If you’re on Medicare, you’re likely hearing about the Medicare Part B Give Back benefit.

This new feature is only offered by a select few Medicare Advantage plans and only in some areas of the country.

If you qualify, this unique benefit can reduce your monthly premiums owed to the government each month.

How Does Part B Premium Reduction Work?

First, you must be eligible for and enrolled in Medicare Parts A and B. And you must already be paying the full amount for your Part B premiums. You won’t qualify for the Part B Give Back benefit if you receive government assistance that pays for your Part B premiums.

Next, you select and enroll in a Medicare Advantage plan that offers the Part B premium reduction benefit.

It’s important to note that only Medicare Advantage plans offer this premium reduction benefit. And it may not be offered where you live. While there are 48 states offering plans, they won’t be available in every county across the U.S. Some areas have no plans at all.

It should also be noted that Medicare supplements currently do not offer any giveback provisions. This benefit is only available if you enroll in certain Medicare Advantage plans. And, of course, there are only certain windows when you can shop for and enroll in a Part C Medicare Advantage plan.

Which Insurance Companies Offer This Benefit?

As this is a relatively new feature, there are only a few insurance companies offering the Medicare give back benefit. Aetna, Cigna and Humana are three companies leading the way.

We imagine more insurance companies will get approved to offer this popular benefit next year – and in more areas of the country. It’s a great way to help those who want to keep their Medicare costs down.

⇒ Learn six ways to save on your Medicare costs ⇐

How Much Can My Medicare Premiums Decrease?

If you qualify and there are plans available in your area, you will see monthly  Part B Giveback amounts range from $0.10 up to the maximum yearly standard premium.

This benefit is designed to work with Social Security. Your premium reduction is reflected in your Social Security check each month. In other words, your check will increase by the amount the giveback benefit decreases your premium.

Typically, plans do not pay you directly. If you defer Social Security, then you would see the credit amount applied to what you owe the government. Your monthly or quarterly premiums owed to government are simply reduced by the amount that applies to your chosen Advantage plan.

The give back benefit does not reduce IRMAA charges, unfortunately. Those with higher incomes can only have their premiums reduced by the same amounts listed above; so $148.50 is the maximum amount available this year.

Are There Any Concerns With The Part B Give Back?

We’ve been helping our clients understand their Medicare choices for over two decades. One plan does not fit all. The mistake consumers sometimes make is enrolling in a plan based on cost only. The benefits and network availability must also be considered.

While it’s tempting to choose a plan with a large giveback benefit, it might be unsuitable if your doctors or hospitals are not in their network. And you should also make certain any Advantage plan covers your most important prescriptions. Especially if you take anything expensive or on a higher Tier.

Also, you want to be sure you’re comfortable with Medicare Advantage plans in general. Some people prefer the flexibility of a Medicare Supplement. And switching back and forth between the two is not guaranteed. There are many variables to consider when choosing a supplemental policy.

Contact Us To Discuss Your Medicare Insurance Options

Hyers and Associates is an independent agency located in Columbus, Ohio. Our knowledgeable and experienced agents service clients across the U.S. If you’re new to Medicare, in an Open Enrollment or Guaranteed Issue window, or just have questions about your options – we can help.

We’ll assist you in comparing Supplements and Advantage plans with or without the Part B Giveback benefit. Contact us today!

It’s Open Enrollment, so expect to see endless advertisements about the free extra Medicare benefits you might be missing. Things like prescriptions, dental, vision, hearing aids, meals, gym memberships & transportation. But are the benefits actually free?

The answer is complicated. Like most things, there’s a trade-off. What these commercials are referring to are the extra benefits you receive with certain Medicare Advantage plans. In order to receive these “extras”, you need to sign up for a certain type of insurance.

Understanding Your Two Medicare Options

First, a little background. Once you’re on Medicare there are two different ways to fill in the gaps. You can either purchase a Medicare Supplement (also referred to as Medigap) or you can enroll in a Medicare Advantage plan. You can’t have both. It’s one or the other.

