Maxim in comments earlier this week asked a great question:
I have a friend in Florida who had an ACA Silver policy this year, and she says it was uniformly awful — “the kind of silver that turns your finger green,” as she put it.
I couldn’t remember if you’d ever made any comments specific to the Florida market and how to choose a policy. I do remember you saying to check every year rather than just renewing the existing policy (in any location), because there’s a good chance your current policy will no longer be the best one. …
Is there anything I can tell her to help her reduce the chances of having an awful policy next year?
This is a great question. And there is not a great answer.
We know from the Medicare Part D literature that people are really bad at picking health insurance in the first year. We also know from that same literature that people get pretty good in a few years. There is a lot of learning by doing and reacting against bad experiences among a population (mostly 65+) that uses their insurance a lot.
The big problem in the ACA is that there is not a lot of opportunity for learning by doing as the median enrollee has about a year of coverage so one or two opportunities to make a choice.
The big thing is that this is messy. I wrote in 2022:
Health insurance is complicated and complex so go get help
Navigators are government funded helpers who can’t make a specific recommendation but can help reduce complexity
Agents and brokers can make specific recommendations but they work on commission/premium while they are only required to give good advice not optimal advice.
Take your time
Open Enrollment goes through at least December 15th for all markets and through January 15 for Healthcare.gov
Be ready to accept good enough instead of perfect.
Look around and actively choose
Looking around and actively choosing is the most important advice I can give every year. The ACA’s use of price linked subsidies combined with the non-stickiness of the marginal enrollees means that every year insurers aggressively compete to offer very low premium plans. This means that a plan in Year 1 that is a great deal may be a really bad deal in Year 2 for an individual who is mostly buying on price. Sometimes this happens even if the same insurer offers the cheapest plan in both years. Looking around and making an active choice minimizes price surprises.
People should figure out what they value and how they think about trade-offs. Are premiums way more important than network? Or vice versa? Which docs and hospitals do you absolutely need to have versus those that you’re okay switching away from? Is a big deductible scary or a reasonable risk? These are the type of questions you need to ask and answer.
Agents are a big deal and we think that they are becoming increasingly important. In Florida, everyone should ask their agent if they are a “captive” agent which means they are contractually obligated to only show a single insurer’s offerings.
Maxim
Thank you, David. I’ll pass that on to her.
Butch
There’s only one option in our area (Blue Cross) so I’m not sure how much ability we have to choose.
cintibud
Hi David, You mentioned using navigators to help in picking a plan. I would like to change my Medicare supplemental policy – not bad but I think there are better deals. Where does one look for navigators? Thanks!
ProfDamatu
@Butch: Yeah, we’ve only got two in my area, Anthem and Sentara Health Plan. And at least last year only about two plans with deductibles of less than $4000, and none with OOP maxima below $6350 (almost all were at the statutory max). So for me, every year the choice comes down to a higher premium with Sentara but likely no issues with getting things covered, versus rolling the dice with Anthem, which is cheaper but about which I’ve heard horror stories of denials (at least on the HealthKeepers plans available on the Exchange), as well as sketchy access to some providers.
WaterGirl
Dave – I just spotted this comment in the previous thread. I’m thinking that perhaps it was added to the wrong thread by mistake?
posted by Sharon Hurley
Sharon Hurley
Hi
Well my other comment ended up on the wrong thread. However I did have a concern-doesn’t Medicare penalize you if you change plans?
Sharon
raven
How do the drug plan companies make money when they have a zero premium? I have Wellcare and I don’t understand it.
Butch
@ProfDamatu: One member of my household needed surgery this summer. Blue Cross paid a total of $46 toward $2,179 in outpatient costs; overall we ended up with a bill of more than $4,000 for the surgery. We’re a fairly low income household so it hurt. I can’t find a Blue Cross plan in our area with a lower deductible so we’re stuck.
Another Scott
@Butch: I’m no expert, but hospitals usually have offices and programs to help people who can’t pay huge bills. They know that getting some money is better than getting nothing, and they know that bankrupting patients looks very bad, so you have some leverage. Look around to see what’s available. Don’t just accept the huge bill and stress out about it. Try to get help.
E.g. Our local hospital conglomerate in NoVA.
Good luck!
Best wishes,
Scott.
Butch
@Another Scott: Thank you, Scott. I am getting some help with the cost of one of the prescriptions but didn’t get a response when I asked about support for the hospital bills.
