Posts Tagged ‘medicare Advantage’

Medicare Supplement Insurance

Friday, February 24th, 2012

Medicare supplement insurance, also known as Medigap insurance, is insurance coverage designed to fill in the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover, like copayments, coinsurance, and deductibles. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Medigap insurance is different from Medicare Advantage because it only supplements the Original Medicare Plan. If you opted for a Medicare Advantage health plan, you cannot also buy a Medigap policy. Although you do have out-of-pocket expenses with Medicare Advantage, they are typically not as great as with Original Medicare.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium.

Insurance companies can only sell you a “standardized” Medigap policy. Eleven standard Medigap policies are available in most states. Each lettered plan — A through G and K through N — offers a different set of benefits, filling different gaps in Medicare Parts A and B coverage. All Medigap plans with the same letter provide the same benefits. Only the premiums and the sponsors of the plans vary. Insurance companies that sell Medigap policies don’t have to offer every Medigap plan. However, they must offer Medigap Plan A if they offer any other Medigap policy.

It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost.

You and your spouse must buy separate Medigap policies. Your Medigap policy won’t cover any health care costs for your spouse.

Generally, standard Medigap policies cover some or all of the cost of:

  • Your Part A deductible and coinsurance (i.e. the 20% that Medicare doesn’t cover) for hospital stays
  • Your portion of your doctor’s bills for Part B services
  • The first three pints of blood annually, if needed
  • Hospice care coinsurance

Medigap plans do not cover:

  • Long-term care to help you bathe, dress, eat or use the bathroom
  • Vision care, eyeglasses, hearing aids or dental care
  • Private-duty nursing
  • Prescription drugs, or any out-of-pocket costs for Part D plans

(AARP Medigap: Your Supplemental Insurance)

 

Sources used:

  1. http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/medicare-benefits-overview.aspx
  2. http://www.medicare.org/
  3. http://www.aarp.org/health/medicare-insurance/
  4. http://www.kff.org/medicare/
  5. http://www.aarp.org/health/medicare-insurance/info-01-2011/understanding_medicare_medigap.html

Part C – Medicare Advantage Plans – Reasons to choose one, enrolling, and leaving Medicare Advantage plans

Friday, January 20th, 2012

Reasons to choose an Advantage Plan

Qualified Medicare participants choose to participate in an Advantage Plan for many reasons. As we have already mentioned, Medicare Advantage offers additional coverage that original Medicare doesn’t have, such as vision, hearing, dental, and/or health and wellness programs. Most also include prescription drug coverage. Additionally, Medical Advantage plans also provide coverage for emergency and urgent care. Keep in mind that these additional coverages often come with additional monthly premiums that the participants are responsible for. In addition to your Part B premium, Medical Advantage participants usually pay a copayment or coinsurance for covered services, and as well as a monthly premium.

Many Medicare beneficiaries have a wider array of health plan options from which they can choose, when they enroll in a Medicare Advantage HMO or PPO. These plans typically offer Medicare recipients benefits at a lower cost because enrollees can only get covered health care through the plan’s network of providers. This restriction allows the insurance company to “manage” the costs. The result is that participants are allowed to obtain the best coverage they can get at a cost they can afford.

Enrolling in a Medicare Advantage Plan

Participants who enroll in a Medicare Advantage program will continue to receive all Original Medicare covered services. Additionally, you may be able to lower your out-of-pocket costs and also receive extra benefits and services that are not offered by Original Medicare. Whether or not you save money, as well as the number and type of extra benefits and services you receive is dependent upon which Medicare Advantage plan you sign up for.

Note: Private insurance companies that offer Medicare Advantage plans have the freedom to change the plans’ benefits on an annual basis. They can also decide whether or not they choose to continue participating in Medicare; they can join or leave the Medicare program at any time.

Qualified Medicare recipients must be entitled to Medicare Part A and be enrolled in Part B in order to enroll in a Medicare Advantage plan. Most recipients do not realize that not all plans are available in all areas. You can only enroll in a plan that is available in your area. Qualified individuals can enroll in a Medicare Advantage plan when they first become eligible, if they are new to Medicare.

Your initial eligibility time frame is a seven-month period called the Initial Enrollment Period (IEP). It begins three months before your birthday month (if your birthday falls on the first of the month, your birthday month is the previous month), includes your birthday month, and the three months after your birthday month.

Thereafter, if you are enrolled in a Medicare Advantage plan, you can only make changes to the plan or adopt a different plan during scheduled times called enrollment periods.

 One enrollment period is called the Annual Coordinated Election Period (AEP) and occurs from October 15 to December 7 of each year. During this time period, anyone with Medicare can make changes to their coverage such as selecting a new Medicare health plan and/or a Medicare prescription drug plan. Any changes made during this time will take effect July 1. For more information, go to Medicare.gov or call Medicare at 1-800-MEDICARE (1-800-633-4227).

