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North Hills Monthly

Medicare Questions Rife during Open Enrollment Period

Oct 31, 2018 08:04AM ● By Vanessa Orr

Unless you’ve been living under a rock, you probably haven’t missed the fact that it’s the open enrollment period for Medicare. But just because there’s a lot of information out there doesn’t necessarily mean that you know what to do. 

“The TV is blaring, the radio is blaring, the mailbox is busting with fliers, and the telephone won’t stop ringing—it’s a hyper information dump,” said Eileen Conners, sales executive, Charles Leach Agency, about the materials that people receive during the open enrollment period between Oct. 15 and Dec. 7. “Unfortunately, all of this information tends to confuse more than it informs.”

While those who are on Medicare or who are using Medicare Advantage plans have the option of switching coverage with new coverage to begin Jan. 1, it’s hard to know what steps to take to make this happen. 

“In all of the mail that you’ve received over the last month, look for an ‘Annual Notice of Change,’ sent by your provider,” Conners advised. “Make sure to open this one, because it tells you how your plan will be changing in the next year. Unfortunately, it is not an easy piece to understand.

“If you have questions about how your plan is changing, call your company, but understand that if you call Highmark or UPMC, you will only hear about their plans,” she added. “The next level of education is to understand your other options.”

Conners noted that people with Highmark Medicare Advantage products need to pay special attention this year. “In the middle of 2019, if you have a Highmark Medicare Advantage product, you will not have access to nonemergency care at UPMC after 

July 1,” she said. “UPMC also announced on Oct. 1 that in some cases, people may have access, but will have to pay for these services in advance. 

“Highmark Security Blue and Highmark Freedom Blue clients will be the most affected,” she added. “There’s no need to panic—but do seek advice.”

Medical Insurance Specialist Melanie Saflin agreed. “While everyone needs to review their plans, if you have either Highmark or UPMC, you really need to look at your situation—you could be paying a lot more than you need for insurance,” she said. “There are third-party options. 

“Reach out for help, but make sure to work with someone independent,” she continued. “Independent agents work with more than one carrier, and there are a lot of carriers out there. They will help you assess your situation, but not just by looking at one product. Third-party plans include Aetna and United Healthcare, each of which has several different plans, and offer both Highmark and UPMC in their networks.” 

Prescription coverage

Every carrier develops a formulary of prescription drugs each year, and those drugs can change tiers within plans every year. This can affect what people are paying, or even if their medications are covered at all.

“A Medicare-insured person taking a Tier 1 drug on Highmark might see that it has switched tiers, and it now costs more money,” said Conners. “Companies can change what drugs they cover, and what they cost.”

While each carrier is required to send a formulary as part of the list of plan changes, they are legally allowed to send an ‘abbreviated’ version, which is causing even more confusion in the marketplace.

“Because people are only getting a list of the most commonly dispensed drugs, and not the 80-page booklet that lists everything, they are understandably upset,” said Conners. “I must have had 50 calls in the last week about drugs that my clients thought weren’t covered. If you want the complete list, you have to either go online or contact your insurance company to have a full formulary sent to you.”

“While there haven’t been a lot of big changes in formularies since last year, people do need to be aware if their medicines have changed tiers, or if there may now be a generic counterpart for what they’re taking,” said Saflin. “If your medicine has gone from Tier 4 to Tier 3 in one plan, or from Tier 3 to Tier 4 in another, that could sway you from one plan to another.”

The advantages of an independent broker

While it doesn’t cost anything to visit an independent broker, it can save you time—and money—in the long run.

“Once you understand how your plan has changed, your second question should be, ‘What about the other guys?” said Conners. “You can go to every carrier, and attend seminars, and spend the next three weeks listening to people talk about their plans, but the smarter thing to do is to find an agent who specializes in Medicare products.”

Conners notes that there are two types of Medicare plans:  Medigap products, which are used in conjunction with Medicare and act as secondary insurance; and Medicare Advantage products, which are offered by private insurance companies, such as Highmark, UPMC, United Healthcare and Aetna.

“You want to get the whole story from someone who will tell you about both sides of the coin, and who is not financially motivated to tell you only one side of the story,” Conners added. 

“An independent agent not only knows about all of the different plans, but is familiar with the ins and outs of each one,” said Saflin. “You can read a brochure and get the numbers, but you probably won’t understand what the workings are behind those numbers. One plan might be better for you than another, and we can give you direction.

“One thing that I’m finding this year is that a lot of people who didn’t feel that Medicare supplements were right for them before are now thinking that they are a good alternative,” she added. “The only drawback is that you have to answer health questions to get it, and the company can deny you. If this is an option that you want to explore, it’s definitely smart to work with a broker.”

For more information, contact Eileen Conners at the Charles Leach Agency at or 814-275-3224 or Melanie Saflin at or 412-266-6270.