Making the most of Medicare changes in 2021

Oct. 26--With the new year coming up quickly, the deadline to file for Medicare is coming up just as fast. The deadline to apply for Medicare is Dec. 7, and some health care providers have become accustomed to receiving panicked calls on Dec. 8 and 9 asking if there is some leeway to sign up.

Roger Van Baaren, the vice president of Medicare sales for Univera Healthcare, is all too familiar with the calls. For 2021, he said the premiums will remain the same, but the benefits will be changing for the better.

Van Baaren explained there will be an insulin benefit for diabetics, which has been a highly charged issue in recent years, along with some other additions for seniors.

"That's a population, if you follow it on the news, has had challenges with their supply costs for their test strips, and especially their insulin. And, some of our plans, we've introduced a $25 co-pay for insulin. That will hopefully bring someone relief to that population. All of our plans have preventative dentals, that's very popular with the Medicare Advantage population. Medicare advantage plan don't automatically come with dental so it's something we've added to the plans that people should shop for when they're between one plan and another."

As the Affordable Care Act might be repealed sometime before the deadline, those who have Medicare don't have to worry. Van Baaren said if the ACA, or parts of it were stuck down, this wouldn't have an effect on pricing for Medicare plans. Some of the things, seniors should be looking for when applying to Medicare is that the doctor they normally see is covered with their plan. People shopping with Medicare might just choose a plan based on price, Van Baaren said, but then realize the doctor doesn't accept that insurance.

People should also be looking at what hospitals and doctor group's they might need access to in the future. Van Baaren said people often go to Roswell Park for cancer treatment but not all carriers have access there. Consideration for the future is a key role as well as making sure a carrier has the types of prescribed drugs on the formulary. He added when looking out for some of these, the best thing to do is to shop around.

"When we try to build awareness around our plans, we try to make it easy for them to look at our plans looking at univera.com for Medicare," Van Baaren said of Univera. "They can see on our website all the physicians they would have access to, all the drugs on the formulary. They would need to go to that website or alternatively, they can also go to Medicare's website. Medicare has a tool called plan finder and that is at medicare.gov, where they can find the CMS Plan Finder."

During the pandemic, the methods for signing up have altered the shopping experience, according to Van Baaren. In the past there used to be plenty of seminars going on at local restaurants and at hotel conference rooms. Given that large crowds would attend, these are unable to be held due to the large crowds they would attract. Now, things have switched to being virtual or over the phone. However, they are still taking individual appointments.

There is a Univera Healthcare resource center located at 205 Park Club Lane in Buffalo where people can speak with someone. Plexiglass is placed between the customer and the representative to keep things safe. Not being able to do seminars are quite difficult as some people who use Medicare typically prefer in-person appointments due to lack of internet access or trouble hearing someone over the phone. Van Baaren is hopeful the pandemic will let up soon so people can have a better experience in shopping.

"I think that for the foreseeable future, the senior population is especially careful. There's not really a rush to go back the way it was now but we certainly think it's more effective for communicating all the things that are important to them when we're in a room with them and they can linger afterward and ask their very personal questions. We can give them that one on one consultation that so many of them crave as they shop for healthcare for the first time."

When asking about coverage, Van Baaren commonly hears questions about plans for no money and this has to be explained that the federal government pays Univera money for the claim. Other common questions relate to going to doctors or specialists, and if someone goes out of state but they'll need coverage.

His answer for that is going to urgent care or a facility out-of-state is fine as Niagara County isn't where their coverage ends and begins. Conversely, some of the questions he felt more people should be asking relate to the Star Rating, Medicare's quality rating and has to be on all the printed material at Univera, which is four out of five. He said people never really shop based around the quality rating, instead choosing to focus heavily on price. Van Baaren broke down how the star rating works to help people know what they are getting into.

"That star rating is the measurement of how happy people are and how satisfied people are with the plan, combined with how clinically effective the plan is," Van Baaren said. "It's really a neutral rating given by the government that people can use, if not a tie breaker than at least as a factor in their decision. We don't get very many questions about how should I consider the star ratings and what do the quality ratings mean."

Van Baaren isn't sure what else the pandemic might bring but urges all seniors to keep on the lookout for the looming deadline to sign up for Medicare.

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