RVers Really Need to Know How Their Medicare Advantage Plan Works to Avoid Surprises on the Road
Understanding how your healthcare insurance coverage works can be complicated for anyone. Add in the extra layer of being an RVer that may be away from your coverage area for extended periods of time, and it gets even more complicated. Mix in the nuance of a Medicare Advantage plan, and it may be time to call in a professional. Fortunately, at RVer Insurance Exchange, we have those!
We asked a panel of four licensed, and certified health insurance professionals for their top ten list of Medicare Advantage facts that has surprised, even shocked…their clients in the last year. We recommend you save, and share, this storehouse of information as it pertains to Medicare Advantage Plans.
1. If you start out with a Medicare Advantage plan you may never be able to leave the Medicare Advantage program.
If you opt for a Medicare Advantage (MA) or a Medicare Advantage Prescription Drug (MAPD) plan when you are first eligible for Medicare, you may be locked into an MA plan as your only option. During your Initial Enrollment Period. You can choose a Medicare Advantage program or a Supplement without medical considerations. After that period, with just a few exceptions, you must be medically underwritten to get a Medicare Supplement.
Suppose you choose a MAPD initially because the low premium is very attractive. You later develop a heart condition. You then could not be medically underwritten for a supplement and be relegated to staying with an MAPD. That is an extreme version of what could happen, but possible, and there are other conditions that could disqualify you as well. Making the right decision initially is paramount.
2. Medicare Advantage Plans have a Limited Network, and You Will have Increased Medical Costs When you go Outside of that Network
Most Medicare Advantage plans use health care providers who participate in the plan’s network. Some plans offer non-emergency coverage out-of-network, but typically at a significantly higher cost. This can become quite a financial burden if you develop a serious health condition and the best specialist that you can find is not in the network. You may need to personally pay out of pocket to receive treatment with that provider. Verify that your preferred doctors and hospitals are in the network before choosing a specific Medicare Advantage Plan.
3. Most Medicare Supplements are Only Guaranteed-Issue during your Initial Medicare Enrollment Period
The initial Medicare enrollment period lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. The best time to buy a supplement plan also known as a Medigap policy is when you become Medicare eligible and first get both Part A and Part B. You then have 6 months after your Part B coverage begins to buy a supplement policy. During this time, you can buy any supplement policy sold in your state, even if you have pre-existing health issues. After this period, you may not be able to buy a supplement policy or switch policies unless you qualify for Guaranteed Issue Rights. For more about Guaranteed Issue Rights, check out medicare.gov.
4. With a Medicare Advantage plan, it’s not Guaranteed that Your doctors will Remain In-Network from One Year to Another
Your doctor’s participation in a Medicare Advantage plan is an agreement between the doctor and the plan. That agreement can change and leave you searching for a new doctor whether you like the doctor or not. Your participation in the plan requires that your Primary Care Doctor be in the plan. There are a couple of events that can occur.
One is that your doctor leaves the plan to pursue other interests or joins another plan. Another is that your doctor may be part of a larger practice or organization that decides to leave the plan or merges with another practice that is not part of the plan. Either way, you are going to have to find a new doctor within the plan or change plans completely. Staying with that doctor is not your choice. However, with a Medicare supplement, you can see any doctor/provider that accepts Medicare itself. It is entirely your choice.
5. Once you Leave your Job and get Original Medicare, you Only Have 63 days to get a Prescription Drug Plan, or you Will be Penalized for Life
Medicare Part D can have a late enrollment penalty for premiums. If you are late to enroll and don’t qualify for a Special Enrollment Period (SEP) you could pay any or all of these higher premiums depending on what kind of coverage and when you sign up. The penalty for late enrollment of Part D is 1% of the national average Part D premium for each month you delay enrollment for as long as you are actively enrolled.
The way to avoid this situation, and the lifelong penalties, is to make sure you enroll during your initial enrollment period, which is seven months long; three months before your 65th birthday month, your actual birthday month, and three months after your birthday month. Make sure you enroll during this period to avoid this lifelong penalty. If you have coverage from your employer and you are retiring and losing that credible coverage you have a defined amount of time to acquire new credible coverage. That time period is 63 days.
You will also need to acquire documentation from your HR department containing the reason why you are losing the coverage and will need to send a copy to your new Part D provider. If you’re unsure whether or not you need to enroll or have any concerning questions if your present employer-based insurance qualifies for credible coverage it is always a good idea to connect with a qualified license health insurance professional.
