Archive for the ‘Seniors’ Category

Medicare Part C – Medical Advantage plans – Description of types, and your costs

Friday, January 27th, 2012

Private insurance companies offer the following types of coverage through Medicare Advantage plans:

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNP)

Other, less common types of Medicare Advantage Plans include:

  • HMO Point-of-Service (POS) Plans — An HMO plan that may allow you to get some services out-of-network for a higher cost.
  • Medical Savings Account (MSA) Plans — An MSA plan combines a high deductible health plan with a bank account.

Local HMOs and PPOs contract with provider networks to deliver Medicare benefits. Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) will cost participants the least amount of money for health care, but they are the most restrictive. For the most part, individuals are covered only when using the provider’s doctors, specialists, and hospitals.

In 2011, HMOs accounted for the majority (65%) of total Medicare Advantage enrollment. Local PPOs accounted for 18% of all Medicare Advantage enrollees.

Regional PPOs were established to provide rural beneficiaries greater access to Medicare Advantage plans, and cover entire statewide or multi-state regions. Regional PPOs accounted for 9% of all Medicare Advantage enrollees in 2011.

Private Fee-for-Service plans (PFFS) are the most flexible plans, but also the most costly. Participants are allowed to see their own Medicare-approved doctor or hospital who accepts the plan’s payment terms. They were originally authorized in 1997, but at the time they were not required to establish physician/specialist networks. However, since 2011, most have generally been required to do so. PFFS enrollment was approximately 0.6 million enrollees in 2011, which is 5% of all Medicare Advantage enrollees.

Special Needs Plans (SNPs), are usually HMOs with specific restrictions. Beneficiaries of these plans must be:

  1. Dually eligible for Medicare and Medicaid;
  2. Live in long-term care institutions (or would otherwise require an institutional level of care);
  3. Have certain chronic conditions.


From 2006 to 2011, the number of SNP enrollees has increased from 0.5 million to 1.3 million enrollees.

Medical Advantage Costs

According to the latest information from, participants’ out-of-pocket expenses depend on several different variables. These may include:

  • Whether the plan charges a monthly premium in addition to your Part B premium
  • Whether the plan pays any of the monthly Part B premium (some plans offer this option, usually for an additional cost)
  • Whether the plan has a yearly deductible or any additional deductibles
  • How much you pay for each visit or service (copayments)
  • The type of health care services you need and how often you get them
  • Whether you follow the plan’s rules, like using network providers
  • Whether you need the additional benefits and if the plan charges for it
  • The plan’s yearly limit on your out-of-pocket costs for all medical services


Sources used for this article:



Using Pennsylvania Medicare Supplement Insurance

Monday, September 19th, 2011

It seems Medicare beneficiaries deal with more and more complicated issues on a daily basis.  There are hundreds of choices for plans which compliment basic Medicare coverage, and for those living in the state of Pennsylvania, several Pennsylvania Medicare supplement insurance choices are available.  Most beneficiaries already have a supplementary plan, but may not understand the proper use of these plans.

Most Pennsylvania Medicare supplement insurance plans work with your Medicare benefits to provide extra coverage for expenses.  The problem is, not all of these plans work the same way and not all plans will provide 100% coverage.  It is important that beneficiaries understand their coverage and which insurance plans are available to them before incurring medical expenses.  A full understanding of your Pennsylvania Medigap insurance coverage will help you avoid surprise expenses after visiting a doctor or obtaining medical supplies.

To learn about your plan, read through your policy materials, or call the customer service line for your Pennsylvania Medicare supplemental insurance plan.  Ask the following questions regarding the policy:

– Does the plan cover 100% of any copay after Medicare pays?  If it doesn’t, you will have to pay some of the expenses, so find out what it does cover.  A common set up is for the Pennsylvania Medigap plans to cover 80% of charges after Medicare.  So, if the charge was $100, Medicare might pay $80 and put $20 toward a copayment.  The supplemental insurance would pay %80 of the $20.  This means they pay $16 and you pay $4.  This doesn’t sound like much, but the expenses can mount quickly if you are not aware of them.

-Does the plan cover deductibles.  Medicare has an annual deductible of $110 for its Part B benefit.  This is the benefit that covers visits to the doctor, some supplies and other outpatient procedures.  If the plan does not cover deductibles, you will have to pay this amount each year before your insurance kicks in.

-Does the plan pay for items that are non-covered under Medicare’s Part B benefit?  Some services and supplies are not covered at all under Medicare.  A very good supplement insurance will also pick up some charges for these supplies, although the majority of these plans will only follow after what Medicare actually pays for.

-Does the plan offer a Pennsylvania Medicare Part D Coverage?  You should always know if you have a drug benefit associated with your insurance, because it can save you a great deal of money at the pharmacy!  Standard medical insurance policies hardly ever cover prescriptions, so ask about this benefit before purchasing insurance.

-What providers can you use under the plan?  Generally, most supplemental insurances will pay for services provided by any Medicare eligible provider.  However, there are some plans which operate under a managed care environment, and providers must contract with them.  Make sure your doctor is contracted with the plan, if that is the case.

Once you fully understand your Pennsylvania Medicare supplement insurance, you can avoid extra expenses and surprise bills.

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!

Annual Enrollment Period for medicare supplemental insurance…Nov.15 – Dec. 31

Saturday, December 5th, 2009

November 15 -December 31, this time frame is called the Annual enrollment period. What that basically means, is that during this time you are able to switch any of your PA medicare plans with no or very little health questions.  

We are having a great success helping Seniors make well informed decisions, and getting into plans that are literally going to save them hundreds of dollars a year. Yet on the other hand, there are some Seniors  who aren’t covered like they really need to be, and I have been able to get them into plans that will give them exactly the coverage they are looking for!

We sell a wide variety of PA Medicare Supplements and Medicare Advantages, and Preciription Drug Plans, so I’m pretty confident that we will have something that will fit all of your needs at the right price.  Just give me a quick call and I’ll help in any way that I can.  (814)368-6980 and ask for Jessica!

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