Get the Most from Your Medicare Advantage Plan: 2 Documents You Must Read
As my mom’s caregiver for the last three years of her life, I remember when I first enrolled her into a Medicare Advantage plan in St. Petersburg, FL. Having just moved her from Puerto Rico after Hurricane Maria, I was going to make sure she was taken care of correctly. When I received her card and plan documents, the card went into her wallet and the documents went into the filing cabinet. I never read them.
Fast forward a year and mom was being released from the hospital and I had NO CLUE what her benefits were: meals on wheels, rehab, home healthcare, inpatient hospital copay, etc.). Why? I didn’t take the time to read the Summary of Benefits nor the Evidence of Coverage. My laziness left money on the table in benefits she never used and caught me by surprise when copays and coinsurance bills arrived. Now, mind you, this was before I became an agent.
Well, since becoming an agent, I learned I was in good company, as the majority of people ignore them as well. Here’s the question: How many benefits are being ignored and lost, because we don’t know what’s in our plan?
So, let’s take a quick look at what they are and how to use them.
The Summary of Benefits: Your Plan in a Nutshell
As the name implies the SOB (not to be confused with another acronym, but I digress) is a summary of the plan benefits. It does not provide all the minutia (little details). It’s made for quick answers in a small booklet, usually about 12 to 16 pages long.
Some Summaries are more detailed, and some are simpler. For example, below are two snippets from two different Summary of Benefits. You will notice one gives little information and the other a more detailed breakdown.
In the first example below, you see a breakdown of how the copays would apply based on where one went for the service. You understand your options.
In the second example below, it provides you a range, but it does not give you the breakdown of how that range is applied. While you know you will have to pay at most $25, it doesn’t explain how it could cost you $0.
This is where the Evidence of Coverage comes in. When you need to know the details of the benefits, you will find it in the EOC.
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The Evidence of Coverage
If I were to look for the details regarding the simple SOB above, what I would find is a multipage explanation, breaking down each and every service it covers. Below is a partial of that explanation, as an example.
When we look at the first example above (the more detailed one), while it gave a pretty good breakdown of how you can get the lower cost copay, it doesn’t cover any stipulations there may be. If we look at the following snippet from the EOC of that plan, you can see there is more information.
Other Information You Will Find
Besides knowing your medical, drug and other benefits, you also learn:
- Your rights and responsibilities
- What to do if you have a problem
- How to file a complaint or ask for an appeal to a decision you don’t agree with
- State agencies contact information
- And more
Invest a Couple of Hours Reading
So, during this AEP, take a few hours and read your Summary of Benefits. If there is anything in particular you don’t completely understand, look it up in your Evidence of Coverage. And if you still have questions, call Member Services at the number on the back of your ID card or your agent. Don’t allow lack of knowledge that is available to you to either make you lose or cost you money by surprise. Become an educated beneficiary and you will love your plan.