By Jim Newell
There are few things more confusing than navigating the health care industry, with the various deviations of insurance plans available depending on what appears to be a myriad of conditions.
With many people now facing changing medical insurance options, especially senior citizens who may be entering a Medicare Plan for the first time, or want to change their plan, the Open Enrollment period is now the time to talk to a professional and explore their options.
Lake Orion resident Wendy Machak has been in the insurance business for 20 years and is co-founder of The Binnacle Group
Machak, who left the automotive industry to co-found The Binnacle Group in 2000, an independent financial professional firm, now has 20 years in insurance and financial services industry, focusing on health insurance, Medicare supplements, life insurance and annuities.
Machak said that what she and her colleagues are seeing right now is people questioning their plans, especially if they are paying a lot in prescription costs, and switching from the Supplement to the Advantage Plans.
“If they’re having difficulty paying, they need to look at different plans that are available,” Machak said. “If they’re on a Medicare Supplement Plan and they go on a Medicare Advantage Plan sometimes they can save a lot of money on their prescriptions. Not always. We weigh the savings on prescriptions with the savings on what they’re paying out.”
The advantage of an Advantage Plan is that everything is combined into one cart – prescription plans, medical plans, some dental, vision and hearing included, Silver Sneakers gym membership, she said.
“They have the ability to still have a PPO (Preferred Provider Organization) and still travel with the Advantage Plans as well,” Machak said. “A lot of people like that almost every plan has an over-the-counter benefit, where they can get money to use either online or at a pharmacy or Kroger, places like that, for over-the-counter drugs and band-aids and other items.
Plans sold during open enrollment start in January 2021. Those who don’t enroll, or re-enroll by the Dec. 7 deadline might have to wait a year before switching plans.
“Some people are just more comfortable on specific plans. But there’s been several prescription companies that have been bought out and changed names and people are losing their prescription plans and they don’t know what to do. So, they’re kind of stuck with what they get rolled into if they don’t change their plans by Dec. 7,” Machak said.
So, what should people be asking a health insurance advisor when shopping for a new plan?
They need to make sure that a new plan is going to cover their prescription plans the same, if not better next year, Machak says.
If their doctor is still in the network if they change plans.
If there is something better, are they open to looking at a different type of plan? Such as an Advantage Plan, or if they need to add dental or vision coverage.
Mostly, they need to feel comfortable with their plan.
“In the big picture, sometimes paying more and having that comfort level is going to outweigh the savings,” Machak said.
“Even though they have a maximum out-of-pocket plan, a lot of people are used to having group health insurance and, even if they retire, they’re used to paying copays when they go to the doctor. So, they’re more comfortable going into an Advantage Plan when they turn 65.”
Even if someone does not ultimately want to switch plans, it does not hurt to contact a professional and find out what options are available should their insurance needs change down the road.
“One thing I do tell every person is that there is no one perfect plan out there for everyone. Someone’s friend may have a Medigap in a prescription plan; someone else may have a zero-dollar plan and everyone likes to think that their plan is the best. Which it hopefully is for them in their situation,” Machak said.
Machak enjoys taking the time to get to know her clients and better understand their needs; she excels at putting a plan together that works for each individual client because of her empathy and compassion for the well-being of others.