How do I choose the right Medicare plan for me?

Patrice King Brown: Whether you’re new to Medicare, exploring your options, or just want to keep up with the latest in Medicare news, we’ve got you covered.

Stacy Smith: No fluff, no jargon. Just real conversations to help you navigate Medicare with confidence. I’m Stacy Smith.

Patrice King Brown: And I’m Patrice King Brown. Welcome to “Medicare for the Record,” brought to you by UPMC for Life.

Welcome back to “Medicare for the Record.” We're glad you joined us today. We've got to share some great information. You'll like this one.

Stacy Smith: We've been through this, Patrice, and that is: Choosing a Medicare plan can feel overwhelming. Between Medicare Advantage plans, Medicare supplemental plans, prescription drug coverage, provider networks, premiums, and extra benefits, many people experience what is known as “decision fatigue.” And in this episode, we'll talk about how Medicare members can simplify the process, focus on what matters the most, and feel more confident about choosing the Medicare coverage that best fits their needs.

Patrice King Brown: Rich Gigliotti is our guest today. He is president of the Gigliotti Insurance Group. He's done a lot of exciting things and he's been helping people for a long time—12 years helping people as part of the Gigliotti Insurance Group. And today he's here to help us understand what's happening with Medicare and Medicare Advantage programs. Thank you very much for joining us, Rich.

Rich Gigliotti: Well, thank you very much for having me.

Patrice King Brown: We also know you are a western PA resident all your life.

Rich Gigliotti: That's right.

Patrice King Brown: And that means you live here and feel the things that people in western Pennsylvania feel as well. So when you're putting this together, it's so many decisions to be made.

Stacy Smith: A lot of decisions do have to be made. As I mentioned just a moment ago, Rich, Patrice and I have been through this. We are past the age of 65. And when you reach that age, all of a sudden you're faced with Medicare and all of the aspects of it. So it is overwhelming for a lot of people.

Rich Gigliotti: I agree. It can be overwhelming. The reason being is there's many good options in our market here in western Pennsylvania. There are many avenues with plans to choose from. So not only health, but it's important to remember there is Medicare Part D prescription drug coverage, as well as ancillary benefits—dental, vision, hearing—that all go into decision making.

Patrice King Brown: But what should someone consider when they're first looking at this? And I remember how overwhelming this was and could not have done it without an advisor, frankly. But what's the first thing you should do when choosing a Medicare plan?

Rich Gigliotti: What I advise is look at your current health. It's important to realize how you're using your coverage, what's normal for you. When you're making these decisions, you don't want to make a decision on one aspect such as monthly premium. Sometimes in our market, a $0 monthly premium plan is a perfect fit. Other times there are plans in the $10–40 range that might be more adequate. If you are looking at potentially having an outpatient surgery in the near future, if you have large dental procedures planned—those are all factors that go into when you're making your choice.

Stacy Smith: All of those factors come in. So there are, as we mentioned, different kinds of plans, and I think we can break down the first two. And that would be a Medicare Advantage plan and a Medigap or a Gap plan, which is called a Medicare Supplement plan. So what's the difference between those?

Rich Gigliotti: Medicare Advantage plans and Medicare supplemental plans are both Medicare Part C. They work differently, however. Medicare Advantage plans encompass your medical. They encompass your ancillary benefits, dental, vision. Some plans incorporate gym memberships and over-the-counter benefits for things like vitamins, toiletry items, soap, socks, shampoo, things like that. The Medicare supplemental plans work with Medicare. Medicare continues to be the payee. The supplemental plan pays partial or full benefits after Medicare is billed. The Medicare supplemental plans also have a large national network. Most providers that are contracted with Medicare would be considered in-network with supplemental plans, so they provide a more flexible network at times.

Stacy Smith: How would one go about choosing which one is best for them between these two?

Rich Gigliotti: So that's what I like to call the meat and potatoes of what we do. That's when we sit down together and review how you have used benefits over the years, how you anticipate using your benefits in the future. We put together an idea of what that landscape looks like. And based on usage and cost, we start to formulate a path that we’d like to go down that would best fit coverage for that individual.

Stacy Smith: Every year you have to re-enroll and choose which plan you want. Can you switch between Advantage and supplemental plans every year?

Rich Gigliotti: You can. When you are in an Advantage plan and you can choose any of the other Advantage plans during the fall season. So in my world, that's called Annual Enrollment Period—October 15th through December 7th. You get to choose whichever of the plans in the market fits you best. With supplemental plans, you do continue to have the ability to change. However, supplemental plans are medically underwritten when you change. So there may be some questions about your history, your health history, that you would need to answer. You can also change from supplemental plans to Advantage plans year after year during that annual election period.

Patrice King Brown: Vice versa as well?