TBone
Choosing plans and wading through that jargon feels like trying to read James Joyce in Sanskrit. I abhor the chore.
I am rarely successful and usually just end up dart throwing at the computer screen in frustration. I like Ulysses in English.
TBone
@Butch: our hospital has what is called a Charity Program that writes down my hubby’s medical bills even though he has regular Medicare. We have to reapply every six months and it is income-based. Don’t hesitate to use the words charity and assistance when making your inquiries. It worked miracles for us.
Here are some more good words:
https://www.kff.org/health-costs/issue-brief/hospital-charity-care-how-it-works-and-why-it-matters/
TBone
@raven: we are always the product when anything is “free.”
https://www.wbur.org/onpoint/2023/12/14/pharmacy-benefit-managers-the-middleman-that-decides-what-you-pay-for-medications
Ohio Mom
These sorts of discussions always bring to mind my sister’s observation, “Their actuaries are better than yours,” meaning of course, you are outsmarted, outnumbered and outmaneuvered before you even start. Because if you are honest with yourself, you admit that you don’t even rate as an amateur actuary.
@cintibud: For what it’s worth, we use the AARP gap plan. There is no middle man making money off of us.
At the start, we met with a volunteer from the Council on Aging who gave us a tutorial on Medicare options but they do not make recommendations. I know there are private Medicare consultants but they are like insurance salesman, it is never clear who they work for because they are making money off of you and may not have your best interests at heart.
TBone
@Ohio Mom: we were steered into a bullshit Medigap plan once by a counselor at the local branch Area Office on Aging (supposed to be a seniors help center sponsored by our Commonwealth and paid for with lottery ticket dollars, I think). We were severely limited in what was covered all of a sudden and dropped it like a rock as soon as we could (after one year).
I like your depiction of confrontation with the reality of trying to beat actuaries.
narya
I also have the AARP Medicare gap (supplemental) plan. This year’s medical adventures cost me a total of $240, i.e., the deductible. I don’t take any medication, so I went with the cheapest (i.e., free) Part D plan. I pay a little extra each month for gym memberships (there are a TON in my area who take this, and you can use any/all of them) and, at least theoretically, assistance w/ dental and vision. I did get a break on vision last year, but my loyalty to my dentist means I don’t get that benefit. Honestly, I got the more expensive plan for the gym stuff; I’ve not used much of it so far, but I suspect I’ll do more over the winter. I believe you can check on the availability near you if that’s something you’d want to use; I can totally see how it wouldn’t be worthwhile for folks.
TBone
@TBone: DESPITE my one bad anecdote, these places are a good source of information!
https://www.pa.gov/en/agencies/aging/local-resources/area-agencies-on-aging-.html
TBone
@narya: ‘supplemental’ and ‘gap’ plans are two distinctly different things.
https://www.forbes.com/health/medicare/medicare-advantage-vs-medicare-supplement/
More fun with words!
Chester
It’s so frustrating. Our Part D prescription plan jumped this year from $28.20 each to $57.20 and next year, it will be $97.20 – I’m glad for all the improvements on caps, etc but neither of us needs many drugs, so we’re paying thousands a year for…?
BarcaChicago
@Butch: I’m just popping in to say that hospitals have to offer “charity care” programs to cover the costs for those who can’t afford healthcare bills in order to maintain their “non-profit” tax status. So fill out their application ASAP. And yes, I think they very cynically do NOT educate patients on this. Signed, former hospital social worker (still sickened and enraged at what she witnessed at that job).
TBone
@BarcaChicago: 💜💜💜
Gold star for you today! And hugs too
NoraLenderbee
If we want anything other than an HMO, it’s Anthem for $2500/month and up. And that’s with the subsidy.
narya
@TBone: Mine is a supplemental plan; I stayed FAR away from MA.
Scout211
@TBone: Are you saying that medi-gap plans are not the same as Medicare supplement plans or are you saying that Forbes is saying that? Because they are indeed the same.
Medicare.gov
TBone
Just now remembered a conversation I had only two days ago with a friend who chose a Medicare Advantage plan because they gave her $150 in food assistance each month. They have abruptly discontinued that money that she’s been counting on 🤬 (her income has to be limited because of the destitution requirements of SSDI).
Now I’m mad again.
TBone
@Scout211: nope. There are two different types of plans – there is a handy chart in the Forbes article that helps cut through the devilish use of jargon.
