Health Archives - Medicare

What Plans Can I Get Under Medicare Advantage?

Medicare Advantage Plans come in a number of types. Each type provides different networks, terms and conditions. These aspects may greatly impact the services you can receive.

Preferred Provider Organization (PPO) plans:

These plans incentivize doctors, health care providers and hospitals within the network. Your costs will be lower if you choose such providers.

Health Maintenance Organization (HMO) plans:

These plans allow you to visit certain doctors, health care providers, and hospitals, as long as they’re within a given network. Many primary physicians may have to provide referrals if you need to see specialized doctors. Medical emergencies are exceptions.

Special Needs Plans (SNPs):

These plans work best for certain populations that require certain types of specialized health care. Such populations include nursing home residents, people with chronic conditions, and people using both Medicare and Medicaid.

Medical Savings Account (MSA) plans:

These plans require a high-deductible and a bank account. Medicare then deposits funds into your account (typically below deductible). This money is accessible for health care services throughout the year. However, Medicare drug coverage is not provided. To receive drug coverage, you must join a Medicare Prescription Drug Plan.

Private Fee-for-Service (PFFS) plans:

These plans mirror Original Medicare. Typically, PFFS plans allow you to visit any provider or medical facility, if the plan’s payment terms are accepted. These plans differentiate payments based on the various types of doctors and providers. Required payments are made explicit.

HMO Point-of-Service (HMOPOS) plans:

These plans are modified HMO plans. Such plans permit you to receive certain out-of-network services, given a higher copayment or coinsurance.

A Medicare plan refers to a federal health insurance program designed for people who are 65 years or older, some young people having disabilities, and people who suffer from End-Stage Renal Disease (ESRD). ESRD is a condition in which kidney failure occurs in the body and there is a plan requirement of dialysis or kidney transplant. Original Medicare plan is health care coverage managed by the federal government. You must consider some vital points before choosing Original Medicare such as

Are you able to get health care from any doctor or a specific doctor?
Are prescription drugs covered in your Medicare program or not?
Do you require the help of a primary care doctor or not?
Do you need to get a referral in case you want to consult a specialist?
Do you need to include an additional supplemental policy or not?

There are different parts in the Medicare program including:

Medicare Part A that includes Hospital Insurance: The plan is aimed to include hospital stays, care in hospitals, and home health care.
Medicare Part B that includes Medical Insurance: This plan covers doctor’s services, medical supplies, outpatient care, and preventive services.
Medicare Part D that includes Prescription Drug Coverage: This plan is aimed to help the providers with the expenses of prescription drugs. If you are still confused about which Medicare Plan to choose, then seek advice from one of the prominent Medicare Insurance firms such as Chermol Insurance Solutions. Consider the following points while choosing a Medicare Plan:

Cost:

Assess your premiums, deductibles, and other expenses. Along with this, make a note of the bills from your hospital visits and doctor visits. Always ensure that you understand that the health care plans will save your overall costs. In Original Medicare, unless you have supplemental insurance, you are required to pay a huge amount for these out-of-the-pocket costs. While having Medicare Advantage plans, there is a limit imposed on the yearly expenditure, and all the additional services are also included thereby making the plan cost-effective for you.

Coverage:

Coverage refers to what is included in your plans. In original Medicare plans, medical services, hospital supplies, and other health care amenities are covered. Some services are included in Part A and Part B. In the health care plans, all the services specified in original Medicare are included, plus vision, dental care, and hearing coverage are included.

Additional Coverage:

If there are any extra coverages in your Medicare plans, such as prescription drug costs or additional health care, then you need to understand how it will be covered. In original Medicare, the supplemental coverage will include out-of-pocket expenses like coinsurance and deductibles. In Medicare Advantage supplemental coverage, the plan is cost-effective in that it offers vision, hearing, and dental care benefits. However, an individual cannot use the Medigap policy while enrolled in the health care plans.