Rich Gigliotti: You have the ability to. However, there is medical underwriting when you're changing to a supplemental plan from an Advantage plan.

Stacy Smith: Basically medical underwriting is they're going to take a look at preexisting conditions or am I wrong on that part?

Rich Gigliotti: You are correct. Yes.

Patrice King Brown: And what about the drug plans? I mean, the drug plan I would think is very important.

Rich Gigliotti: Absolutely. So one of the things that is most important with prescription drug plans is making sure that your prescription medication is covered in the specific dosage your doctor recommends. Most of our Advantage plans will have a Medicare Part D plan incorporated into the plan. However, not all of them do. So when you're making your choice, that's an important aspect of what you need to be looking at.

Patrice King Brown: Now you mentioned the Annual Enrollment Period—which is, again, October 15th to December 7th. And this is the time everybody has an opportunity to look at everything. But one of the things that is happening during that time—there's so much information and now there's an end date. We know it has to. So I think sometimes people feel really pressured to make sure I get it right, get it in, and I'm not sure what to do. The decisions can be overwhelming. And there's something called decision fatigue during this Annual Enrollment Period. How does one avoid that?

Rich Gigliotti: That is a very real thing. What I always recommend is when you are looking at your plan options to look at what benefits you most, what makes our decision so difficult is we actually have many plan options that are strong, good options. And when you're choosing between good and bad, it's easy. You typically would choose good. However, in our market, we're choosing between good and good and good—which makes it quite difficult.

Patrice King Brown: Yeah. But that's good to know though, that there's so many positive options for something like this.

Rich Gigliotti: Absolutely.

Patrice King Brown: Yeah.

Stacy Smith: Unfortunately, a lot of times it comes down to the price of a plan, too. So talk a little bit about that.

Rich Gigliotti: Yeah. So when I sit down with someone, I'm looking at monthly premium and a regular amount of doctoring. So how many times do you see your primary care physician? What's normal and realistic for visits to [a] specialist office? So we look at monthly premium plus the costs that we anticipate as normal or realistic costs. So I had mentioned before about $0 plans. For a healthier person, those are a wonderful fit. If you see your PCP once or twice a year, maybe a specialist here and there, maybe one maintenance medication, $0 plans make a lot of sense. If you regularly see specialists, when you add those copayments in, sometimes it's better to look in that $10–40 range for the savings on the copayments as you pay your monthly premium.

Stacy Smith: Does Medicare require all of the plans to offer certain benefits—or coverage, I should say.

Rich Gigliotti: Yeah. So there is a baseline that all Medicare Advantage plans must follow to at least be the coverage they would receive from Original Medicare. Then the Advantage plans have the option to put additional coverages in as well.

Stacy Smith: All right. If you've signed up for one and all of a sudden, you find out you've got a major change in your health, what do you do at that point? Or can you do anything or do you just have to wait for the next enrollment period?

Rich Gigliotti: So there are many avenues to the rules and regulations for what's referred to as SEP, Special Election Periods in the Medicare world. Typically in our market in western Pennsylvania, we have an OEP, an Open Enrollment Period, January 1st through March 31st. So if you have had a life change, or perhaps if your doctor's office was acquired through the new year and they didn't make it public until January, and now your preferred providers are no longer in-network, we have an opportunity with Medicare Advantage plans to make one more change to get yourself in a plan that fits best.

Patrice King Brown: That’s good to know.

Stacy Smith: Rich, a lot of people are signing up for Medicare for the first time. They may have doctors who are affiliated with different healthcare systems. Does that make a difference in when you sign up for Medicare?

Rich Gigliotti: It certainly does. That's one of the first things we work on when I meet with someone is to look at their providers to check the provider network. That's an aspect of making choices right from the beginning.

Patrice King Brown: No, that's good. So what if now you've been healthy, things have been great and suddenly that knee kicks up or the hip's a problem and you learn you're going to end up needing an outpatient surgery, a joint or hip replacement of some kind. How do you plan for that?

Rich Gigliotti: Yeah. So that's a very normal conversation in my world, in the Medicare world. I would call that an everyday conversation. Typically, things like knee replacements, shoulder surgeries—you don't wake up and need a knee replacement. Typically, it's a long period of time. Most people will try physical therapy or other methods to alleviate the issue before surgery. That's an ideal situation because we know it's coming. We have time to look at that over the course of a year and make a decision during that Annual Enrollment Period for a plan that may have a slightly stronger benefit grid for things like physical therapy as well as outpatient surgery. There are always going to be times where something happens immediately. In our market, our Advantage plans have strong medical coverage. There is usually not much risk involved as far as financial for an outpatient surgery or even an elongated inpatient hospital stay with most of our Advantage plans in our market.

Stacy Smith: All right, let's just say that someone is not facing any changes in their health, and so the enrollment period comes again. Should they just stay with the same plan?

