Choosing a health insurance plan: choice and confusion

“It’s incredibly confusing,” says Terri Vineyard.

Coming from the Director of State Medicare in the Office of Elderly and Adult Services of the State Department of Health and Human Services, that says a lot.

Medigap or Medicare Advantage?

It’s a veritable alphabet soup of options. And that’s something everyone should think about before they turn 65.

These nauseatingly aired TV ads – featuring celebrities such as Joe Namath, William Shatner, Jimmie “JJ” Walker and William Devane – only add to the confusion, experts say.

“Regardless of the option you consider, it’s critical that consumers get information from trusted sources,” said DJ Bettencourt, Deputy Commissioner of the State Insurance Department, during a recent webinar on Medicare.

“Let’s be honest,” Bettencourt said. “Insurance is complex for many of us, and when you’re a senior it can seem almost overwhelming to figure out, especially if you’re someone going through this process for the first time.”

Traditional Medicare, or “original” Medicare, consists of Part A (hospital coverage) and Part B (doctor visits, lab tests, and other outpatient services).

Part D, sold by private insurers, provides prescription drug coverage.

But these are not the only options to consider.

Medicare supplemental insurance, sometimes called Medigap, is sold by private insurance companies and can help pay for some of the costs that original Medicare doesn’t cover, such as co-payments and deductibles. There are 10 standardized Medigap plans, named by letter (Plans A, B, C, D, F, G, K, L, M and N).

Medigap only works with original Medicare and does not cover prescription drugs; you still need a Part D plan for this.

Then there’s something called Part C, or Medicare Advantage, offering alternative plans to Medicare sold by private companies that contract with the federal government. These plans may provide coverage for services that Medicare does not cover, such as vision, hearing, or dental care.

Christina FitzPatrick, state director for AARP New Hampshire, said choosing the right Medicare plan is a “double-edged sword.”

“Having more choices means you’ll likely find something that really suits your needs, but it adds so much complication that it’s hard to sort through what’s right for you,” FitzPatrick said.

Advocates recommend older adults contact the State Health Insurance Assistance Program (SHIP), where trained counselors provide free, unbiased information about the range of plans available. Provided by ServiceLink, there is a SHIP office in each county. You can find your local office by calling the ServiceLink Resource Center at 866-634-9412.

Vineyard, the state health insurance director, said literally hundreds of plans are available for New Hampshire seniors, varying by insurance company and even county. And those plans can change from year to year.

“There’s no sugar coating,” she said. “It’s overwhelming, and it’s under constant flux.”

Vineyard said SHIP advisers cannot recommend one approach over another and cannot tell older people what to do. “However, what we can do is help the recipient weigh their options based on their individual needs,” she said.

“Someone may not need so much medicine; they might be relatively healthy,” she said. “Someone who may have more ongoing health issues will have very different needs than someone who only has to take a statin once in a while.”

Becky Rostron trains SHIP counselors who help people find the best options for their personal situation.

“We listen to the consumer and what their needs are and what their concerns are and take it from there,” she said.

For many consumers, when it comes to Medicare, she said, “You don’t know what you don’t know.

No one has to subscribe to an additional or Advantage plan, Rostron said. If someone has traditional Medicare, they can enroll in prescription Part D coverage during their initial Medicare enrollment period.

Medicare Advantage plans are required to provide the same benefits offered by original Medicare, Rostron said, and these plans may also provide additional benefits that Medicare does not.

“However, they can, and often do, apply different rules, different costs, and restrictions such as provider networks or referral requirements,” she said. “If you see a provider that is not in this network, you may pay more or have no coverage.”

These are all difficult and emotionally charged decisions, Rostron said. “You manage your money, you manage your health care,” she said.

And no one can predict what his future medical needs will be. “You can tell you’re really healthy now, but none of us know what tomorrow has in store for us,” she said.

Cay Bowman of Concord has been a SHIP counselor for 15 years, working in the Community Action Program office for Belknap and Merrimack counties in Concord.

At 71, Bowman works the equivalent of a full-time job as a SHIP volunteer. “It’s my passion,” she said.

Medicare, Bowman said, “is a very confusing little beast.”

“So many people are struggling to connect with the right coverage they need for their care,” she said.

Bowman helps people understand their options and the cost of different plans based on their medical condition and the cost of prescription drugs. “We can show them everything, but the final decision is up to them,” she said.

SHIP’s trainer Rostron said she brought in seniors asking for shots pushed by their favorite celebrity in those ubiquitous TV commercials.

“We have to explain to them that you have the right to sign up for whatever you ask for and if that’s what you want, we’ll help you do that,” she said.

But she also points to the small print at the bottom of these national ads, warning that the plans may not be available in all regions.

In rural New Hampshire, she said, “Ninety percent of the time what they advertise that catches their eye doesn’t apply here,” she said.

These TV ads have intensified of late, with the looming Dec. 7 deadline for Medicare beneficiaries to enroll in Part D plans.

“You can’t watch a Hallmark movie or even listen to a hard rock station without being bombarded with open sign-up ads,” said Vineyard, the state’s director of Medicare. “And they all promise different things.”

Vineyard said she understands why these ads work for some seniors. “You have a familiar face, a comfortable personality, telling you, ‘Hey, sign up for this plan,'” she said. “I imagine that would be comforting and kind of like a lifesaver: OK, I’ll do that and that solves the problem for me.”

“The problem is that the particular plan that Joe Namath or William Shatner comes up with might not meet your needs.” said the vineyard.

During the recent webinar, Bettencourt, the assistant insurance commissioner, said his department has seen an increase in complaints to its consumer division from senior citizens about “confusing, misleading, misleading and aggressive advertising by these types of blueprints”.

“It is therefore extremely important that consumers exercise good judgment when choosing between a Medicare Advantage or Medicare supplemental product,” he said.

The Department of Insurance approves Medicare supplemental rates and policies, and it licenses companies that offer and sell these plans. The department also oversees advertising for these plans and handles complaints about improper sales practices.

But it has no authority over Medicare Advantage products; that is the responsibility of the federal government, officials said.

Bettencourt said his department asked the state’s congressional delegation to push for state oversight of advertising for these products, to better protect seniors.

“We’re talking about a consumer group that we know is particularly vulnerable to these misleading advertising campaigns,” he said.

Meanwhile, some ads can have the opposite effect on many viewers.

A recent online story warning seniors against celebrity ads has sparked a torrent of complaints.

“Years of exposure to Namath/Walker commercials have convinced me that I want nothing to do with the program or the people who choose and pay for them,” one person wrote.

“What’s going on here,” said another. “Are you trying to drive us completely crazy, seniors…?”

Vineyard said the Centers for Medicare and Medicaid Services track complaints about such ads.

His advice: “If an offer seems too good to be true, it probably is.”