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Revisit Medicare Plan Every Year to Ensure the Right Coverage
By Vanessa Orr

Every year, changes are made to Medicare supplements and to Medicare Advantage Plans, which is why it’s always important to review your plan to see if you could be getting better coverage or saving money. According to Licensed Specialist Shari L. Leckenby at Medicare Specialists of Pittsburgh, that’s even more important if you live in the Pittsburgh market.

“While people often chose advantage plans in the past, they are now revisiting Medicare supplements and buying more of these plans than ever,” she said. “With the ending of the contract between UPMC and Highmark in 2018, people are very concerned about what doctors they can see.”

One of the problems with Medicare Advantage Plans is that they restrict the physicians that patients can see to those in their own networks. “If you buy a UPMC plan, you can only see UPMC physicians, and it’s the same with Highmark plans,” Leckenby explained. “With a supplement, you’re not limited to being in a network, so you can see any doctor, at any hospital, anywhere in the country.”

While Medicare supplements can allow greater freedom of choice, the fact that they are medically underwritten raises some concerns about patient enrollment. “There is a misconception that someone with cancer, for example, can’t get a Medicare supplement,” said Leckenby. “It can be done, but you have to find the right plan.”

Those people who are new to Part B don’t have to answer any medical questions, and those who are losing health care, for example, through a job loss, are guaranteed issue as well. However, applicants who have applied for Part B before must go through the underwriting process, answering medical information and supplying the names of their doctors.

“While some people will be automatically denied, others will just be rated higher because of their medical conditions,” said Leckenby.

If all of this sounds confusing, that’s because it is. At Medicare Specialists, Leckenby walks clients through a basic ‘Medicare 101’ course, explaining how original Medicare works including coverage, deductibles and copays. She then explains the differences between Medicare supplements and Medicare Advantage Plans so that clients can make more informed decisions.

“Basically, you look at who is paying,” she explained. “With a Medicare supplement, Medicare pays first. They are making decisions about what treatments you can and cannot get. With an advantage plan, Medicare reimburses another company for taking care of you.”

The most important feature, said Leckenby, is prescription drug coverage. “This is hugely important, especially if you’re on a limited income,” she explained. “Some supplements offer cheaper prescription drugs, and some advantage plans offer cheaper prescription drugs—it depends on what you’re taking.” Leckenby tells all of her clients to bring a list of medications they’re on, and the names of their doctors to make sure that all of these are covered on the plans they choose.

“It is especially important to review your plan every year because the formularies change,” she added. “New drugs come on the market, others drop off, and some medicines move from brand name to generic.”

Medicare Specialists provide this service for free, because as a broker, they are paid by the insurance companies. “We work with everyone, so we’re not pushing one plan or another,” said Leckenby.

The company also works with the health exchange set up as part of the Affordable Care Act (ACA), as well as many other programs, including Social Security and programs designed to help people in need.

“There are many programs available, from the federal government’s Extra Help program to the PACE program provided by the Department of Aging, to Medicare Assistance and Medicare Savings Plans,” said Leckenby. “Our goal is to help people—especially those with limited resources—find the right plans.”

To learn more, visit Medicare Specialists of Pittsburgh at www.medipgh.com or call 412-343-0344.

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