Medicare Information flow can get complicated, counselors say

Oct. 22--When it comes to health insurance these days, Berks County senior citizens face choices and maybe even choices within choices.

The flow of information can get complex, according to public and private Medicare counselors who urge seniors to seek help.

"The trend I'm seeing is middle-income people signing up for government, or original Medicare, that's supplemented with private insurance plans, while lower-income folks are opting for Medicare Advantage plans offered by different insurance companies, a more pay-as-you-go approach," said Tom Smith, 62, a private Medicare counselor in Mount Penn.

He also is a member of the advisory board of the Berks County Area Agency on Aging.

Of his more upper-income clients, Smith said 95 percent of them are staying with the original Medicare and supplemental insurance. Medicare covers about 80 percent of medical costs and supplemental insurances pick up the rest.

"What I also have been seeing is supplemental insurance premiums going up 9 percent in the past six months when the annual increase historically has only been 4 or 5 percent," Smith said.

But Smith believes that while some monthly Medicare supplemental insurance premiums may run high, some less expensive Medicare Advantage plans may wind up costing consumers more money out-of-pocket in deductibles and copays.

Smith cautioned seniors about three features involving Medicare Advantage plans:

--"Some may offer people a zero copay for preventive testing such as mammograms or colonoscopies," he said. "But with 70 percent of colonoscopies, doctors usually find something and what was a preventive test immediately becomes a diagnostic or surgical test. You wind up paying the bill for $200."

--"Some companies don't talk about catastrophic coverage for strokes or heart attacks that could require long-term stays in intensive or critical care units," Smith said. "It's possible consumers could pay up to $6,700 for this, although for my clients I've only seen bills in the $2,000 to $3,000 range."

--"Benefits and premiums on Medicare Advantage plans can change like clockwork," Smith said. "You know the benefits in Medicare supplemental plans year after year, but the premiums can rise annually like anything else."

Contact Bruce R. Posten: 610-371-5059 or bposten@readingeagle.com.

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