Rich Gigliotti: So that is an option. I always recommend if you're going to stay with your same plan, let's take five minutes and review it. The only guarantee in my world is everything's going to be a little different next year. So it's important to not get surprised. It's good to know what your benefits are. We have the luxury of about eight weeks each year where we can look at those updates. It's a great thing to be able to just automatically renew your plan, which means you don't make any changes in that Annual Enrollment Period. That means your health has stayed the same, which is what all of us really want, of course. But it is important to just be aware of those little changes and tweaks from year to year.

Patrice King Brown: How important are the extra benefits when you're comparing costs or when you're comparing plans?

Rich Gigliotti: So it depends on how your year's going to be. I view them as very important. You could be in a $0 plan, very healthy with no expectation of needing any medical services and you go in for a routine cleaning and your dentist tells you, "I'm sorry, we have to do a $5,000 crown in a month." So it's kind of like a water boy in professional sports. Who's the most important person on the team? It depends on what time the game is because if it's a timeout, the water person's the most important, not the quarterback. So at those times of need, it's very important to have a strong benefit so that you're not being strapped to come up with four or five thousand dollars without any time to plan for it.

Patrice King Brown: We've mentioned that it is a difficult process and anybody going through it knows that it can be challenging. What do you think are some of the biggest mistakes that are made?

Rich Gigliotti: So one of the most common things I see is a misunderstanding between two key terms in medical coverage. The term “deductible” and the term “maximum out-of-pocket” or MOOP as we refer to it. A deductible is something that you're responsible for before the insurance provider starts to pay. A maximum out-of-pocket is the opposite of that. A maximum out-of-pocket is a culmination of what has been paid by you throughout the year. Once you hit a maximum out-of-pocket, your financial responsibility on covered medical services becomes zero and your insurer then takes over all payments.

Patrice King Brown: And this differs between an Advantage plan and a supplement?

Rich Gigliotti: You are correct. Yes. The Advantage plans have maximum out-of-pockets on their plans so that when people are planning, they know exactly what a potential risk factor would be. Meaning, how much potentially in a worst-case scenario would I actually have to pay out each year? Whereas supplemental plans do not have maximum out-of-pockets because they're structured a little differently.

Stacy Smith: Can the maximum out-of-pocket be used as the deductible or are they entirely two different things?

Rich Gigliotti: So that's probably the best question you could have asked to understand exactly how they work. When you pay monies towards a deductible, that money—in addition to any other monies that you pay, copayments or percentages—each dollar is put towards the MOOP, the maximum out-of-pocket. So it's a culmination throughout your year of whatever you're paying for a covered service.

Stacy Smith: You've given us a lot of information today, Rich. I want to thank you for that. But where can people go if they want to find out a little bit more? Because it's coming up. They need to sign up.

Rich Gigliotti: Certainly, certainly. So I'm a licensed Medicare broker. Of course, I recommend reaching out to myself, my agency, or many others that do what I do. Another good option is to have a trusted friend or a family member. Even if they come into our in-person meetings or a phone meeting, it's good to have a second set of ears and a second person to ask questions, which can be very helpful.

Patrice King Brown: We've always heard, Rich, that if you're going to get sick, it's not a bad idea to get sick in Pittsburgh in this area because there's some really good medical care.

Rich Gigliotti: You are right.

Patrice King Brown: And knowing that there's support for people during this time as well for making plans makes a big difference.

Rich Gigliotti: Absolutely.

Patrice King Brown: Thank you very much for joining us. We have a few things for you to take away from our conversation today. To avoid becoming completely overwhelmed, focus on what is important to you and your health and your budget when reviewing your plan options. There are big differences between Medicare Supplement plans and Medicare Advantage plans, and there are benefits to both, depending on your specific needs and your budget. What works for one person may not work for someone else.

Stacy Smith: So you can contact a licensed Medicare Advisor or someone you trust to help you make your decisions. For more information, you can visit medicare.gov, cms.gov, or the UPMC for Life website, which is upmchealthplan.com/medicare.

Patrice King Brown: Again, the president of Gigliotti Insurance Group, thank you very much for joining us, Rich.

Rich Gigliotti: Thank you for having me.

Patrice King Brown: And we also want to thank you for joining us for this episode of “Medicare for the Record.” Hope you'll join us again soon.

Thanks for tuning in to “Medicare for the Record,” brought to you by UPMC for Life. To learn more about your Medicare options, visit upmchealthplan.com/fortherecord.

This podcast is provided for general informational and educational purposes only. It is not medical care or advice. For questions regarding medical care, please consult with your healthcare provider. Views and opinions expressed by the participants are solely their own and do not necessarily reflect those of UPMC Health Plan, its subsidiaries, parents, or affiliates.