Tag Archive for medicare advantage

admin | 05/22/2013
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Understanding Medicare- Part D

Part D- This is a prescription drug coverage plan created to help cover most or all of you prescription drug costs and that is offered to anyone with Medicare . There are two ways to get coverage and they are by getting a Medicare Prescription Drug Plan (PDP) or through Medicare Advantage plans such as a Health Maintenance Oranization (HMO) or Preffered Provider Organization (PPO) plan. If you get it through a Medicare Advantage Plan, you get all of your Part A and Part B coverage along with Part D.

With a Medicare drug Plan payments include:

  • a monthly premium
  • yearly deductible
  • copayments
  • costs in the coverage gap
  • costs if you get extra help
  • costs if you pay a late enrollment penalty

Your actual drug care plan costs vary upon:

  • the drugs you are taking
  • the plan you choose
  • whether or not you go to a pharmacy in your plan’s network
  • whether or not your drugs are on your plan’s list of medications covered within the benefit plan

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

 

Category: Compare Medicare Plans, Medicare Advantage, Medicare Tips, Prescription Drug Coverage | Tags: , , , ,
admin | 05/21/2013
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Understanding Medicare- Part C

 

Part C- Medicare Part C, otherwise known as Medicare Advantage is a program that allows you to enroll in private health insurance that offers both Medicare Part A and B benefits. These are separate health insurance plans rather than supplemental insurance. Medicare Advantage can also include prescription drug coverage in addition to vision, hearing, and dental.

There are many different options for Advantage plans including:

1. Health Maintenance Organizations (HMO) – These plans are required to cover both Part A and Part B healthcare, but can also offer additional benefits. You are limited to physicians and hospitals that are within the network except for emergency care. These plans can lower costs making them less expensive than traditional Medicare plans

2. Preferred Provider Organizations (PPO)- These plans allow you to use doctors, hospitals, and specialists within the network but unlike HMOs you are allowed to use health providers outside the network at an additional cost to you without a referral.

3. Private Fee for Service (PFFS)- With this plan you can use any physician as long as they abide by the terms of the PFFS. This plan chooses how much it will pay for the services and you can spend more or less on PFFS plans than on the traditional Medicare Plans.

4. Medicare Special Needs- These plans are limited to people with certain diseases, disabilities, or other health needs and are customized to the needs of that specific group, for example those who have diabetes. These plans also include the Medicare Part D prescription medication coverage.

In addition to these plans, if you enroll in a Medical Savings Account you do not have to pay a monthly premium because you pay a high deductible. Once you pay for the Medicare Part B premium, pay for Medicare covered services, and reach the deductible, the plan will pay for Medicare services. These accounts do not include prescription drugs.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

 

Category: Compare Medicare Plans, Medicare Advantage, Medicare Tips | Tags: , ,
admin | 05/20/2013
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How to control retiree healthcare costs

Retirement is supposed to be a time of freedom from decades worth of hard work throughout your career and a point in your life where you feel financially secure. However, over the years we have seen healthcare costs rise dramatically, obscuring the image of a stress free retirement. According to an article by Fidelity, a couple retiring in 2013 is expected to need $220,000 to cover health care costs in retirement. While this is a big chunk of change for anyone to undertake, there are several ways you can manage your health care costs and feel comfortable as you approach retirement.

The first way in which you can manage these healthcare costs is knowing what is available to you in terms of health insurance coverage. You need to know what you need, where you can get it, and the cost of the coverage your looking into. Once you figure out your options you can start to answering these questions.

If you don’t have employer-based insurance, Medicare, a government-based insurance program is a great option to look at. There are four different parts (A,B,C,D) and you automatically qualify for Part A at the age of 65, which is hospital insurance, if you paid Medicare taxes throughout your career. The second part, part B includes outpatient care and is paid by a monthly premium. Lastly, part C and D are supplemental coverage plans that fill in the gaps not covered by A and B and include prescription drug coverage.

