.

  5. We have a company here in Louisiana that will negotiate on an individual basis for clients to go to MD Anderson and will treat it as in network. They are the exception by far.

    The article is very convoluted. I agree that it seems like he wants to remove agents from the picture. That would be unfortunate because there are many people who think they want one thing or the other until they get it and it ends up not working for them. The whole point of the agent is to advocate for the client. Advocate well, eat well.

  6. Replacing labor/saving costs drives tech. They say artificial intelligence will replace a lot of people. The future may have to implement a universal income funded by the soylent green factories. It'll be a good time to be Amish.

    Speaking of which, I see they are exempt from mandatory insurance and their life expectancy is the same as other Americans. But, you gotta eat scrapple.

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