Providing Value for Medicare Clients
Scott Maibor
Making Medicare Easy|Beekeeper|Helping Individuals, Adult Children, Trusted Professionals & Employers
In a recent discussion with a client (prospect) she asked about my fees and what sense it would make for her to pay a fee for assistance in understanding and selecting Medicare plans.
I think that I can best illustrate how I help by describing three recent client interactions. As I write this on the Sunday morning before Thanksgiving (2021) these conversations are fresh in my mind, having happened only this past Friday and Saturday.
The goal of course is to ensure that the savings in working with me exceeds the cost of working with me.
Case #1: An 80 year old CPA from a suburb west of Boston asked me if he and is wife were paying too much for their coverage as it seems many of his clients and friends are paying far less.
Both have Part A&B along with a Blue Cross Blue Shield of MA, Gold Plan. The problem is not with the plan but that it is NOT a Medicare plan! In this case they are paying approximately $1800/mo for a full health insurance plan when a Medicare Supplement, for approximately $225/mo each would provide similar coverage.
He questioned how that could be possible. Aside from the premium they pay for the BCBS plan, it has co-pays for services, an annual deductible and network limitations. The Supplement, has no copays, a $233/yr/pp (2022) deductible and no network.
No one ever looked at their plans or advised them that their coverage didn't mesh. They thought it was pricey but it was great coverage and never investigated further.
Net savings from premium alone by switching plans:
BCBSMA Gold Plan Monthly Premium $1800//mo
Annual Net Premium Paid $21600
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Medicare Supplement Plan 1a $225/pp/mo
Annual Net Premium Paid $5400
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Net Annual Savings $16,200
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Case #2: Referral to a couple in Central MA from a financial planner who happen to be his parents. Both are currently on Tufts Medicare Preferred HMOs for approximately $43/mo/pp.
The wife has a degenerative condition of the eye.
Both have expressed some frustration with the limited HMO network.
Looking at her list of Prescriptions and Providers there were several creams and ointment that were quite expensive. With those in the calculation one plan was clearly the best in terms of anticipated drug copays but she mentioned that she has found them to be far less expensive using GoodRx so would like the list rerun without those medications in the mix.
Doing so yielded 2 less expensive options for her. The new Tufts Medicare Preferred Smart Saver HMO or the United Health AARP Medicare Walgreens PPO. Both plans are $0 (zero) premium plans and both will cover the medications she wants covered. Both plans have her needed Drs in-network.
She is leaning towards the UHC/AARP PPO plan for the added flexibility. While the medication copays are a bit higher ($137/yr) they still realize an overall cost savings of around $1135/yr for the two of them and the added flexibility to go out of network gives her piece of mind.
Current Tufts Medicare Preferred Plan Premium ('22 rate) $53/mo/pp
Tufts Medicare Preferred Smart Saver Plan Premium $0/mo/pp
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Net Annual Cost Savings $1272
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Current Tufts Medicre Preferred Plan Premium ('22 rate) $53/mo/pp
UHC AARP Walgreens Medicare PPO $0/mo/pp
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Net Annual Cost Savings (premium only) $1272
UHC AARP Walgreens additional medication copay ($137)
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Net Annual Cost Savings $1135
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Case #3: Couple in the Worcester area. Referred to me by another client, interested in looking at their current plans to make sure that they are on the best plans possible for the coming year.
We had a phone discussion Saturday morning to gather some information about their situation...
She is currently undergoing treatment for cancer. Both have Tufts Medicare Preferred HMO plans. The husband's plan is a $0 premium plan. The wife's monthly premium is around $200!
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My first recommendation was that due to her health situation she would be better served by having a Supplement plan rather than the existing HMO. A Supplement would eliminate any network restrictions should she wish to see a particular Specialist as well as eliminate all of her co-pays for any Medicare covered procedures. No more second guessing the cost of a recommended test or treatment.
This situation is somewhat out of the norm...
When I suggest a Supplement to MOST people currently on an Advantage plan they push back against the fixed cost of having a Supplement. However, in her case, she is already paying (too much in my opinion) around $200/mo for her Advantage plan. Her fixed cost remains virtually the same while eliminating ALL copays!
Her potential savings lies in the elimination of her current copays...
Supplement Cost $200/mo
Advantage Plan Cost $200/mo
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Net Savings/Cost $0
Max-Out-of-Pocket Supplement $233 (Part B Deductible)
Max-Out-of-Pocket Advantage $3450
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Potential Cost Savings $3217/yr
We then discussed their medications which she said she currently fills at Walmart.
I corrected her and asked if she meant CVS, knowing that the preferred pharmacy on her Tufts Medicare HMO is CVS. Unfortunately, she was correct, they do indeed use Walmart for their prescriptions, foregoing the cheaper pharmacy option for their particular plan, and paying extra money each month in UNECESSARY copays at the pharmacy.
She said she never fully understood how the preferred pharmacy would benefit her and no one ever mentioned that she was going to the "wrong pharmacy". Prior to joining Medicare she found CVS was routinely more expensive than Walmart so she continued going to Walmart even after enrolling in the Tufts plan.
Net Savings...
Prescription Co-pays at Walmart $42 monthly
Prescription Co-pays at CVS $0 monthly
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Annual Savings $504
The recommended Part D Drug Plan for her, should she change to "Traditional Medicare" with a Supplement and Drug Plan is $13/mo. Copays for her medications at CVS, $0.
Finally, we focused on the husband. He is already on a $0 (zero) Premium plan but as mentioned above, there is a new plan available from Tufts in 2022, also $0 (zero) premium plan that has a lower Max-out-of-pocket.
Tufts Medicare Preferred Saver Plan MOOP $7550 (current plan)
Tufts Medicare Preferred Smart Saver Plan MOOP $5900 (2022 version)
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Potential Savings/exposure $1650
Every case is unique and savings vary by situation. Some save more, some save less.
Your particular ailments, the medications used to treat those ailments, your home county your Drs and what pharmacy you use all weigh in to the mix.
While I can't always save you money, and I don't always recommend changing plans, sometimes another set of eyes, with the experience of looking at literally hundreds of plans for different clients, all with different scenarios helps me to quickly identify areas of potential cost savings that are frequently missed.
Sometimes, something as simple as a going across the street to another pharmacy can save someone $100s or even $1000s of dollars per year in unnecessary cost and more than pay for my services!