A second way in which you can manage your healthcare costs is deciding whether or not your going to be retiring early, or before the age of 65 when you start qualifying for Medicare. If you do retire early some of your options include: Medicaid if you qualify, paying to continue your employer based insurance, or purchasing an individual policy.

Due to the fact healthcare costs are one of the biggest expenses people now face it is a good idea to factor in these expenses into your income planning. According to an article in Fidelity, current retirees are now spending more on health care than they do on food. You can start figuring these numbers in your budget once you know how much the options your looking into cost. Its also a good idea to take into account your current health status and your family’s history of health as this information will help you determine what health issues you may encounter as you get older.

Another great way to counteract these upcoming healthcare costs is by setting up a health savings account or HSA by annually setting money aside for future expenses. These accounts are not subject to the if you don’t use it, you lose it rule making them very accountable. As a result, there are many ways to prepare and be ready for the healthcare costs you are about to encounter.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Citing: Fidelity Viewpoints. “How to tame retiree health care costs”. Medicare Solutions Blog. Admin. May 15, 2013. May 20, 2013.

 

 

 

 

 

 

Category: Medicare Tips, Senior Healthy Living | Tags: , , , , , , ,
admin | 07/17/2012
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Are You Ready For Annual Enrollment?

The Annual Enrollment Period is quickly approaching. This is the period of time where you can make changes to you Medicare coverage. Between October 15th and December 7th every year, you may join, drop, or switch Medicare Prescription Drug and Medicare Advantage plans. You may also choose to revert back to original Medicare Part A and B and leave third party coverage altogether. The changes you make will be effective for the following year, so it is very important that you make sure that you are satisfied with any changes you plan to make. Weighing your option in Medicare is difficult, especially when you are altering an existing Medicare plan. We at Medicare Solutions have put together a short list of questions to help you evaluate your current plan. That way you can make any necessary changes with confidence.

  • Are your monthly medications the same or have others been added that could possibly put you in the ‘donut hole’ sooner than expected?
  • Are you seeing the doctors you need or want to see? Are you visiting the doctor more frequently?
  • Are your copays manageable based on your habits or are they putting you over budget? Are the remaining copays after your Medicare discount still too high for your budget?
  • Are you seeing doctors that are within your network? If you are seeking treatment outside your network, how much extra is it costing you?
  • Does your plan charge a monthly premium? (In addition to your Part B premium)
  • Do you find yourself with a new diagnosis that requires extra benefits that were not included in your original policy choice?
  • Are you utilizing vision, hearing, dental and/or wellness health programs that may or may not be embedded in your policy?

If you are realizing that you aren’t satisfied with your current plan, don’t worry. You have plenty of time to explore different options and make any necessary changes. If you are not satisfied with your current Medicare Advantage plan, Prescription Drug plan, or even Original Medicare plan, then you may choose to do one of the following during the Medicare Open Enrollment Period.

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

Are you satisfied with your Medicare plan? Are you having second thoughts about your current coverage? Let us know in the comments section!

 

Category: Compare Medicare Plans, Medicare Advantage, Medicare News, Medicare Tips, Original Medicare, Prescription Drug Coverage | Tags: , , , ,
admin | 06/14/2012
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Your Medicare Plan’s Half Birthday

Medicare Plan Half BirthdayIf you opted to change your Medicare Advantage or Prescription Drug Plan during Open Enrollment last year, then you’ve had your new policy for over half a year. At this point, you most likely have a good sense of how the plan is performing for you and your needs. It is a very good idea to take this opportunity to evaluate your plan and decide whether or not you need to make use of the Open Enrollment Period this year. To make things a little easier, we have included a short list of questions to help you figure out if it’s time to explore new Medicare options.

