Wading through the maze known as health insurance can be a difficult task, especially when you’re approaching retirement age, and Medicare coverage is constantly changing. Many people opt to carry only Original Medicare, but insurance brokers, like LaTasha Rozier, owner of LaTasha Rozier Health Advisors, can help customers navigate their options and get the most value for their hard-earned money.
As a broker, Rozier, who has been in the insurance business 11 years, isn’t limited to selling one product line. She currently represents United Health Care (UHC), Aetna, WellCare and Humana.
“I worked with UHC as an ICA agent for seven years, and four years as an independent broker,” she said. “I decided to become an independent broker so I could maintain long-term relationships with my clients and help them annually choose a plan that best fits their individual needs. I cherish my personal relationships with every client.”
Dealing with a local insurance advisor, rather than a large company, has its advantages, and customer service is at the top of the list.
“My company provides an in-person or virtual consultation with each individual client at their request,” she said. “During your private session (which is) free of charge, we discuss your personal needs and determine what plan is the best fit. One of the many topics we discuss is the coverage gap.”
The coverage gap, in Medicare parlance, is also known as the “donut hole.” It’s an important time of the year to discuss Medicare and its related issues, because open enrollment for Medicare Advantage policies is from Oct. 15 until Dec. 7.
First of all, it’s important to know whether or not you’re eligible for Medicare. Then it gets confusing, because many people don’t understand the difference between Medicare Advantage plans and Medicare Supplement (Medigap) plans. Rozier says there is a simple explanation.
“Medicare supplement plans (Medigap) are health insurance policies and are secondary to Medicare,” she explained, whereas Medicare Advantage plans combine the original Medicare Parts A and B into a single plan.
People are eligible for Medicare Parts A and B if they’re 65 years old, or under 65 and qualify on the basis of a disability or other special circumstances. You must be a citizen of the United States, or a legal resident who has lived in the U.S. for at least five years.
Medicare Advantage plans can save consumers a significant amount of money. With Original Medicare only, the beneficiary is responsible for 20% of their medical bills. Medicare Advantage plans provide a financial safety net to help offset the cost.
“Your plan will pay some of the cost, and you will pay a co-payment or co-insurance,” Rozier said. “How long you stay in the initial coverage period depends on your drug costs and your plan’s benefit structure.”
For most plans in 2020, the initial coverage period ends after a total of $4,020 has been accumulated in total drug costs (retail) – which includes what the insured and the plan have paid for covered drugs.
Then comes the coverage gap, or donut hole. After the $4,020 has been reached, the coverage gap begins.
“The donut hole closed for all drugs in 2020, meaning that when you enter the coverage gap, you will be responsible for 25% of the cost of your drugs,” Rozier said. “In the past, you were responsible for a higher percentage of the cost of your drugs.”
For example, if a drug’s total cost is $100, and you pay your plan’s $20 co-pay during the initial coverage period, you will be responsible for paying $25 (25% of $100) during the coverage gap.
There are multiple safeguards built into Medicare Advantage insurance. First of all, it is illegal for telemarketers or agents to call or drop by to solicit sales. There is additional help available for people whose income falls below specified limits and still need coverage called extra help, and the maximum amount of out-of-pocket costs per coverage year.
Rozier said she looks forward to talking with anyone who’s interested in exploring options for Medicare Advantage or Medigap coverage.
LaTasha Rozier, of LaTasha Rozier Insurance Advisors, is open by appointment on weekdays and weekends. For more information, call 912-264-1500 or 912-270-7818.