Will Medicare Advantage premiums be lower next year?
A recent announcement from the Centers for Medicare and Medicaid Services (CMS) indicated that, on average, Medicare Advantage premiums will be 1 percent lower next year. Plus the CMS expects that enrollment in Medicare Advantage plans will increase by 5 percent.
"These predictions are just further proof that many Americans find that the Medicare Advantage plan options are the right choice for them," suggests Alan Weinstock, insurance broker, at www.MedicareSupplementPlans.
Medicare Benefits for 2011
The good news is that the CMS said that the majority of Medicare beneficiaries will see little or no change in their 2011 benefits. In addition, there will be more drug plans offering coverage during the donut hole, that period in prescription drug coverage when there is a gap in coverage. And, consistent with the Affordable Care Act (ACA), beneficiaries in most Medicare Advantage plans and original Medicare will gain access to preventive benefits with no out of pocket costs.
The CMS further indicated that nearly the same percentage of Medicare beneficiaries with current access to Medicare Advantage plans will continue to have access in 2011. That number is 99.7 percent. And all Medicare beneficiaries will continue to have many prescription drug plans to choose from.
Medicare Resources for Seniors
It's important that all Medicare beneficiaries, especially those who are new to the program, get the information they need to make the right decisions about the type of coverage they want: Medicare Advantage or original Medicare with a Medigap plan.
One way to do this is to read the Welcome to Medicare brochure put out by the CMS. This booklet explains which health care services and supplies Medicare covers and how to get those benefits through regular Medicare Part A (hospital insurance) and Part B (medical insurance). In addition, Medicare and You 2011, the official Medicare handbook from the CMS, is due out in mid-October.
Seniors may also want to reach out to service organizations for assistance. Medicare beneficiaries who have questions about Medicare Advantage, original Medicare or how changes from the Affordable Care Act (ACA) might affect them, should consider contacting their state Senior Health Insurance Program (SHIP), a free statewide health insurance counseling service for Medicare beneficiaries and their caregivers.
And for Medicare beneficiaries who are considering Medigap insurance to help supplement their Medicare coverage, speaking to a reliable insurance broker like the brokers at http://www.
Wherever you turn for information, be sure to be proactive and investigate your options before you turn 65.
Supplement For Medicare
Health care reform has sparked heavy debate regarding the appropriate supplement for Medicare. It is widely known that seniors ages 65 and above are eligible for government medical aid (Medicare) to assist in healthcare cost. Medicare covers a portion of senior's medical cost. Although government assistance is available, many seniors still lack ample funds to cover the holes in Medicare. Thus, seniors are left to decide whether to adopt a Medicare advantage plan or to simply adopt a supplement for Medicare.
Though this segment is dedicated to the appropriate supplement for Medicare it is prudent to explain differences in what Medicare advantage plans would provide as well. As stated above traditional Medicare covers certain medical needs for seniors. The government covers (by paying doctors and hospitals) certain senior medical needs based on a fee for service schedule. There are options for seniors to be covered by an advantage plan with 0 out of pocket monthly. It goes without saying that where one medical plan may be ideal for an individual; the same medical plan may fall short of covering another individual's needs. Advantage plans are plans in which the government pays insurers a specific amount monthly for every Medicare member that they enroll (the plans cover hospitals and doctors as well). Individuals covered under advantage plans are able to choose HMO plans which require advantage recipients to choose from a network of health care providers as well as PPO plans which allow for in network providers as well as out of network providers. It should be noted that individuals going outside of the network would likely have to pay additional fees. All advantage plans offer the same benefits (regardless of the insurer). However, the benefit to the Medicare Advantage plans is that they cover things such as hearing, vision and dental care whereas traditional Medicare plans do not. Medicare Advantage has become increasingly popular due to the advantages provided over and above traditional Medicare. However, that is precisely the issue that critics raise. Advantage plans are said to "pay out" more than traditional Medicare plans. The congressional budget office has estimated that over 150 billion additional dollars has been spent in the last 10 years on advantage plans (that would not have been spent with standard Medicare). Ultimately, the additional expenditures mean more money spent by taxpayers. Which is why Medicare Advantage plans have been targeted by government and health care reform.
