Are your Pain Points Covered?

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Medicare Advantage Plans

Higher hospital co-pays!  High co-insurance payments!! More out of pocket expense!!!  Some people call these “pain points” as they can take a bite out of a savings account.  What can a person do to control their “pain points”?

The history: let’s first address Medicare Plans then health insurance for those under age 65.  It was about 2006 when the Central Illinois market had Medicare Advantage Plans (MAPD) with low premiums, a network of providers and zero co-pays for covered medical expenses.  Some people chose these MAPD Plans over Medicare Supplements and it made good sense.

Flash forward to 2017: MAPDs have changed and have co-pays for doctor’s visits, hospital stays, surgery and such.  They also have a co-insurance percentage (usually 20%) due for services such as chemotherapy.  It is very important to know that for the policyholder’s protection MAPD Plans have a maximum out of pocket (MOOP) for covered medical expenses incurred during any year.  These MOOPs are usually between $3900 and $10,000 depending upon the plan and insurance company.  The MAPD co-pays and co-insurance amounts that can be called “pain points”.

For people with underage 65, and do not have employee sponsored medical coverage.  These plans are referred to as Obamacare Plans (also called ACA Plans), or some people yet have the pre-Obamacare Plans that they have been able to keep.  In the past 3 years ACA plans have changed significantly as you know from the news reports.  Deductibles have skyrocketed, co-pays for services like doctors visits are up, as are co-insurance amounts.  Like MAPD Plans, these out of pocket costs are your “pain points”.

Here are a couple of examples from the Central IL area. A person in her early 40s caught the respiratory sickness going around and ended up hospitalized for 2 days.  This family’s ACA plan has a $7,150 deductible and of course that was quickly met with this hospital stay.  The plan to reduce “pain points” paid $5,000 to this person to assist her with expenses.

A second example: a person in Northern Illinois is on Medicare and has a MAPD plan.  He had a heart attack and subsequent surgery. He had a 7 day hospital stay where he had a $275 per co-pay days 1 -6 for his hospital stay.  His plan to help cover “pain points” paid him $300 a day for days 1-6 or $1,800 to assist him with his out of pocket costs.

The questions become: do you wish to reduce any “pain points” you may have?  If so, what can you do?  Watching this problem develop several progressive insurance companies have introduced or expanded upon existing low premium indemnity policies to help reimburse people’s pain points.  Best yet, some of these products are designed to approximately mirror the co-pays and coinsurance exposures of MAPD or ACA plans.  As always, plans differ company to company: read the outline of coverage for benefits, limitations and exclusions.

.So – what to do?  First, purchase and maintain a good ACA medical or Medicare plan.  Secondly review your coverage every year.  See if you can make changes that benefit you such as lower premiums or more coverage for the same premium.  If you have or consider buying a plan to help with “pain points”; keep a list of the policies and coverage in front of the medical file you keep.  (Yes – keep a medical file)  For information on these types of plans, call you agent.  If you do not have an agent, research health insurance brokerage firms for a qualified agent.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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