Question: My friend insures with the same Health Insurance Company as I do, but she pays less than I do. Why is that?
Answer: Your question could have many answers. I will begin with an analogy. My friend, Amy and I both have Toyota’s. We love our vehicles, but mine gets much better gas mileage and my monthly payment is much less. Why? It is because I have a Corolla and she has a Highlander. We have the same company, but VERY different models. You and your friend’s situation is very similar.
There are many different types of Medicare Health Insurance products; Medicare Supplement Plans (Medigaps), Prescription Drug Plans (PDP’s), Medicare Advantage Plans. Those Medicare Advantage Plans come in many different varieties- Health Maintenance Organizations (HMO’s), Preferred Provider Organizations (PPO’s) and Private Fee For Service plans (PFFS).
There are many Health Insurance Companies that sell products in many of those categories. When talking about Health Insurance and Medicare products I try to be very careful about using a company name, (like Toyota). I try very hard to use the product name, (like Corolla). Here is a Health Insurance example; There are Univera Medicare Advantage Products sold as Univera Senior Choice. Under that name there are six different options. Most providing drug coverage, one without drug coverage. There are also Univera Medicare Supplement Plans now sold in our region. Under that type of insurance, Univera offers eight different types of Medigaps. Of the 14 possible Univera products I just listed, the prices range from $0 to $363.78 and the types of products have completely different rules and coverage. Each product is useful for a particular situation. That list of 14 is as different as 14 different fruits and vegetables. You would not say that a grape and pea are the same because they are both round. Similarly you can’t say that Univera Senior Choice Secure ($140) and Univera Medigap Plan G ($184.70) are the same because they are both Univera.
The name of the insurance product type is VERY important in distinguishing the type of coverage you are purchasing.
I regularly see mailings from many different companies highlighting a particular feature of the plan (like $0 premium). Individuals ask “Why am I paying $14.20 per month, when I can get this $0 plan which covers dental?” My answer is that your $14.20 per month plan is a WellCare Prescription Drug Plan. That $0 premium plan is a WellCare Medicare Advantage product (either PPO or PFFS) and may not include Prescription Drug Coverage. You can’t mix and match all of these products together. You also may end up in a difficult place if you use just the premium as your decision making threshold.
As I have said many times that advertising is about highlighting features that the company wants you to focus on. There may be more to the story. With insurance products there is definitely more to the story. You can’t compare products strictly using the name or the price point (premium).
Insurance companies sell products because they believe they can create a profit margin to maintain their business model. It is your job to be sure you are getting the best insurance product for your situation. Just because a company offers a product does not mean you need to buy it.
I love to hear about individuals talking about their insurance coverage and comparing it with other products. I also know that sometimes what individuals highlight in talking about their insurance is what they love most about it. I do that myself. I love my Toyota Corolla, I get great gas mileage. It has a back-up camera and a sun roof. All features that are important to me. It would not be good for Amy, she has 4 children and a husband. They literally wouldn’t fit in my Toyota. She needs that Highlander for her situation.
Be sure to pick out the correct Medicare Insurance product to meet your particular needs.
Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.