With Medicare Advantage plans being heavily scrutinized and funding likely to be cut at least to some extent, supplements are becoming more appealing. Where advantage plans offer 0 out of pocket, a supplement for Medicare would require some payment by the senior. Where advantage plans replace traditional Medicare, a supplement for Medicare is literally that...a supplement that covers certain holes left by traditional Medicare. Therefore, Medicare is considered the primary plan and a supplement for Medicare is considered secondary to the plan. Medigap plans are also offered through private insurers at specific cost. Medicare supplement plans are also considered medigap plans as they fill the gaps left by Medicare. Gaps such as Deductibles, Coinsurance and Co-pays can be filled with an appropriate supplement for Medicare. Any doctor that accepts Medicare should accept a supplement for Medicare. Medicare participants must be enrolled in Medicare part b in order to be eligible to buy a Medigap plan. Medicare part b covers things like doctor services, outpatient care, home health services as well as some preventative services. There are several Medigap plans available and participants typically need not go through underwriting if they will attain the age of 65 within the next 6 months(and two months following their 65th birthday). Open enrollment occurs from November 15th through December 31st and this is the time that changes may be made by existing supplement users. Medigap options vary and are labeled A through L. Each plan offers different options to fill the holes left by traditional Medicare plans. Core benefits include hospital coverage for specific periods during Medicare benefit period, approved hospital cost for co-payments during specific periods, skilled nursing coinsurance, doctor deductibles, foreign travel emergency coverage, at home recovery, drug benefit as well as preventative care. Benefits vary from plan to plan and may be viewed in the Medicare handbook. You may also view supplement for Medicare options by searching Medicare resources at the Texas low cost health insurance site.
http://www.texaslowcosthealthinsurance.com, Medicare resources
Medicare and Medicare Advantage Update 2010
Q. What are the changes to Medicare in 2010?
A. Medicare is made up of three parts: Hospital Insurance (Part A), Medical Insurance (Part B), and Drug (RX) Insurance (Part D). Part A Deductible for 2010 is $1,100 for a hospital stay of 1 - 60 days, $275 per day for 61-90 days, and $550 day for 91-150 days of a hospital stay (lifetime reserve days). After 150 days, you pay all costs for the hospital. Part A also includes Skilled nursing facility and some home health care but not long term care. Skilled nursing facilities is subject to a $137.50 per day co-insurance for days 21-100. Part B covers Medicare eligible physician services, outpatient hospital services and certain home health services and durable medical equipment. You pay 20% of the Medicare-approved amount after you meet the $155 deductible.
Part D coverage is for both short and long-term prescription needs not given in the hospital, coverage for both brand name and generic drugs and can differ dramatically from one company to the other. Part D is not deducted from your Social Security check.
Q. Can you explain the difference between a Deductible, co-pay(ment) and out of pocket.
A. The deductible is the amount you must pay for health care before Medicare begins to pay. These amounts can change every year. A co-payment is a partial cost you will spend to see the doctor. These can be zero or more. These are out of pocket which are costs that you must pay on your own because they are not covered by Medicare.
Q. What are the differences in HMO, PPO, PFFS, SNP and MSA plans?
A. Health Maintenance Organizations (HMO)- Just like the private sector, HMO is a group of doctors, hospitals and other care providers that agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. You get your care from the provider in the plan.
Preferred Provider Organization (PPO)- Doctors, hospitals and providers that belong to the network and with most PPO plans, you can use doctors, hospitals and providers outside the network for an additional cost.
Private Fee for Service (PFFS)- These are sometimes referred to as regional PFFS since the doctor or hospital accepts payments from the insurance plan rather than Medicare. The Insurance plan decides how much it will pay and what you pay for the services you get. You may pay more or less for Medicare covered benefits.
Special Needs Plan (SNP) - A type of plan for people with chronic illnesses or conditions with special needs.
Medical Savings Plans (MSA) - A type of savings plan for those people who do not go to the doctor often but need a savings plan to pay some of the costs of the deductibles and co-payments.