Medicare Supplements (like Plans F, G & N) are simply secondary payers. They fill in the most common gaps in Medicare, but don’t include much else. If you want/need prescription coverage, dental, vision or other benefits, you have to purchase those separately. Some Medicare Supplements will pay for a gym membership like Silver Sneakers, but that’s about it.

Medicare Advantage Plans (also referred to as Part C coverage) are more easily explained as replacement plans. They cover and replace your Medicare Parts A & B benefits privately and then fill in some of the gaps. These are private insurance plans from companies like Aetna, Anthem BCBS, UHC AARP, Humana, etc.

However, these policies are allowed to offer much more in the way of extra benefits. Many are provided at no additional cost. Some benefits, like comprehensive dental & vision insurance, can increase your monthly premiums, however.

The Extra Benefits Associated With Advantage Plans

The simple fact is Medicare Advantage insurance policies, per government rules, can offer many more perks than a Medicare Supplement plan. The list is comprehensive and growing. There’s nothing inherently wrong with this trend. Advantage plans serve many people very well.

Not all policies include everything below, but here’s a list of common benefits:

• Part D prescription drug coverage
• Dental care like routine cleanings and x-rays
• Vision care including eye exams & allowances for glasses
• Hearing exams and money towards hearing aids
• Free gym memberships, fitness classes and Silver Sneakers
• Telehealth appointments for $0
• Wellness & preventive care
• Post hospital discharge meals
• Nurse hotlines and disease management
• Quarterly allowances for over-the-counter items
• Diabetic supplies
• Transportation to doctor’s appointments
• Community based programs
• Monthly premiums of $0 with some policies
• A Medicare Medical Savings Account to cover costs
• Medicare Part B Give Back premium reduction

This isn’t an all-encompassing list. And you are not entitled to all of these benefits with every Advantage plan. Some policies are better in certain areas than others. And it helps to live in an area where several companies compete for your enrollment.

But should you choose an Advantage plan on the benefits alone? Probably not, but they are enticing. There’s more to the story…

What Are The Tradeoffs?

We understand the benefits listed above are attractive to consumers. They can provide significant savings throughout the year. So what’s the catch?

The main issue is you must enroll in a Medicare Advantage plan to get these benefits. It’s the only way. And these types of policies have some drawbacks of their own. First and foremost, most are private, network-driven, HMO & PPO plans. This means it’s prudent to stay in their network for your care. If you’re out of network for anything other than an emergency, you’re responsible for more, if not all, of the costs.

And Advantage plans have more out of pocket costs than most Medicare Supplements insurance policies. That’s okay for some consumers, but if you have health issues – or are anticipating future procedures – know that you’ll likely have higher cost-sharing.

It’s common to see many Advantage plans with a yearly in-network out-of-pocket maximum of around $4,000 for the year. Some are higher. And if you go out of network? It can be $10,000 or more with many PPO plans – or not covered at all with a HMO policy. These are the amounts you’re responsible for each year should they arise.

Thus, there are the two major issues:  Networks and out of pocket costs. Again, most members don’t encounter serious problems here, but we talk with some that do. Sometimes their preferred doctor group or hospital won’t accept their plan – or later leaves the network. Other times, they’re running into big bills after a hospital stay or a procedure with significant after-care.

Can’t I Switch Back Later To A Medicare Supplement?

There’s the Open Enrollment window every year, right? Yes, every year from October 15th through December 7th.

This window does not necessarily allow you to jump from an Advantage plan to a Supplement, however.

The rules state you get 12 months to try an Advantage plan. After that time, you must pass medical underwriting to qualify for an enrollment into a Medicare Supplement. In other words, the insurance company offering the Supplement does not have to accept those with preexisting conditions or ongoing health issues. This can make it difficult to switch back and forth.

Why might you want to switch? Perhaps you’re having issues with their network of doctors and hospitals. Or maybe you’re running into significant of out of pocket costs year in and year out.