Prescription Drugs:

One thing to think about is your need to sign up for a Medicare Prescription Drug Plan or if you already have signed up for creditable prescription drug coverage. You must also ensure that you do not have to pay a penalty later by completing all the formalities within the time frame. In original Medicare, you have to join Medicare Drug Plan Part D if you want to include drug coverage. In the Medicare Advantage plan, it is included in most plans. If your plan does not include prescription drug coverage, then you can join the Part D plan separately.

Choice of Doctors and Hospital:

You need to see whether the doctor you are seeing uses these plans or not. In the Original Medicare plan, you can go to any doctor who accepts Medicare whereas in the health care plan you need to seek and consult health care providers who are part of the plan. You’re required to find out whether doctors or pharmacies are within the coverage or out-of-coverage as some plans cover out-of-coverage networks also.

Quality of Care:

Quality of care covers the aspect of your satisfaction (or lack of) with your medical care. The quality of care may vary for each Medicare plan and the covered health care providers. Some people also choose a plan by seeing the ratings of previous customers and the health care services.

Travel:

The travel coverage in Original Medicare does not include the coverage outside the United States. You need to buy supplemental insurance offering emergency care while traveling outside of the United States. In the health care plans, the coverage does not include care outside the United States. Considering all the above-mentioned points you must choose the right Medicare plan. Your decision must be based on whether your requirements are met by the plan that you have selected. The Medicare plan must also match up with your health care needs and lifestyle. Therefore, it is advisable to take time while selecting the Medicare plans as various options are available for you to choose from. Your health care is a personal thing and therefore your Medicare plans must also be personalized. You must choose a plan that covers all your requirements and desires in accordance with your health care needs. The plan that you are choosing must be analyzed from all perspectives.

People who are nearing 65 years old usually qualify for Medicare plans. These plans will give you the necessary medical coverage that will be helpful for your healthcare needs. However, there are different aspects of Medicare. Medicare Part A, Part B, prescription drug coverage, and Medicare Supplemental Insurance are different Medicare plans. Choosing from so many plans might be confusing and overwhelming. To simplify the health coverage, you might sign up for a particular health care plan. The statistics suggest that approximately 19.8 million people in America enroll for Medicare Advantage plans and more than 2,700 health care plans are given to people in different states across America. Although, these plans are well-known and approximately 33% of America’s Medicare beneficiaries have been enrolled in these plans. There are experts in the Chermol Insurance Solutions who would guide you in evaluating, reviewing all the Medicare Advantage plans, and helping you in choosing the best plan for you.

Advantages of Medicare Advantage Plans

Easy coverage choices

The original Medicare plan gives two types of coverage, including hospital insurance and medical insurance. However, if a person wants extra coverage, then he or she will have to buy a Medigap plan that offers supplemental coverage, as well as a Medicare Part D plan that offers prescription drug coverage. Therefore, to avoid enrolling in different plans, the Medicare Advantage plan offers most of the coverage options in one easy plan.

Customized Plans Available

Considering your individual situation, Medicare Advantage plans can offer various options that can be personalized according to your needs. For example, if a person has a chronic disease, then choosing a Special Needs Plans (SNP) that target long-term benefits for the chronic condition can be beneficial for their healthcare needs. This is because it will help you offset the additional medical expenses. You can also choose from the Preferred Provider Organization (PPO) that has variable charges or Private Fee for Service (PFFS) that offers provider flexibility and special payment plans. Although, if someone wants additional services relating to dental, vision, or hearing care then consider choosing the Medicare Advantage plans that incorporate them as well.

Economical plans

Most healthcare plans include no premiums, thus offering providers with low to zero deductibles. One of the benefits of choosing an advantage plan is that these plans will limit the extra expenses for the year. People tend to save money that is usually spent on lab services or medical equipment by choosing the healthcare plans. In the Healthcare Maintenance Program (HMO) there are more savings through utilization of in-house doctors.