Leaving a Medical Advantage Plan

As of January 1, 2011, there is no longer an Open Enrollment Period (OEP). Instead, there is now the Medicare Advantage Disenrollment Period (MADP). The MADP runs from January 1 through February 14. Participants can disenroll from their Medicare Advantage plan and return to Original Medicare during the MADP. By disenrolling from the Medicare Advantage plan, individuals may also enroll in a Part D Prescription Drug plan, whether or not their Medicare Advantage plan included prescription drug coverage. They are also then eligible to apply for a Medicare Supplement (Medigap) policy.

Participants may also qualify to leave their Medicare Advantage plan if they become eligible for a Special Election Period (SEP).

 Some examples of special election period qualifications are:

  • That you are in a MA plan that is leaving Medicare.
  • Your Medigap insurance company goes bankrupt and you lose your coverage.
  • You are in a MA plan and you move out of the plan’s service area.
  • You live in a Long Term Care Facility (e.g., a nursing home or rehabilitation hospital).
  • You are losing Employer or Union Group Health Coverage.

 

 

Sources used for this article:

http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-c.aspx

http://www.medicare.org/medicare-basics/part-c.html

http://www.medicare.org/medicare-basics/part-c.html

 

 

Thinking of Switching to A Modernized Medicare Supplement? (Plan’s M or N)

Tuesday, March 30th, 2010

First thing we need to do is figure out what type of plan you have now. If it is a Medicare Supplement, you are able to change plans any time during the year. If you have a Medicare Advantage Plan, unfortunately you have to wait until November 15 to make any changes, but right now is a good time to start learning!

It is important to understand what is and isn’t included in the new Medicare Supplement plans. It is also important to remember that no matter what company you choose to do business with, the coverages will all be the same. With Plan M, you will get the same coverage as you do now, BUT in exchange for the lower premiums, you will be sharing the cost when you go to the hospital. Plan M has been estimated to be about 15% lower than your Plan F premiums, just bear in mind, you will be responsible for 50% of the Medicare Part A deductible which is $1,100 for 2010. (That’s what I mean by cost sharing….)

This plan maybe be a perfect fit for someone that has not been to the hospital in a very long time, and doesn’t expect to go to the hospital in the near future, since the Part A deductible relates to inpatient hospital expenses. EVEN if you visit the doctor frequently, this plan may benefit you as long as the lower premiums save you at least $550.00 per year (half of the 2010 Part A deductible). If the premium savings isn’t at least $550.00, at best, then to change plans would be a terrible mistake.

Medicare Plan N also has a form of cost sharing, but in this plan, it’s a co-pay when you visit your doctor. In exchange for the premiums that are estimated to be about 30% lower, you will have a $20.00 co-pay when you see your doctor. If you go the E.R. (Emergency Room) you will be responsible for a $50.00 co-pay. IF you are admitted to the Hospital, then the co-pay is waived!!

Figuring out if this plan would benefit you may be a tad bit more difficult. What we would need to do is take a look at the number of doctor visits you expect to have over the next 12 months, figure out the co-pay’s and the savings, then make an informed decision as to whether it will be a significant savings or not, to justify a change.

For example: If you are like many seniors, you may visit one or more doctors every 3 months. One of my clients has four doctor visits every three months. His co-pays total $80.00 every three months in addition to his monthly premium. On an annual basis, the total co-pay costs would be $320.00. Now if his premium savings is less than $320.00, this plan would not benefit him, it would end up costing him a lot more in the end. I wouldn’t suggest him to change to this plan!!

Please be wise about your decisions… if you ever need a little help deciding, I’ll do my best to point you in the right direction. Just ask for Jessica!

Loving my job helping Senoirs with their Supplemental Insurance!

Tuesday, January 12th, 2010

    Not too many people can say that they love their jobs! I have been blessed with this wonderful job of selling Medicare Advantage and Medicare Supplements. What I love the most about my job is that I help Seniors to keep their supplemental insurance affordable.

   One of the biggest pleasures of being an insurance agent are the smiles on the faces of a struggling Senior that just saved $1200 a year in their Supplemental insurance, and it was I who steered them in the right direction.

   I hear so often from new clients who are turning 65, they say “I just don’t understand this whole mess! Sometimes you would think it takes a Philadelphia Lawyer to understand Medicare”, although I’m not a Philadelphia Lawyer, I can say that I understand Medicare and I get such enjoyment out of helping you to understand it.

   Daily, it’s my goal  to be honest and up front with each and everyone of the clients I meet. According to their testimonials, I have kept that goal, and I will continue in that goal!

 Please call if you have any questions, want a quote, or just would like to talk about your plan! I’d be more than happy to give you and honest opinion as to whether you should stay right where you’re at or if I have something that is better for you.

Behave and Take care!

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