Contact Us to Learn More About Your Options

While it’s true there are several low-cost (and even $0 monthly premium) Medicare Advantage plans with desirable extra benefits, there are some strings attached. It’s a little misleading for commercials to say you’re entitled to these benefits, but our friend Joe Namath has to make a living too.

There’s a lot to know. Decisions you make now will determine your insurance options later. If you would like to learn more about Advantage plans with extra benefits in your area, contact us today. We’ll do a deep-dive and share with you all there is to consider during the Open Enrollment window.

Every year there are changes to provider networks for many Medicare insurance plans. The biggest change for 2021 is Ohio State University will no longer be in network for Medical Mutual Medicare Advantage plans. This does not affect all of their insurance plans, however.

It’s not uncommon to see large providers move in and out of network with Medicare Advantage plans. This might happen due to high costs or low utilization by the insured population. But for 2021, OSU hospitals and affiliates won’t be in network for Medical Mutual Advantage plans. This includes both their HMO and PPO plans.

This means that beginning Jan. 1, 2021, all PCPs, specialists and facilities associated with the Ohio State University Wexner Medical Center (including Ohio State University Hospital, Ohio State East Hospital, The James Cancer Hospital and The Ohio State University Physicians) will no longer participate in Medical Mutual’s Medicare Advantage network.

What If I Want To Change Plans?

The good news is that Medicare Open Enrollment is right around the corner. It runs from October 15th thru December 7th. If you’re enrolled in a Medical Mutual Advantage plan and wish to continue to see doctors in the OSU network, then switching plans is advisable. Any change you make will be effective January 1, 2021.

In Central Ohio, there’s a lot of competition for Medicare Advantage plan enrollees. Aetna, United Healthcare, Humana, Anthem BCBS, and a few others all offer comprehensive coverage. And many of these include Ohio State hospitals and doctors in their networks. And many also offer $0 HMO and PPO plans that include prescription drug coverage just like Medical Mutual.

In other words, it should not be hard to find a new Advantage plan with your same doctors and hospitals in network while also including OSU. And the benefits should also be similar. Many Advantage plans are structured in similar ways in terms of out of pocket costs and the ancillary benefits offered.

Copays, coinsurance, out of pocket maximums may not differ much. And these plans typically include the dental, vision and hearing coverage (among other perks) you’re used to.

Does This Affect Their Medicare Supplements?

The answer is, no. Almost all Medicare Supplement plans do not have networks to worry about. They are simply a secondary payor after Medicare. This means you can go see any doctor or hospital you choose so long as they accept Medicare.

If you own a Medical Mutual Medicare Supplement plan, you can still go to Ohio State University. This change only affects their network-driven Medicare Advantage plans. This is one of the pros of having a Supplement (also referred to as Medigap coverage). You don’t have to worry about being bounced in and out of networks like you would with an Advantage plan.

You do not need to worry about changing insurance if you own a Medicare Supplement with Medical Mutual of Ohio. You can still go see every provider you’re used to seeing – same as before.

What About Individual & Group Health Insurance?

OSU has not been in network for Med Mutual’s individual and family insurance plans for some time. In Central Ohio, all plans sold today only offer Ohio Health as a network of choice. This gives you access to Riverside, Dublin Methodist, Grant and several other facilities, but not Ohio State.

So there are not changes there. Those on individual and family MMO plans sold on the exchange will continue to have access to Ohio Health facilities in and around Central Ohio for 2021.

And group health plans sold off the exchange will continue to have OSU in their network. There should be no disruptions there either. Again, this change only affects Medicare Advantage enrollees.

Contact Us to Discuss Your 2021 Medicare Insurance Options

Network changes are inevitable in today’s insurance environment. In many cases, the two parties later reach an agreement and things return to normal. However, if you’re utilizing OSU and own a MMO Advantage plan, you may want to shop for new coverage. We can help. Contact us today to learn more about your 2021 options.