Synchronized medical care

If you want to include coordinated medical care, then there are various healthcare plans for that as well. With this plan, the healthcare providers have to coordinate activities between your different healthcare services and the medical specialties This ensures that you have a dedicated healthcare team just for you. This will avoid any superfluous expenses and extra issues such as medication interactions. In coordinated care, there have been more positive medical staff experiences and higher patient ratings.

Disadvantages of Medicare Advantage Plans

Some people may be satisfied with the Medicare Advantage plans. However, there are some disadvantages of the plans.

Providers provide limited services.

If people choose a popular healthcare plan like the Health Maintenance Organization (HMO) plan then they might be provided with limited services. You might end up paying a large amount of fees by choosing an out-of-network provider when covered by this plan. Although the other Medicare Advantage plans offer you more freedom, some of those plans may include higher premiums and fees including copayments and deductibles.

The offerings of some plans are complicated.

An individual must research the different options for the health care plan as they will vary with the person’s zip code. For some, choosing from all the options might be overwhelming. You must consider various tips and follow them to narrow down your search for the best health care plan. Some of the tips include:

How much can the person spend on the plans?
What prescription drugs will be required by them?
What additional coverage might you require such as dental, hearing, and vision?
Will the Medicare plan provide long-term health benefits?
What are the customer ratings for the particular plan that I am choosing?

Any extra expense for the coverage

In the original Medicare plan, there are premium, coinsurance, and deductible charges for Part A and B or any Part D or Medicare plans. Medicare Advantage Plans often combine all these expenses. However, an additional fee may be charged.

Coverage varies from state to state.

With the original Medicare plans across the United States, the same coverage is offered to everyone. However, the health care plans may offer specific coverage in particular service areas. This is important if a person is moving from one service area to a new service area, as his or her current Medicare Advantage plan may not be available there. Health care plans have advantages as well as disadvantages. Medicare Advantage plans do offer many benefits such as different plan options, convenient coverage, and long-term savings. You may experience some disadvantages such as lack of coverage while you are traveling, additional expenses, and provider constraints. Whether you select the original Medicare or other health care plans it is your choice. However, what you must take note of is understanding your healthcare requirements and Medicare options when choosing a coverage plan.

There are more than 60 million people who get their health care coverage through Medicare. About one-third of those choose to receive benefits from Medicare Advantage instead of the original Medicare plan. Many private insurers offer advantage plans and will constrain you in providing a specific network only of care providers. Although, Medicare Advantage plans are more cost-effective when compared to the Original Medicare. Medicare commenced in the year 1965. Many people call themselves the experts understanding the plans Medicare offers, but there are a variety of rules and options for the diverse Medicare plans. They all can be confusing. Refer to a Medicare Insurance Agency that will help you to choose the best plan and evaluate the benefits associated with each particular plan. There are 5 important things that you must know about health care plans:

You have to choose a Medicare Advantage plan from different options

As there are many Medicare Advantage option plans available, you do not have to choose a traditional Medicare plan. You can choose from:

Medicare Parts A and B: This plan aims to provide hospital care and access to any of the doctors or hospitals across the country that accepts the Medicare plan. This is also known as the “original” Medicare.
Medicare Advantage plan or Medicare Part C: This is a plan that an individual can buy from a private insurer providing the benefits of Medicare. Along with these options, you will need to also select a Medicare Part D plan that will provide you with coverage for prescriptions, including drug prescriptions. There is a supplemental policy that is referred to as a Medicare plan that many people also prefer to add as well. This will provide you with additional benefits, including deductibles. Some of the plans in Medicare also have a limitation on other expenses meaning that a person has a yearly limit of what he or she has to pay. When individuals choose a specific health care plan, it will include the prescription drug coverage as well. This ensures that you do not have to choose a separate plan for medications, such as through the Part D plan. Sometimes, the health care plans will also include eyeglasses and dental coverage as well. However, it varies for every individual’s plan.