6. Your Medicare Part B Premium May be Higher Than Your Neighbor’s
If you meet certain income levels, you will have to pay an Income Related Monthly Adjustment Amount. The Medicare part B premium is adjusted annually and is the same for everyone. For 2023 that amount is $164.90. If you are very low income there are ways to mitigate that. We want to look at the other side of the coin. If you are a high-income individual that premium is adjusted accordingly. If you file as a single person and have an income of over $97,000 ($194,000 if filing jointly), your premium will be increased from $230.80 to $560.50 depending on how much your income is over those amounts.
7. Medicare Advantage Plan Out-of-Pocket Limits Can Change Every Year, and Usually Do
The federal government mandates a limit for Medicare Advantage (MA) plan out-of-pocket maximums, however that limit can change every year. In the past, these limits have only ever moved in one direction… up! Initially set at $6,700 in 2011, the MA out-of-pocket max has been on the rise ever since. For instance, in 2022 the MA out-of-pocket max was $7,550 for in-network services. This year, it has jumped to a whopping $8,300.
One of the largest appeals of the Medicare Advantage program to many people is the low monthly premiums these plans can offer.
Clients often say “I can’t afford the monthly premium of a Medicare Supplement plan. I live on a fixed income!”Insurance experts at RV Insurance Benefits
Sadly, what these folks are failing to see is that if they sign up for a MA plan and need medical care, they may be responsible for up to the out-of-pocket limit every single year. The average cost for a Medicare Supplement policy is $139/month.
How is someone who cannot pay $139/month in Medicare Supplement premiums going to afford $8,300 every year if they begin to experience major medical hardship? Who’s to say that in 10 years the MA out-of-pocket maximum will not be $15,000 per year? At that point many MA policyholders would probably want to jump ship from the program, but sadly many may not qualify for other products and would be stuck for life with MA plans.
8. Medicare Advantage Prescription Drug Plans have TWO Deductibles, One for Health Coverage, and one for Medications
Many folks on Medicare sign up for Medicare Advantage Prescription Drug (MAPD) plans without understanding that each of these plans contains two separate deductibles, one for health coverage and one for medications. Many people choose MAPD plans because they have attractive low monthly premiums. They may not consider if they are taking medications that they will have to pay a potentially large prescription drug deductible in addition to the medical deductible.
Even more worrisome; your Part D cost sharing doesn’t contribute to your MAPD plans’ yearly out-of-pocket maximum. Meaning if you were to have both a serious illness and take expensive medications in one year, you would be liable for potentially much more money than the MAPD $8,300 yearly out-of-pocket maximum.
9. Medicare Advantage Companies are Currently Under a Huge Audit by the Federal Government! What does that mean for Policyholders?
In 2022 news of Medicare Advantage (MA) companies overcharging the federal government surged. When a person signs up for a MA plan, the government pays the MA company (for instance Humana, Aetna, or United AARP) a hefty set rate per person, in addition to other payments. MA companies were audited in 2022 and accused of receiving gross overpayments. The government is going to take action against this fraud, waste, and abuse that MA companies have committed. But what does that mean for MA policyholders? Why does this matter to you?
Two of the most appealing factors of MA plans are the low monthly premiums, and the “value added benefits” often included with these plans. Value added benefits are things like dental and vision coverage, Silver Sneakers and gym memberships, Part B premium buybacks, and more. If the MA companies are shelling out millions of dollars to the government in restitution for overcharging, they may (and probably will) have to cut back plan benefits and increase monthly premiums. The first benefits to go will be the non-essential ones, the value-added benefits.
Would that Medicare Advantage plan be so appealing if you had to pay a higher monthly premium, purchase separate dental and vision coverage, and pay for your own gym membership? What are you left with at that point? A plan with a limited provider network, high out-of-pocket maximums and costs, and uncertainty about what your coverage will look like in future years.
10. RVers Have a No-Cost Medicare Advocate
At RVer Insurance Exchange, we are RVers trained and licensed to assist RVers and those who frequently travel. Our focus is to provide affordable health insurance and Medicare options that work for your unique lifestyle. Once your policy is in place we serve as your nationwide customer service advocate helping you maximize your benefits.
This is a passion and a commitment from all of our licensed agents. As RVers ourselves, we understand first-hand accessibility and affordability are key to your peace of mind while traveling. Your dedicated agent will analyze, advise, and enroll you in a plan best suited for your specific needs. We craft a personalized plan that is designed for the individual based on their own situation, then we act as your advocate to assist when necessary. Contact us today for a no cost hassle free personal needs analysis. Safe Travels!