Sally Field from Fincastle sent me a question recently that is probably relevant to many people in the Roanoke Valley. It’s about enrolling in Medicare.
Her husband will turn 65 later this year, and lately the couple have been bombarded with phone calls from salespeople wanting to help with the process.
“My husband will be of Medicare age later this year. (Much later, many months away.) We have recently had many (MANY) calls from toll-free numbers claiming to be people who want to talk to him about “options” and offer to help him register.
“He and I are deeply suspicious of these calls. They always come from numbers that appear as “free call” on caller ID, or random city and state names. (Lynchburg, VA, Springfield, IL.) When we let calls go to voicemail, they never leave a message where we can call back to take advantage of their services.
“Is it a scam, as we suspect? Or is there a government or other entity that really wants to help us? Could you let us know?
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To answer these questions, I consulted an expert in the field. His name is Shannon Abell. For decades, he served as director of senior services for the local Office on Aging. He retired at the end of 2020.
Best of all, he himself recently went through the experience of enrolling in Medicare, as did his wife. Although the two are officially retired, they volunteer to help run Medicare seminars for seniors with the Virginia Senior Medicare Patrol.
I sat down with them for lunch last week and showed them Field’s email. The very first thing Abell told me was that old people should ignore all those phone calls.
“When you hit about 64 1/2, the letters in the mail start coming in,” Abell told me. “You can be inundated with spam and companies trying to sell you policies and such.”
Calls can be particularly dangerous, Abell added. Indeed, to enroll in Medicare, the applicant must disclose a lot of personal information.
While the calls can come from legitimate businesses, they can also come from scammers looking for information for identity theft. And there’s no way to tell the difference between the two.
You can’t trust your phone’s caller ID because scammers can falsify or “spoof” this information to make it look like the call is coming from a legitimate entity.
“There’s no way when you get an unsolicited call to believe it’s from a legitimate seller,” Abell told me, “You bet they’re not a scammer and they’re not going to take your information and ruin your life.
“When you see a call like this, let it go to voicemail,” he added. “If they don’t leave a message, it’s a scam.”
If you don’t want to ignore the call, then act smart, Abell added. Note the name of the calling company from the caller ID information displayed on your phone. Then find their toll-free number independently and call that number, Abell said. It’s the best way to make sure you’re talking to someone who is legit.
Once you’ve avoided the scammers, there are plenty of other issues to consider. The most important thing for a 64-year-old man is whether to enroll in traditional Medicare or a Medicare Advantage plan. This can have huge implications down the road.
Traditional health insurance has been around since the 1960s, and about 36 million seniors are enrolled in it, Abell said. Medicare Advantage appeared around 2003. It has 32 million enrollees.
Medicare Advantage plans are managed care programs run by insurance companies. Medicare pays an insurer a flat fee per month per Medicare Advantage enrollee, and then the insurer is responsible for paying the enrollee’s bills.
In this case, a Medicare Advantage patient will receive care from hospitals and physicians only within the insurer’s Medicare Advantage network. If an elderly person is traveling and is not part of the insurer’s network, they may not be covered. (Traditional health insurance, on the other hand, is accepted almost everywhere in the United States.)
Medicare Advantage companies make a profit when the bills they pay for elder care are less than the monthly Medicare reimbursement the insurer receives. And those benefits can be substantial.
Abell said insurers are spending millions hiring aging “stars” such as retired quarterback Joe Namath, actor JJ Walker and Martha Stewart to push Medicare Advantage in TV ads precisely because Medicare Advantage is very profitable.
Although premiums for Medicare Advantage plans are generally lower, copayments and deductibles are generally higher than under traditional Medicare, Abell said.
Under traditional health insurance, the federal government pays hospital bills (Medicare Part A) as the patient incurs them. These patients typically also enroll in Medicare Part B, which covers medical and other non-hospital costs. They pay $170 a month for it, usually as a deduction from their monthly Social Security payment.
Traditional Medicare enrollees also typically purchase a private Medigap policy to cover their copayments and deductibles and medical expenses.
In Roanoke, six insurance companies offer 26 different Medicare Advantage plans. And nine companies offer 23 different Medigap plans. Choosing the wrong one can cost a senior thousands of dollars.
How to choose the best package? This will often depend on an elderly person’s health, wealth, and prescription medications. A good way to sort it all out is to go to Medicare, which the local Office on Aging offers by appointment.
Abell told me that in the long run, traditional Medicare is a better choice for most people than Medicare Advantage. But this decision must be made after analyzing individual factors such as health, age and medication.
Medicare Advantage plans typically provide coverage for vision, hearing, dental, and other ancillary services that traditional health insurance doesn’t cover. But coverage for these services is often limited to a tiny fraction of the actual cost — and that “limited” nature is usually buried in the fine print, Abell said.
Another reason people might want to avoid Medicare Advantage plans is that it can be hard to get by for a patient who has been in it for over a year, if they have common illnesses such as high blood pressure.
Indeed, traditional Medigap supplemental insurers may refuse to cover or raise premiums to a level unaffordable for a registrant who wishes to switch. This same person would have been guaranteed Medigap coverage if they had enrolled in traditional Medicare at the start.
“If you make a mistake, Medicare can be very ruthless,” Abell said.
Abell will host a free Medicare counseling event at 1 p.m. April 7 at the Friendship Retirement Community Chapel, 327 Hershberger Road in Roanoke. It’s open to the public, he said.
You can also call the local Office on Aging to schedule Medicare counseling appointments. This number is (540) 345-0451.
Contact Subway Columnist Dan Casey at 981-3423 or [email protected] Follow him on Twitter