Medicare Advantage Plans and your Insurance Options

Just to make sure that you completely understand what medicare advantage plans are, the following is the official definition from the Centers for Medicare and Medicaid Services (CMS) -

The official definition – Same 2012 Medicare Advantage Plans - These medicare plans are medical plan options (like an HMO or PPO) which are approved by CMS/Medicare and marketed by private medicare companies. These sort of policies are sometimes called Part C or “MA Plans” and are all a part of Medicare and administered by CMS. A fixed amount is paid for your medical care by Medicare to the companies that offer medicare advantage plans.

Learn about Medicare reform and myths/facts here

All of these companies have got to follow all regulations and reforms that have been set or being created by Medicare/CMS.  Advantage plans are going to provide you with comprehensive (depending on the plan/premium that you choose) medical coverage and sometimes prescription drug coverage. These are not supplemental insurance plans, aka Medigap.

There are two fundamental points that you must understand about Medicare Advantage Plans:

Advantage Plans are part of Medicare. Enrolling in an Advantage Plan does not mean that you are leaving or dis-enrolling from Medicare. You are still in Medicare, your Advantage Plan is being administered by a private insurance company that must follow the rules set by Medicare.

A Medicare Advantage Plan is NOT supplemental insurance. Medicare Supplements  (Medigap) are offered by a private insurance company to work in conjunction with original Medicare to supplement or fill in the gaps that Medicare does not pay.

So, the first thing you must know before you join a Medicare Advantage Plan, is that you are not buying supplemental insurance. You are joining an Advantage Plan where your Medicare will be administered by a private insurance company and you are still enrolled in Medicare.

What Do Medicare Advantage Plans Cover?

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D) – learn more here.

Understanding the different types of Advantage plans – Medicare Advantage Plans 2012

When choosing a Medicare Advantage plan, it’s important to understand the different types of plans available and understand the plans rules before joining. Medicare Advantage Plans include the following:

• Preferred Provider Organization (PPO) Plans.
• Health Maintenance Organization (HMO) Plans.
• Private Fee-for-Service (PFFS) Plans.
• Medical Savings Account (MSA) Plans.
• Special Needs Plans (SNP) – Keep reading all of these are explained below.

All Medicare Advantage Plans for 2012 provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Which means that all the services/benefits that Original Medicare covers they’ve got too as well. However, each Medicare Advantage Plans can charge different out-of-pocket costs. These are usually co-payments but can also be coinsurance and deductibles. The following article from AARPMedicare offer some further insight for all shoppers:

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage, sometimes at an extra cost.

PPO Advantage Plans are another type – These plans are fairly predictable making them quite popular among seniors on Medicare. you’ve got a huge network of doctors and hospitals to choose from with a PPO, but using an out-of-network provider is an option for a specific service, it will be at a much higher price. With a PPO plan referrals are not needed and you can see as many different doctors as you’d like. You can get a PPO  with Part D prescription coverage included or without the coverage.

What is covered with a 2012 Medicare Advantage Plan?

• All the benefits of Medicare Part A, including hospital stays, skilled nursing care and home health care, but not hospice care. However, because you must be enrolled in Part A to get a Medicare Advantage plans 2012, your Part A benefit helps cover hospice care – See AARPHealthCare.
• All the benefits of Medicare Part B, including doctor visits, outpatient care, screenings, shots and lab tests.
• Prescription drugs, if Medicare Part D prescription drug coverage is included in the Medicare Advantage plan (many do include this coverage).

Some Medicare Advantage plans may also include coverage for extra services such as a fitness benefit or hearing and vision care.

Getting a Medicare PPO plan may be ideal for you and your family/spouse if you are okay with the network size, but prefer to have the flexibility to see multiple doctors and visit different hospitals for treatment.

Medicare HMO Plans – Cost sharing is more affordable making it perfect for a percentage of seniors. With Medicare HMO plans (no matter the insurer) you have got to stay within the network. There are exceptions which include: emergency care or dialysis services and out-of-network urgent care. Certain HMO plans will allow you to see a physician out of the network as long as you are willing to pay a higher price – see more on medicare plans for 2012 at Mostmedicare for 2013. Part D is included 99.9 percent of the time and getting referrals are always required as well as selecting a primary doctor, except for certain preventative care services. The following are some top plans (enter your zip code above to compare all plans):

• Anthem Medicare advantage  - Anthem is one of the most popular options.
• Cigna Medicare advantage – Not one of the most popular choices but still great for certain people.
• kaiser Medicare advantage – The differences with Kaiser senior advantage and how it all works.

If your living in a large area a Medicare HMO plan may just be the ideal policy to get your insurance coverage, since its networks are often comprehensive and cost sharing is relatively low – If you are living in California then another terrific provider Western Health Advantage, they offer some of the best plans in the industry. On the other hand, if you live in an area with a pretty small network or you travel extensively, a PPO plan might be the right choice.

Medicare PFFS Plans  - At first glance, PFFS plans give you a great deal of flexibility and independence, but getting covered services can often be unpredictable. You are not required to use a network and can choose your own providers, but the plan decides how much they will pay doctors and hospitals and how much you will pay for services. This said, you can go to any Medicare approved doctor or hospital if they agree to treat you. Not all providers will accept the plan’s payment terms or agree to treat you. In fact, they can decide to treat you on a visit by visit basis, except in the case of an emergency.