  • Are your monthly medications the same or have others been added that could possibly put you in the ‘donut hole’ sooner than expected?
  • Are you seeing the doctors you need or want to see? Are you visiting the doctor more frequently?
  • Are your copays manageable based on your habits or are they putting you over budget? Are the remaining copays after your Medicare discount still too high for your budget?
  • Are you seeing doctors that are within your network? If you are seeking treatment outside your network, how much extra is it costing you?
  • Does your plan charge a monthly premium? (In addition to your Part B premium)
  • Do you find yourself with a new diagnosis that requires extra benefits that were not included in your original policy choice?
  • Are you utilizing vision, hearing, dental and/or wellness health programs that may or may not be embedded in your policy?

If the answers to these questions have you feeling that your plan isn’t meeting your current needs, it may be time to start thinking about a new one. The Medicare Open Enrollment Period runs from October 15th to December 7th. This may sound far off at this point in the year, but it is important to be prepared so you can make the right choice. If you are not satisfied with your current Medicare Advantage plan, Prescription Drug plan, or even Original Medicare plan, then you may choose to do one of the following during the Medicare Open Enrollment Period.

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

With so many options, it is easy to get confused. Changing your Medicare coverage is a big decision, and if you end up switching to a plan that is not what you hoped for, you’ll be stuck with it for the entire year. It is never a bad idea to ask for help in order to make the best decision. Medicare Solutions has licensed Medicare experts who can put difficult information into simple terms. And the best part is their expertise and advice is free of charge. Don’t hesitate to call 1-877-614-2333 today to speak with our Medicare experts to get the information you need to be ready for Open Enrollment.

Category: Medicare Advantage, Medicare Tips, Original Medicare, Prescription Drug Coverage | Tags: , , , , , ,
ElizabethGHoward | 02/10/2011
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Do You Know the Difference Between Medigap and Medicare Advantage?

Do You Know the Difference Between Medigap and Medicare Advantage?

Do You Know the Difference Between Medigap and Medicare Advantage?

Both “Medigap” and Medicare Advantage plans are often referred to as “supplemental insurance” plans in Medicare articles and literature.  This language is confusing and somewhat misleading. Do you understand the difference?

Nicknamed “Medigap,” it is technically the only real “supplemental insurance”; its formal name is Medicare Supplemental Insurance. Only people enrolled in traditional Medicare can use a supplemental insurance plan.

Medigap is NOT a government run plan. Medigap is private insurance. You can buy it to defray some or most of your out-of-pocket costs. These might include:

  • The hospital deductible for Part A, which is currently $1,100 for each hospital benefit period.
  • Part B costs such as the percentage you pay for doctor’s visits and outpatient services.
  • The costs of emergencies up to plan limits you incur when traveling overseas.
  • Other costs as defined by the plan.

 

There are 10 types of medigap policies, and they are legally standardized, which means that the benefits you get are the same, regardless of who sells them to you.

However, that does not mean you will receive the same price from each insurer so it’s a good idea to check around. To compare the benefits in each Medigap plan, enter your zip code at Medicare Solutions.com to get started.

Medicare Advantage is an umbrella name for a VARIETY of private health plans which include HMOs, PPOs, PFFS (Private Fee For Service plan.)

Medicare Advantage, called “Medicare Part C” is an alternative to the traditional Medicare program. Those who enroll in Medicare Advantage may NOT purchase a Medigap plan or a stand-alone prescription drug plan.

Each Medicare Advantage plan covers all the same benefits as traditional Medicare (called “Part A” and “Part B”), but the plans operate on the copayment system and may offer extra benefits. Sometimes the copayments are lower than traditional Medicare, and sometimes not. Each plan is different.

For example, some plans may include vision and hearing services, and include prescription drug coverage at no additional cost. However, most plans will require you to go to in-network doctors, or to pay high co-pays if you go out of network.

To compare Medicare Advantage plans, go to Medicare Solutions.com and enter your zip code to begin.

Category: Medicare Advantage, Medicare Tips, Supplement Medigap | Tags: , , , , , , , , , , , , ,
ElizabethGHoward | 12/15/2010
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Time to Make the Switch!

tax

Medicare Advantage Disenrollment Period Begins in January

Medicare Advantage health plan members can disenroll and return to Original Medicare from January 1 to February 14, 2011. This period is called the Medicare Advantage Disenrollment Period (MADP).

