Q And A About Medicare Advantage and Medigap in Michigan


I was visiting with a lady from Michigan on my car phone today.   She called me with questions prompted by a post from a couple of weeks ago, “People In Michigan Are Up In Arms Over Medicare Advantage.”   Before the cell phone dropped the call she was able to ask some very good questions.  I attempted to call her back once I got to a land line but apparently, she is a school teacher and I did not get her name.  Hopefully she will call me back at (832) 767-8059 or send me an email at info@theinsurancebarn.com so I can email the paper work required for her mother.

Anyway, enough of my commercials, here are the questions she asked and the answers I gave, as best I can recall.  Hopefully, they will help you if you or a loved one is in a similar situation.

Although the answers I gave her apply to people in Michigan, they also apply to people in the other states The Insurance Barn operates in.  This information is good for people in Indiana and Texas.

Q.  The hospital in my area no longer accepts my mother’s Medicare Advantage plan.  What are her options?

A.  The Patient’s Protection and Affordable Care Act of 2010 has made some changes to the Medicare Advantage program.  In the past people had the entire first quarter of the year in which they could change from one Medicare Advantage plan to another.  That has changed this year from an open enrollment period to a more restrictive disenrollment period.  People who currently have Medicare Advantage plans have the right to cancel their plans and re-enroll in traditional Medicare through February 14.

Q.  Does my mom need a separate plan to cover her prescriptions?

A.  Some Medicare Advantage plans have prescription coverage built into them and some do not.  Older Medigap plans do offer some prescription insurance but those plans are retired now.  Although insurance companies still honor Plan J for people who have them, they are not available for purchase any longer.  Regardless of the type of Medicare Advantage plan you are leaving, if you want your prescriptions covered you will need both a Medigap and a Medicare D (Prescription Drug Plan).

The annual open enrollment when people may choose which Medicare D plans they want for the following year ended on December 31.  Those people who previously had a Medicare Advantage plan and elect to change to traditional Medicare have an extended period of time in which to obtain a Medicare D plan.  They have until Feb. 14.

Q.  Is Medigap and Medicare Supplement the same thing?

A.  Yes, Medigap is a form of Medicare Supplement.  Medicare Part A pays for medical attention in the hospital and Medicare Part B pays for medical attention obtained out of the hospital.  Both parts of Medicare pay 80% of the medical bills after an annual deductible has been paid.  Unfortunately, there is no Out-Of-Pocket cap for people on Medicare.

Medigap plans pay the portion of medical bills that Medicare A & B do not.  I use the term Medigap to differentiate from the other form of Medicare Supplement that is also known as Medicare D.

As discussed above, Medicare D is used to pay for prescription Medications that are not covered by Medicare A & B.  Medicare D is technically a part of the Medicare program but since it is optional and managed by private health insurance companies it is often referred to as a supplement.  Since Medigap and Medicare D plans are both called Medicare Supplements, I use the more specific terms to help me keep straight what I am talking about.

I am approved to work with Medicare D plans only in the State of Texas.  I am licensed and legal to work with Medigap in Texas, Indiana and Michigan.  What that means is that I can help people in Texas with all the paperwork they need to switch back to traditional Medicare and still have similar benefits to what they had previously.  I am limited in what I can do for people in Indiana and Michigan.  I can help them with the Medigap portion of their switch but they would have to obtain a Medicare D on their own.  The Department of Health and Human Services provides a web site that can help them.

Q.  Is there a chance hospitals will reverse their decision and accept Medicare Advantage?

A.  At the risk of sounding like a politician, there is always a chance; however, it is not likely.  The PPACA  made some fairly restrictive laws regarding the Medicare Advantage program.  For one thing the law freezes federal funds at 2010 levels for future years.  The anticipated result is that health insurance companies will exit the program, reduce benefits or increase premiums to make up for the cost of medical inflation in future years. 

The statistics I read say that 60-80% of people who had Medicare Advantage plans in 2010 will be forced to transition back to traditional Medicare by 2014.  

It was here that we got cut off and I was unable to re-establish phone contact.  If the lady who called from Michigan happens to read this, please call me back at the same number and leave her name so that if cell phone technology lets me down again, I can call her back on a land line.

If you are not the lady I spoke with earlier today but the questions she asked have prompted thoughts, call me at (832) 767-8059.  I am happy to speak with you and answer any questions you might have if I know the answer.  I just ask one thing.  Please tell me your name so I can call you back if my cell phone drops the call again.

The most important lesson that I learned is, I really have to get a new cell phone if it is going to continue to drop calls.

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