IMPORTANT INFORMATION ON YOUR HEALTH INSURANCE COVERAGE CHOICE!

posted on: Tuesday November 19, 2013

Now that it is open enrollment with Medicare, there are plenty of free meals and other opportunities to meet with insurance salespeople. These sales representatives provide information about the policies they represent, but we urge you to use caution when making the choice that will affect your health insurance coverage for the entire upcoming year.

Before you choose an insurance policy or sign paperwork about your insurance coverage, ask the representative the following questions, and get the answers IN WRITING.

1. Is this a Medicare SUPPLEMENTAL policy or REPLACEMENT policy? (A supplemental policy will help cover the copayment and deductibles under Traditional Medicare, while a replacement policy is a substitute for Medicare offered by a managed care insurer, often referred to as Medicare Advantage or Medicare Choice plan.)
2. Can I choose my doctor from all the physicians that accept Medicare or am I limited to a smaller group of physicians identified by the insurer? (Traditional Medicare allows the patient to select any Medicare physician; replacement policies generally limit your selection of a doctor to a panel of insurer selected physicians.)
3. If I choose a replacement policy and my physician is not on the panel of the insurer’s physicians, can I still be treated by my physician? If yes, at what cost? (Some policies will permit you to see an out-of-network physician with a larger copayment amount, others will not.)
4. Is my physician participating in the insurer’s panel for this insurance product? Confirm that the physicians you see will be participating in the plan the next calendar year. Insurer websites, directories, etc. are sometimes slowly updated, leaving you to believe a physician is participating who is not. Consider calling your physician’s office to ensure they will be on the panel for your plan next year. Also, recognize that most insurers can terminate physicians from participating in their plan with 9O-days notice, forcing you to change physicians in mid-year.
5. Does the plan require PRE-AUTHORIZATION for procedures, doctor visits and testing? (Pre-authorization is a process by which the physician’s office must receive approval for your care from the insurance company before the physician may treat you.)
6. Are you paid per person who signs up for this coverage? Many insurers hire individuals to market their products who are paid only if you purchase the product sold by the company which hired them.
7. Where do I find the list of names and prices of medications covered by this insurance plan?

Verify that your medications are available at a comparable price.

Most, importantly, before you select an insurance product call ALL of your doctors and verify they will be able to treat under the policy, DO NOT RELY ON THE INSURANCE COMPANY WEBSITES!

Remember, flashy sales meeting are just that -SALES MEETINGS. Good food and nice salespeople are) not reliable indicators of good (insurance coverage.

You may stay with or return to Traditional Medicare during open enrollment. An optional supplemental policy is a good idea to help cover any costs not covered by Medicare.