Regardless of whether your current Medicare Advantage plan included Part D drug coverage (PDP), you may disenroll during the MADP and will be eligible for a Special Enrollment Period (SEP) to enroll in Part D prescription drug plan. The effective date of a disenrollment request using MADP will be the first of the month following the date of the request. For example, a request made in January would be effective February 1.

Current Medicare Advantage-only (MA) plan members have three options:

  1. Disenroll from the MA-only plan and return to Original Medicare
  2. Disenroll from the MA-only plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
  3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-only plan

Current Medicare Advantage with Part D prescription drug (MA-PD) plan members have three options:

  1. Disenroll from the MA-PD plan and return to Original Medicare
  2. Disenroll from the MA-PD plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
  3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-PD plan

Current Medicare Advantage-only Private Fee-For-Service (PFFS) plan members (PFFS plans without Part D prescription drug coverage) have two options:

  1. Disenroll from the PFFS plan and return to Original Medicare
  2. Disenroll from the PFFS plan, return to Original Medicare AND use the SEP to enroll in a PDP plan

NOTE: PFFS members must first request disenrollment from the plan before requesting enrollment in a PDP.

If you have questions, call the Health Plan One Medicare expert at 1-800-328-7305.

Category: Medicare News, Medicare Tips | Tags: , , , , , ,
ElizabethGHoward | 12/09/2010
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Hurry! Just 22 days remain in Medicare’s Open Enrollment Period

senior cyclist

Medical plans change often, even Medicare. It’s important to review your prescription and health coverage and ensure you have the coverage you need.

During the annual Medicare Open Enrollment, going on now through December 31, people with Medicare can add, drop, or change their prescription drug coverage. They can also select a health plan for their 2011 coverage.

The Center for Medicare and Medicaid Services offer online comparison tools to help you decide what changes you need to make. The U.S. Government’s Medicare page also offers a “Plan Finder” that allows users to compare policies, research choices, and links to resources on enrollment.

Evaluate the “three Cs,” experts say, when you decide on a plan: cost, coverage and convenience. There are multiple factors such as mail-order services for prescriptions, coverage gaps, copayments, and others to consider as you weigh your options.

The online tools will assist you in estimating of your out-of-pocket costs and reviewing quality and customer service ratings from current plan members.

Since health care and prescription changes to Medicare can be confusing, an organization called State Health Insurance Assistance Program (SHIP) offers one-on-one counseling and assistance to families on Medicare.

Category: Senior Healthy Living | Tags: , , , , , , , , ,
KatieParker | 09/23/2010
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Ride the Medicare Advantage Roller Coaster

Enrollment Goes up and Premiums Go Down In 2011

11.3 million of the 46 million Medicare beneficiaries are cheering, because President Obama announced premiums for Medicare Advantage plans will be less costly next year. Meanwhile, enrollment next year should go up 5%.

MA plans (or Part C) are run by private insurance carriers but partially paid for by the government. They are more comprehensive plans than traditional Medicare. In additional to inpatient hospital or skilled nursing facility stays, MA plans also have dental and eye care. Medicare plans don’t have these extras, and Medicare recipients either do without these services or pay full price.

This news comes as a surprise because just yesterday, it was announced that premium costs for privately purchased individual and family insurance plans have gone up in the past year, and will likely continue to rise.  The New York Times reports that “…commercial insurance premiums for many people under 65 and many small businesses are increasing 10 percent to 25 percent or more.”

More surprising is the MA Plans will offer some additional benefits to seniors, as required by the Patient Protection and Affordable Care Act. These include an end to a cap on lifetime coverage. Some ‘luxury’ benefits such as discounted gym memberships, are gone.

“Despite the claims of some, Medicare Advantage remains strong and a robust option for millions of seniors who choose to enroll or stay in a participating plan today and in the future,” Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), said in a statement. “The Affordable Care Act gave us new authority to negotiate with health plans in a competitive marketplace. As a result, our beneficiaries will save money and maintain their benefits.”