Q. My Doctor takes Blue Cross but he does not take Medicare Advantage Blue Cross. What does that mean?
A. Medicare Advantage plans are a hybrid of coverage offered from an insurance company. When you are eligible for Medicare at age 65, you select Part C--Medical Insurance offered by a company. You still pay your premiums out of your social security check for Part B but the government pays the insurance company to administrate the benefits. These Medicare Advantage Plans appear to have many benefits and include Drug coverage (Part D). Medicare Advantage plans are the best of both worlds but they have some drawbacks. If your doctor is not a Medicare Advantage plan doctor, you will pay additional costs to see him/her but with most plans you can see another doctor (usually not available with HMO plan). You will be subject to separate deductibles and separate co-payments and often need a referral for approval before you can get care from the specialist. If you do not get a referral, the plan may not pay for your care.
Q. Since Medicare Advantage provides all Medicare health care through that plan, what if I don't like it? I have heard Doctors payments will be cut and the company I sign up with may stop insuring them. What protection do I have?
A. Since Medicare is a government provided plan for those 65 and older, you have many options for coverage. Every November 15 through December 31 you can switch from one Medicare Option to another--you can enroll in any Medicare Advantage or Part D at this time. This is called the Annual Enrollment Period. (AEP) Your new coverage would begin on January 1. From January 1 to March 31 Medicare members can make ONE plan change to a like kind. For example, you can change to another MA plan. The member CANNOT change Part D coverage during this time unless they have it with the plan they are leaving. This is called Open Enrollment Period (OEP). During Special Enrollment Period (SEP), members must enroll within 63 days of a special event. This is if you move outside the service area, move into or out of a long term care facility, loose credible prescription drug coverage, return to the US from another country or get assistance from the state in which you live, loose coverage under an employer or union either voluntarily or involuntarily.
Q. What other benefits do I get with a Medicare Advantage Plan?
A. You may get extra benefits by selecting a Medicare Advantage Plan. These may include vision, hearing, dental and/or health and wellness program including membership to a specific gym. Because you do not need to buy a Medigap or Medicare Supplement policy, the premium are supplemented by the government and are less expensive than a traditional supplemental plan.
Q. I hear there are many gaps in the Part D (Drug) coverage and I take 5 prescriptions a day. How do I get most of my drugs covered?
A. Every insurance company that offers Part D coverage has a written list of drugs. These include generic and brand name drugs. (Check the web sites or ask your agent for a printed formulary drug book.) Your plan may have several tiers and your co-payment amount depends on which "TIER" your drug is listed. Not all brand names will be covered and these can be very expensive if you have a high copayment or it is not listed. Always ask your doctor whether the drugs prescribed are available as generic. Be sure to ask your doctor whether you can split a high-dose version of the prescribed drugs as
they are often the same price as low-dose version or go to http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/MPDPFIntro.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home&ViewType=Public&PDPYear=2010&MAPDYear=2010&MPDPF%5FMPPF%5FIntegrate=N to compare drug plans in California.
Q. I like what I see--a policy issued by a leading insurance company that does not cost me the same as a Medigap or Medicare Supplement. Why should I buy a Medicare Supplement instead of a Medicare Advantage Policy?
A. That is a good question. If you can afford the individual premiums for a Medicare Supplement with a separate part D, you should do that. You can choose you own doctor as long as that doctor takes Medicare patients. Today many plans are a hybrid and some cost ZERO monthly premium and include a RX plans are also a PPO so people have the freedom of a PPO. As Seniors age, options and benefits become very important and we are here to help you decide which plan is best for you. Be confident in your Medicare Choices.
For the past 30 years, Karen Adams has been an independent insurance agent working primarily in Southern California. She has help hundreds of clients find the right insurance program to meet their needs. Rapidly approaching age 65, she decided to become as knowledgeable as possible about Medicare solutions. "I have written articles about Medicare Supplements and have insured clients who have reached Medicare age. Most Medicare Supplements (MS) are about the same and as long as a doctor takes Medicare he/she must accept the supplement their patient uses (not an HMO plan). Therefore, the advantage from one company over another is how easy they make their payment process, how patient orientated the company is, how large their network of Doctors and the premium they charge for the plan," says Karen. "Then came highly government regulated Medicare Advantage (MA) plans and the ball game changed. Now there is ZERO premiums with Drug coverage. What cost from $200 to $300 a month in premium in a supplement with a prescription drug card now appears to be free. What's that all about? Karen can help you untangle the web of MEDICARE insurance. Call her today or go to http://adamsinsuranceagency.com/ for your personalized quote.
