LymeBlog - Ask the Insurance Guy: Lyme Disease and Medicare Plans

LymeBlog News
Lexington, KY USA
By Rick Vassar, LymeBlog News Staff

Dear Insurance Guy,

Tis the season for those of us with Medicare to choose Medicare supplement and replacement plans. Each of the sales people who are pitching these plans smile and say, "... and if you find that you don't like the plan you can change to a different one next year."

From my point of view, as the customer, this means if I pick the wrong plan I am stuck for a year. I get the feeling that from the sales person's point of view it means they will get a good commission for a year.

I can understand how the insurance companies with plans that have a monthly premium make money on these but how do the companies make money on the PPO and HMO "zero premium" plans?

Rick Vassar CPCU, ARM, AIS, ARM-P

Rick Vassar CPCU, ARM, AIS, ARM-P has been a risk manager and insurance specialist for over 20 years, and has spent a great deal of time and effort in claims analysis and education.

He is the author of the book Hide! Here Comes the Insurance Guy – A Practical Guide to Understanding Business Insurance and Risk Management as well as the principal of The Vassar Group, LLC, a risk management consulting firm in Sterling, Virginia.

Mr. Vassar is also the spouse of a chronically ill Lyme patient or, as the Infectious Disease Society of America (IDSA) likes to call her, completely healthy.

Read Rick's column "Ask The Insurance Guy" in LymeBlog News. Submit your questions to Rick at: AskTheInsuranceGuy@Lymeblog.com

For some reason I do not trust a sales person when they say that the plan they are selling will meet all of my needs so my second question is: Where can I get advise on which plan will be best for me considering I have a chronic illness?

All of the decision making websites, like medicare.com, base the decision solely on which prescription drugs I am taking right now. I don't know which prescription drugs I will be needing to take next year. Also, I compared the co-pay with these plans with the amount that Wal-mart charges, $4 per prescription for most generics, and found that it would be more expensive, $5 to $10 co-pay, to have the insurance.

How can I get advise in my state based upon my all my needs, not just prescriptions?

Any help would be appreciated.

Ima Lymie
Kentucky

Dear Ima,

Although the rules governing Medicare plans can be quite complex and overwhelming, there is information on the ...

Internet that will give you the tools you need to make an informed decision.

The key is to do your research before you choose a plan. If you rely upon the agent to tell you what plan fits your needs, you run the risk of getting the best coverage for the agent's commission and not one that would cover the needs of you as a chronically ill patient.

Also, an insurance agent who does not understand the issues involved with an illness such as chronic Lyme may have the best intentions, but will not have the knowledge necessary to give you the best advice.

YOU are your best advocate. My wife has had chronic Lyme for well over seven years, and we have both become astutely informed on the various treatment options. We have also been successful in getting insurance coverage for treatments that our health insurer have deemed as not covered.

The key to this is education. Learn what each plan covers, how it is applied in your state, and where you can go to get additional information. Below, you will find links to a website and a blog entry that gives you a heads up on what each plan covers and where you can go to get additional information.

Since I do not know your specific needs, where you live, and most importantly, because I do not sell insurance, I can only encourage you to get as much information you can and ask as many questions you can think of.

http://www.quickbrochures.net/ The Medicare Project. If you scroll down, you will see links by state. when you go to your state, it will show links to specific information that may help in the decision-making process.

http://treports2003.blogspot.com/2007/12/guide-to-health-insurance-for-people.html This blog entry has some good information on all Medicare plans.

Both links are informational only, and should be treated as such. Also, if there are any readers out there who can help, please write in and let us know.
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