Medicare Replacement plans need a lot of research before they can be affective. The average person who has never worked in the insurance industry, rather on the provider or insurance side, rarely understands what they are getting into with a replacement plan.
I will state now I am not against the idea of replacement plans or whats commonly known as HMO plans. I personally have my children on an HMO. I have the knowledge of how to use an HMO, my daughter has had thousands of dollars worth of test this year alone and all at 0 charge to me.
However a person needs to get educated before replacing their Medicare plan with an HMO. I have heard it over and over “I thought I was only getting the drug coverage” or “They said it was a supplemental coverage” and of course ” The sales man said I still had Medicare”. Be sure to ask a lot of questions, because the only person that is going to educate you is YOU. Here are a few pointers to use:
1. A very common practice for HMO sales people is to assure the Medicare beneficiary that they still have Medicare. Technically this is true, however ask: “What address will my claims go to?”
Do not let them tell you that the address is on the card make them tell you the address (write the address down). If the address is different than the address on your current Medicare card, this is not the same policy you have been with.
2. Importantly be sure to ask: ” Is this policy going to move my Medicare Coverage to another company or carrier?”
3. Also be sure to ask: “How long do I have to stay on this plan?” Some plans are a year long commitment, if you don’t like the plan you are still stuck for a year.
4. Ask specifically: “Is there a list of doctor’s that I have to use, or do you assign me a doctor.”
With Traditional Medicare you can see any doctor who accepts Medicare patients, with HMO you MAY have to see a specific doctor. Some of the HMO plans now offer options to see any doctor, YOU HAVE TO ASK!
5. Ask very directly: “What happens if I see a doctor other than the one you assign me?”
Some of these plans will not pay if you do not use the doctor you are suppose to use.
6. Remember to ask about co-pays and deductibles as well. These may change depending on the plan you choose.
7. Any time you sign up for ANY medical/dental/vision/DRUG coverage even if you are positive that it is a supplemental plan be sure and ask all of the questions above about your basic Medicare coverage. What tends to happen ( and I have seen this and heard it from Medicare patients) the sales people tend to talk very fast, and they move from one block to another, pointing and asking you to initial here and there. The explanations for your initials are given very quickly, very briefly and very vaguely.
AT ANY TIME IF YOU DID NOT CLEARLY HEAR WHAT THE SALES PERSON SAID, OR DIDN’T UNDERSTAND WHAT THEY MEANT, TELL THEM TO STOP AND ANSWER THE ABOVE QUESTIONS ABOUT THAT SPECIFIC PORTION OF THE PAPER WORK!
All of this is a lot of information, however if a person educates them selves and HMOs do have advantages such as lower out of pocket expense. The important part is education on the ins and outs of what ever plan your on. Sales personnel are not going to educate you, this is the patient’s responsability.