By Tamia R. Banks HSM BA, LPN, CMCN, Senior Solutions Broker
Options, yes everyone wants options when shopping. It could be as simple as picking up a bag of peanuts at the local supermarket, to buying a new vehicle, television, or even health insurance. Many times, we choose certain brands or products based on either our own experience, a family member experience, or a professional’s advice. So, if the purchase is a bit foreign and you need information, do you really know what questions to ask to get your best value? Sometimes a subject is foreign enough or has changed enough that we do not even know what questions to ask. Does one size even fit all with bag of peanuts, regardless vehicles and insurance.
People 65 and older know how much Medicare Plans are pushed in the Annual Enrollment Period (AEP). Ads, postcards, letters, and phone calls abound. Of course, the AEP is from 10/15 – 12/7 every year when people can change their Medicare Plans to best fit their current needs. Your needs could change yearly. They may have even changed since 1/1/2021, so do you work with an 800# or a local brokerage agency that will help you know what questions to ask?
Therefore, what questions might become important? A few examples include:
- Do you wish to pay a higher premium and have open access to all providers (no network) accepting Medicare? Or pay far less premium and have additional services included.
- Being familiar with the meaning of network in the health insurance industry can be critical. Does the plan have a network? If so, might that limit provider choices:
- The two most familiar are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Did you know if you purchase an HMO, you should know that your primary care provider (PCP) is the gatekeeper, and you must stay in-network (with a few exceptions). Basically, your PCP makes all referrals. If you have not seen your PCP within a year to six months most will not refer you without an office visit first.
- If you were to purchase an PPO, you do not need a referral. You will pay more money out of your pocket for this benefit. You should know that there are providers that are considered in-network and out of network with PPO plans. Your costs are less within the provider network.
A couple of other questions: Are you receiving infusions, or cancer therapy? What if I am traveling or wintering in the south? What is the maximum out of pocket – and how does that work? Can I change plans other than during AEP? Hopefully, this is nothing new to you. If it is, you should call or come visit with one of our agents today.
Does hearing and seeing all the commercials confuse you? Hearing there are plans that have are $0 premium can also be confusing, right? It makes you wonder if you are in the right plan or is this too good to be true.
Regarding insurance telemarketers. If you choose to answer you do not want to give your personal information out over the phone. These are a few more reasons to call one of our agents who will sit down with you, listen to your needs, explain your options in an easy to understand to help you make the best decision based on you situation. After you understand your options and your best values; you can feel secure in your healthcare. We say “Education = Peace of Mind”
Tamia R. Banks | HSM BA, LPN, CMCN, Senior Solutions Broker with Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting Older Americans and all people with health insurance, including seminars and consultation on Medicare Plans, Long Term Care, other types of insurance, claims issues, and sales/service of insurance products since 1984. Offices are at 809 W. Detweiller Dr., Peoria, IL 61615. Tel: 309-693-1060. website www.MRMS-INC.com