Underused Medicare Benefits

By Deborah Jeanne Sergeant

Medicare benefits can be confusing, especially as plan benefits can change from year to year and among different insurance providers. It certainly can pay to talk with a qualified Medicare adviser to better understand your benefits, even if your plan remains the same because some benefits may go unused.

Lee Kern, licensed insurance agent and owner of NY Medicare Specialists in Rochester and Buffalo, said that part of the reason some people don’t fully use their Medicare benefits is that the explanation of benefits is online. People who don’t go online to read up may not know everything that is included in their plan.

Some pick the wrong plan.

“The commercials and inbound phone calls bombard them with information,” Kern said. “The unsolicited phone calls and mail can cause people to shut it out and not choose the right plan. Using a local person where you can walk in their office or do a Zoom meeting, that’s an easier way to get away from all the mess that is Medicare. Work with someone who can explain it.”

While those providing plans must receive consent from a beneficiary before contacting them, Kern said that many unscrupulous companies use overseas call centers to make cold calls to skirt the law. Once they have obtained consent, they’re switched to a domestic call center and thus technically follow the rules.

“It’s a numbers game,” Kern said. “Let’s say 40% are on UnitedHealthcare. They call and say, ‘I’m calling to review your United plan.’”

The beneficiaries using UnitedHealthcare assume that the caller is from that company, so they willingly go over their plan. A few not on the named health plan may even volunteer the correct information.

If the beneficiaries end up switching to the wrong plan, they may continue to go to their trusted providers but not have their visits covered because their benefits have changed without their knowledge.

Failing to use their plan correctly can also minimize the benefits they receive.

“I think that the most underutilized benefits are dentists and eye doctors,” Kern said. “They don’t accept all the insurances. A client might go to a dentist and not realize they need to fill out a form for reimbursement, so they don’t use the benefit. If you have a benefit on a plan and it’s hard to use, it’s essentially useless.”

Another example of an under-used benefit is the Part B “giveback” that’s included with some Advantage Plans.

“They pay the individual to be on the plan,” said Vicki James, AHIP-certified CEO of Clear Benefits Advisors, formerly MEDICARE EASY! in Rochester. “Many of those plans are $0 premium plans. A few of them do have a medical deductible, so be aware of that. Typically, the copays will be slightly higher than other zero premium plans.”

In all cases, it’s vital to review your Medicare plan and any supplemental plans with a trusted, local adviser and discuss your preferred medical, dental and vision providers to ensure you understand your coverage and benefits.