Timeframe in which you need to sign up for Medicare Advantage Plans

There is a time period of 7 months total that is given to a person to sign up for the health care plans. The time begins 3 months that person turns 65, the month the person is born in and the three months following the person’s birth month. Some people may automatically become enrolled in Medicare Parts A and B whereas others may have to sign themselves up. If you are not sure which category you fall in, automatic enrollment or not, please reach out and check with the Social Security office. If a person is not enrolled automatically and fails to enroll within the time frame, they must enroll then they will have to eventually pay a penalty. The penalty will increase every month that it is unpaid. Therefore, you must be aware of when to enroll in your specific health care plan.

A person will not always qualify for Medigap plan

If you intend to enroll in the Original Medicare plan, then having a Medigap policy will be added as supplemental insurance. The Medigap will be paying some of the costs that are not covered in the Medicare plan, including deductibles and copayments. While your Medigap is open for enrollment then you are free to purchase any policy for Medigap according to your health status. Although, after that time lapses then you will not be able to get the most beneficial Medigap policy.

There may be limitations on dental and vision coverage.

Medicare plans may not cover dental care until an individual gets the dental services or applies for an emergency dental process while in the hospital. The eye coverage, including the provision of eyeglasses is also limited in the original Medicare plan. The plan may cover eye exams for some health condition, including macular degeneration and glaucoma. The hearing aids are also not covered and may require you to purchase the health care plan or supplemental insurance to accommodate those costs.

Medicare Advantage plan has various parts

You might confuse the health care plans with other health insurance plans and think that it is one-stop shopping. However, if you are signing up for a Medicare Advantage plan or traditional Medicare plan, then you need to also enroll for Medicare Parts B and D. These parts cover just the medical care of the patient and prescription drugs coverage. If you want additional coverage, then you might require a supplemental plan to help you in paying any extra expenses. If you still have any questions regarding Medicare plan then you must know that there is a State Health Insurance Assistance Program (SHIAP) for every state. The SHIAP has various counselors who are available to answer all of your questions regarding Medicare or the health care plans. You can also seek help from Chermol Insurance Solutions who will provide you with necessary information about the Medicare plans and help you decide which plan will be the best for you. The experts of CMIS will be there to assist you in choosing plans according to your health status that will include health insurance, medical insurance, dental, vision, and hearing along with emergency assistance. This can simplify your choice in selecting the Medicare plan that is best for you.

Why can’t I add an existing drug? Why isn’t my drug listed?
Plan Finder doesn’t include every drug that Medicare covers. The Plan Finder drug list is updated on a regular basis. If you can’t find your drug, contact your plan to find out if it is covered. Remember that Medicare drug plans may choose to cover some or all of the drugs that Medicare covers. Plans may also cover drugs that aren’t listed. Plan Finder doesn’t show pricing for over-the-counter drugs or diabetic supplies (e.g. test strips, lancets, needles), so these items can’t be added to your drug list.

Why are the drug prices I’m paying higher at my pharmacy than what Plan Finder indicates?
A number of factors affect drug prices: drug dosage and quantity selected, pharmacy selection, the subsidy level of the beneficiary, as well as the actual timing for drug purchases. Plan Finder provides estimated pricing for what you will pay at your pharmacy. If the dosages and frequencies you use on Plan Finder are different than what you’ve been prescribed, you may go into a coverage phase that may have an effect on the cost share you pay.

Why are some mail order pharmacies higher in cost than some retail pharmacies?
Generally, plans are able to negotiate more competitive pricing from mail order pharmacies, but this may not always be the case. In order to find the most cost-effective way to buy your drugs, refer to the Drug Benefit Summary popup you’ll find on the Plan Comparison and Details pages, or you can contact the plan.

Why is my plan charging extra for a certain drug?
Plans can have preferred dosages that are provided to beneficiaries at a discounted price. For example, a preferred generic version of a drug may cost the beneficiary less than the brand name drug.

When are drug prices updated on Plan Finder?
Plan Finder drug prices are updated regularly from October through August. Pricing for the current year is frozen in September in preparation for the new plan year’s display.