This was explained to me at that Office on Aging I spoke of.
Ohio Mom
Once again I will point out that anyone crying out for Medicare for All obviously does not participate in Medicare. It’s a confusing Rube Goldberg kluge of public, private and out-of-pocket.
In contrast, traditional Medicaid (at least in Ohio) has no copays, deductibles or any other nonsense. Ohio Son has been on it as a disabled person and it has been a breeze for us.
Steve LaBonne
On switching Medicare supplement plans- I just looked into that because my wife, less than 2 years older than I am, is paying $90 a month more for Plan F from United Healthcare / AARP than I am for Plan G from Med Mutual of Ohio (and the difference between those plans in Ohio is not that much). Bottom line is that there is no guaranteed enrollment after your initial open enrollment period when you turned 65. So you can be subjected to medical underwriting and possibly charged extra or even rejected.
BarcaChicago
@TBone: Thank you!! I very much appreciate you! Working with patients and families was beautiful and deeply meaningful. Working with dysfunctional and corrupt systems drove me out. I hope you’ve had some positive experiences with medical social workers – they can be a big help, but plenty of them are burned out and all are understaffed and unable to provide the care that they are meant to provide. Working in healthcare in the US is a recipe for mental distress – we even have a name for it now: “moral injury”. Hospitals are run like for-profit corporations and insurance companies make billions by denying/delaying care. Time for change – vote Blue!
TBone
@Ohio Mom: 💜 yep. A rose by another name smells as sweet but it’s those thorns we need to be aware of!
Scout211
An interesting thing about part D plans that my sister learned is that there are sometimes hidden providers that the plan allows but doesn’t necessarily promote. My BIL has blood cancer and the pharmacy that they both thought he was required to use did not have his medication. After what seemed like hours on the customer service line on hold, my sister finally talked to a person who gave her other pharmacies that they could try. When asked about that, she admitted that the pharmacy that was recommended was a “partner,” but others are on the plan. Hmmm.
Ohio Mom
@TBone: That’s SSi that limits you to $2,000 in assets, SSDI has no limit. Don’t worry, lots of people confuse the two programs. Social Security programs can be very confusing.
My fabulous Senator Sherrod Brown has been working on getting the asset limit raised to $10,000 but hasn’t had any success yet.
Steve LaBonne
@TBone: Wrong. The terms are interchangeable. That’s straight from Medicare.gov. And your Forbes article also uses the terms interchangeably- I think you’re getting confused because the article also discusses Medicare “Advantage”.
TBone
@BarcaChicago: aww 😍 🥰
Medical social workers saved my life during Dad’s death, first at Pennsylvania Hospital and then at Presbyterian hospice facility. My family were about as useless as tits on a bull during that nightmare.
Scout211
@TBone:
I’m sorry, but Medicare disagrees with that. In all of its literature it treats them as the same.
ETA: As Steve LeBonne also says.
ETA 2:
TBone
@Steve LaBonne: yes, but a gap plan is NOT a Medicare Advantage plan.
The Forbes article was written so that people would understand the difference.
Steve LaBonne
@TBone: Nobody said they were. Again, you seem to be confusing Medicare supplements with Medicare Advantage.
Scout211
We aren’t talking about Advantage Plans.
Here’s what you wrote:
TBone
@Ohio Mom: thank you, I did mix that up!
I hope Sherrod Brown is successful, it will make such a difference in people’s lives.
OId Man Shadow
One day, someone will have to explain to me why having all of these plans and expecting people to do hours of research to find the best plan out of hundreds for their families and themselves and still having to go to in-network hospitals and make sure your doctors at the hospital are in-network, and pay out of pocket mostly for ambulances, and generally pay a lot more for a lot less health care is better than paying a portion of that in taxes, getting a health card, and being able to walk into any doctor or hospital, pay a modest fee, and get services without worrying about massive bills and bankruptcy.
Steve LaBonne
@OId Man Shadow: We are not the people for whom it’s better, nor the people the ownership class cares about except as marks. But you knew that.
TBone
@OId Man Shadow: 💙
TBone
@Steve LaBonne: amen!
TBone
@Steve LaBonne: yep. The jargon renders me too frustrated to care after a short while.
That’s why I likened it to reading James Joyce in Sanskrit right out of the gate today. I spent my career cutting through legal jargon and medical jargon and those are easier. This insurance stuff is ridiculous.
