A Patient Advocate's View

2022 Changes for the Better ?

Seniors are buzzing about the news that social security is giving seniors a raise. The problem is that other things are going up and the raise doesn’t come near to covering them all. Groceries, gasoline, home heating and drugs are just a few of the things we can expect to pay more for in 2022. Many people are looking at Medicare Advantage plans to save some money on health costs. Advantage plans are advertising plenty of extra perks like no premiums, transportation, dental and vision care to lure seniors away from traditional Medicare. That’s the carrot approach, offer a treat. Then there’s the stick approach. NYC retirees are getting the stick. Either accept the Advantage Plan or opt out and pay a steep penalty.

Here is an article from Robert Intelisano, CSA, CLU, LUTCF aka The Insurance Doctor, Certified Senior Advisor

NYC Workers, Supplemental vs Advantage!

The BIG WINNER here is New York City, who has found some type of loophole and passed on the plan subsidy to the Federal Government.  We estimate the city will be saving about $200 per person.  I would not be surprised if there was some type of “class action” lawsuit against the city over the next 6-18 months. 

For hundreds of thousands of retired NYC workers, a big choice is looming during open enrollment!  Whichever path you take will determine how you get your medical care and how much it costs out of your pocket. The choice is not as simple as it appears.  Most people would ask, which one is better?  Answer is, “It Depends!”

The first decision is; do you want to enroll in Federally run “original” Medicare, or select a “Medicare Advantage” Plan?  For foodies, think of it as ordering a “price fixe” meal (Medicare Advantage) where most decisions are already made for you or going to “the buffet” (original Medicare) where you need to decide for yourself what you want.

Both options will cover your “pre-existing conditions” and you will be able to obtain coverage for prescription drugs.  Differences begin with going to the doctor.  Original Medicare allows you to choose ANY doctor that accepts Medicare.  A Kaiser Family Foundation survey said that 93% of primary care physicians accept Medicare.  If you are looking for a new physician, research needs to be done to see which doctors are accepting “new” Medicare patients. 

Under “Medicare Advantage,” you will be joining a “private health insurance plan” probably similar to what you had when you were working.  Most of the common private insurance plans are HMO’s (In-network only Health Maintenance Organizations) or PPO (in and out of network Preferred Provider Organizations).  Keep in mind, with the private plans you will likely need to see your PCP (primary care physician) first then get a referral to a specialist, which is more time consuming.  This can also be an issue if you travel out of state and have a health issue as you will likely need to go out of network which will cost more out of your pocket.

See my 5 top tips below on how to address this new “predicament!”

  1. Do Research:  Familiarize yourself with what Medicare Part A (hospitalization), Part B (physician and outpatient services), Part C (A Medicare Advantage Plan),  Part D (prescription drugs) mean. 
  2. Speak to a Licensed Professional:  Insurance brokers must get “re-certified” every year, which consists of passing multiple tests of their knowledge.  A trained Professional can guide you much more easily than trying to do it yourself.
  3. Don’t Wait Until the Last Minute: Waiting until the December 7th open-enrollment deadline increases the probability of making the incorrect decision.  Doing “nothing” is a decision as you will automatically be put into the Empire Blue Cross (or Emblem) plan.  Many people will see “FREE” and choose that option, which could lead to higher co-pays and more money paid “out of pocket!”
  4. Check With Your Preferred Doctors:  Make sure your doctor still accepts Medicare, which is frustrating for doctor’s offices to deal with the Government, delaying reimbursements and many other issues to deal with.  It is also important how much you utilize benefits and how many prescriptions you might be on.
  5. Determine Your Need for Dental, Vision and Other Services:  Under Medicare Advantage, you will get all of the services you are eligible for under original Medicare.  Some Medicare Advantage plans offer additional services such as vision, dental and some gym memberships.  The Government has been adding some services over the years like home improvements (wheelchair ramps), transportation to doctor offices and getting meals delivered.

Remember, with the Advantage plan the insurance company and your doctor make your health decisions whereas with the Supplemental plan it is YOU and your doctors making these decisions!

Whatever you do, take time to do the proper pre-planning as these choices can have a big effect on your next 12 months of care. 

You can see more about Robert Intelisano at

November 9, 2021 - Posted by | Uncategorized

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