In other words, the government strong-armed private industry to not increase the premiums or cost sharing, even though CMS reimbursements increase was well below the medical trend costs.

The health care reform law gave power to CMS to reject potentially new plans, and also gave them the ability to negotiate with insurance carriers over the benefits of their MA products.  Medicare officials said they rejected 7 plans offered by 3 companies, but most insurers re-jiggered close to 300 plans to be acceptable to the government. The most common rejected proposal included an increase to seniors’ out of pocket expenses that created a profit for the insurance carrier.

This is good for the consumers, short-term, for sure. They get more services for less money. But in the long run, will it last?

Category: Medicare News | Tags: , , , , , , , ,
Lucy Dylan | 07/15/2010
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Fighting Medicare Fraud

Medicare Fraud Identity Theft

Medicare Fraud Identity Theft

One issue plaguing the Medicare reforms is Medicare fraud. Every year, both seniors and the government lose quality health care and billions of dollars to corrupt providers.  Medicare fraud isn’t new (see my previous blogs on fraud and scams), but as the new health care reforms have passed, fraud has been in the spotlight. Medicare fraud affects everyone, from the government to seniors to taxpayers.

Cutting costs for health care is integral to health care reform. According to the United States government, taxpayers lose over 60 billion dollars every year due to Medicare fraud.  The government uses taxpayer money to finance Medicare, so when people abuse the system, it is the taxpayers who pay the price.

South Florida is the hotbed of these schemes, full of phantom pharmacies and providers, where criminals can earn tremendous amounts of money by cheating the government. Scammers sometimes purchase businesses like pharmacies, along with Medicare licenses and patient records, and use that information to charge Medicare for drugs and other services. According to a report by ABC news, one man’s Medicare card was used to purchase two prosthetic legs—even though the man had both of his legs, Medicare was slow to respond. Because Medicare moves very slowly, even when dealing with something like fraud, it is easy for con men to get away with their crimes.

Con men and fraudsters aren’t the only ones to participate in Medicare fraud schemes. Some corrupt health care providers overcharge Medicare for certain services that may or may have been performed improperly. Not only does this swindle the government out of millions of dollars, but also can harm the health of Medicare beneficiaries.  Most doctors and other providers are not involved in any of these scams, but the minority who do fraudulently charge Medicare waste government cash and harm senior health.

Preventing Medicare fraud could save the government—and taxpayers—billions of dollars annually, making it imperative to crack down on scammers and corrupt providers.  In the current system, responses to fraud are often slow and cumbersome, with little action taken. When Medicare cracked down on fraudulent equipment sales in South Florida, Medicare durable medical equipment claims dropped by $1.76 billion. By making more of an effort to combat fraud, it will be possible to save billions of dollars.

Recently the Department of Health and Human Services proposed that individual workers found responsible for Medicare fraud should be removed from the Medicare program.  Currently, only people who are still working for a company convicted of Medicare fraud can be excluded from the program, so employees can leave the company in order to evade exclusion.  Two Representatives from Florida proposed legislation that cracks down on individual executives, preventing them from working with Medicare after they have been convicted.

President Obama plans to sign a memo that would create a “do not fraud” list to combat Medicare fraud.  Consequently, the government would not send payments to deceased people, suspended contractors, or other delinquents to cut down on fraudulent payments. According to the Washington Post, within a three year time span, CMS sent approximately $182 million to dead people. CMS will use an online tool that will detect fraud, and provide more comprehensive background tests on providers, hoping to cut down on fake payments.

In general, I feel that the crackdown on such scams will be beneficial to the Medicare system. By preventing employees responsible for fraud from again working with Medicare, and keeping more detailed records of payments and providers, the government can save billions of dollars that will be better used elsewhere.  Hopefully these measures will improve the current health care environment in the United States.

Category: Medicare News | Tags: , , , , , , , , , ,
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