Supplemental
Gap
Advantage
Duly noted.
Steve LaBonne
@TBone: I hate that it probably feels like a few of us were piling on, but the confusion between Medicare supplements and Medicare Advantage is both very common and very harmful so it’s really important to keep it straight.
TBone
@Steve LaBonne: thank you!
It is supremely important and that’s the very reason it so, so angers me, a person who spent life looking stuff up to figure it out and is still confused keeping terms straight. What should less able people do, for crying out loud? It’s designed to confuse.
Scout211
Well said. There are lurkers here that read posts everyday and we really need to post facts and clear up mistakes.
Another confusion that we have experienced IRL, is a misconception that Medicare supplement/medi-gap plans are the same as secondary insurance plans in traditional insurance, like when both spouses are covered by a plan provided by their job. Medicare supplement/medi-gap plans are not secondary insurance plans. They only cover the portion of your bill that would be your out-of-pocket expense if you only have Medicare. So if Medicare denies a charge, the supplement plant also denies the charge. And healthcare providers are required to tell you this up front, before you agree to the treatment.
We ran into this with Quest Lab staff who have said to us many times over the years, “Medicare won’t cover this test but we’ll bill your other insurance to see if they will cover it.” I tell them we have a Medicare supplement, we don’t have another insurance. I’ve actually argued with them about this but they keep doing it. And you get a bill for the test unless you refuse the test and sign a release. But their speech implies that your supplement may cover it so many patients go ahead with the test and then get a bill.
Sloegin
I’ll never pick anything other than vanilla Medicare after Mom’s “Advantage” plan tried to screw her out of covering stroke rehab to the tune of $18.5k. They didn’t bank on her kids being willing to fight them for 9 months with the aid of the WA St Insurance Commissioners office.
Private plans make their money by denying you coverage. Advantage plans take advantage of you when you need it the most.
dnfree
@Steve LaBonne: Yes, I got my Medicare supplement plan from Blue Cross-Blue Shield when I first retired and at that point they don’t look at your actual health conditions in price or acceptance. When I looked into changing supplement plans later, no other plans wanted to take a chance on me. So choose carefully when you first go on Medicare.
wmd
I’ve had good employer sponsored insurance, and then COBRA. When COBRA ended my choice through CoveredCalifornia had none of my physicians in network – literally no plans. As a cancer survivor I value continuity of care – the lift involved in bringing a bunch of new physicians up to speed, and more importantly the personal relationships just makes it important to have continuity.
So I ended up getting hit by a meteorite coverage through and HMO. Bronze, $9000 OOPM, high deductible.
Cash payments to existing providers for necessary care and medication.
It also made getting new employment much more attractive – I’ve been interviewing a lot since COBRA ended, and should be working by the end of the year. I’ve deferred some care for a few months – my annual Oncology surveillance will be in January, not this month as originally planned so the cost of the camera down my nose is in the 2025 benefit year for my new insurance.
Steve LaBonne
@wmd: Good luck with your job hunt.
wmd
@Steve LaBonne: Thanks.
I had a positive recruiter screen this morning for half an hour. I’ve performed in this rodeo many times, although it’s new to me to not need work for day to day expenses thanks to good compensation from 2018-2022.
I’m looking forward to Medicare eligibility in a couple of years. Likely will stay employed for a few years after that because I enjoy making contributions to advancing technology. But this past couple of years has been fun, travel, personal project work, activism. I’ve got no doubt that full retirement will still be active.
Kosh III
@WaterGirl:Where do they think retired people are going to get any extra 300? This affects people who are sick and need certain drugs.
Silly Wabbit. You assume that they give a frak.
Kosh III
@Ohio Mom:Once again I will point out that anyone crying out for Medicare for All
This crier wants Medicare for All without all the confusion and complexity. Just go to a doctor/whatever, get treated, no bill no hoops no nothing. Kinda like Doc Martin(UK tv series)
Or heck like NHS or the plans in any sensible country.
Schtreaky
I did not know that “captive” agents existed. Or that such specimens are “contractually obligated to only show a single insurer’s offerings.” The benefit for the agents and their “keepers” is obvious, but how is this arrangement legal, ethical and in the public’s best interest?
I’m with @Kosh III. Medicare for All without the confusion, complexity — and excluding the predatory private corporations — will finally give us the “world best” healthcare system we’ve been paying for all along.