Click here to learn about medicare advantage dis-enrollment periods.

How do I enroll?

You can join a Medicare Advantage plan as soon as you become eligible for Medicare, or during your initial enrollment period. You’ll also need to enroll in Part A and Part B at this time.

Once you’ve joined Medicare Part A and Part B, you can’t be refused coverage by any plans in your area that are accepting new members. However, special rules apply to people with end-stage renal disease.

Each private insurance company that offers a Medicare Advantage plan handles the enrollment process for its plans. You’ll need to contact the company directly and ask how to enroll. Original here.

In some rural areas, PFFS plans may be your only choice (though your choices are fewer in 2011) because credible networks are difficult to put together by Advantage Plan carriers. Because of legislation to be effective in 2011, many carriers have ceased to offer PFFS plans in certain areas.

This legislation requires PFFS plan sponsors to offer a provider network to members in service areas where two or more network plans already exist. Assembling a credible network in less populated areas is more of a challenge than some plan sponsors are willing to under take. This has resulted in less Medicare Advantage options in those service areas.

Medicare MSA Plans – They are no where near as popular as any of the other advantage plans, MSA Plans are made up of two very different components/parts; a bank/savings account and a deductible (one that is relatively high). It works like this: Medicare gives over a lump sum of money to the policy and a portion of it is deposited into the bank account. You will have a ton of out-of pocket expenses since the sum that was deposited into your account is much less then the deductible. Your plan will cover everything for the year once the deductible is met. Any money that is left in the account can be used for your next year. Your MSA plan will not include prescription drug coverage, you are going to have to look into medicare part d plans for that. One of the pros to this sort of plan is that you will not need a referral to see a specialist or any kind of doctor in the network.

Choose a MSA Plan if you are extremely healthy and can cover the out-of-pocket expenses.

Medicare SNP Plans - Only a limited a very specific group of seniors can get access this type of medicare policy. For it to be the right fit, you are going to have to be dual enrolled with Original Medicare plus Medicaid, or if you have some sort of part in a certain type of institution, sort of like a nursing home, having a chronic health condition like heart failure or requiring bull-time nursing care at your own home, diabetes, HIV/Aids, among others. Medicare Part D will be incluided in any plan you enroll in and you will need a refferal to see a specialist and it will have to be one that is within the network (except for emergency and certain types of preventative care).

Consider a SNP if you meet the criteria for enrollment, as these plans are designed to best meet your needs by offering a higher degree of coordinated care and case management.

Understanding the different types of plans available and how they relate to your circumstances can go a long way towards a fulfilling experience in your Advantage Plan membership and usage.

Medicare Part C is an alternative to Parts A and B, delivered through a private managed care plan, such as an HMO. Also called Medicare Advantage, Part C combines Part A and Part B in one plan. If you enroll in a Medicare Part C plan, you don’t separately use or pay for Medicare Parts A or B. People enroll with Part C Medicare because it may cost slightly less than care with traditional Medicare Parts A and B, and because it sometimes offers a few minor extra services. Some Part C plans also have drug coverage (with one of these, there’s no need for a Part D plan). Part C plans limit the choice of healthcare providers from whom you get your care.

Are there limits to Medicare advantage coverage for 2013?

Coverage limits vary by plan, so you’ll have to look at the specific 2013 Medicare Advantage plan’s details to see if there are any coverage limits or exclusions.

Plans that include prescription drug coverage may have additional restrictions, such as the cost-sharing amounts you pay for your medications.

The advent of Medicare changed medical insurance for Americans over sixty-five. It was a much-needed program for those who were older and could no longer work to pay for medical insurance. It allowed America’s senior citizens to receive affordable medical care so that they could be healthier and live longer. Since 1965, when Medicare was signed into law, the program has undergone some significant changes and welcomed some additions in the quest to improve the quality of care that people receive under the program. One of the most popular recent additions to the program has been the Medicare Advantage Plan. You should now understand all about:

• Medigap vs Medicare advantage – the differences between the two.
• Medicare replacement plans – plans that can replace Original Medicare.
• Medicare advantage enrollment – The best times of the year to enroll in a plan.

Part of the Balanced Budget Act of 1997, the Medicare Advantage Plan allows Medicare beneficiaries to receive their benefits through private health insurance plans, as opposed to the original Medicare Plans (Parts A & B). Medicare Advantage allows beneficiaries the option of receiving insurance through the private plan of their choice. While these plans are often limited to a specific network of doctors, most companies allow you to pay an additional fee to see a doctor outside of the specified network. This allows beneficiaries to receive the care they want from the doctors they want and still receive their Medicare benefits, albeit in a different way.

• Medicare advantage news – Exactly what’s happening with 2012 Medicare advantage plans

The Medicare Advantage Plan also allows for a little more flexibility than traditional Medicare does. Medicare Advantage includes prescription drug coverage, and beneficiaries can choose Advantage plans that include dental and vision care as well as health club or gym memberships. Medicare Advantage places a heavy emphasis on preventive care. These advantages come with the condition that you must stay in-network for your care, but many beneficiaries find this trade-off more than reasonable. Overall, those who decide to participate in Medicare Advantage generally do so because they see the Advantage Plan as a better value than traditional Medicare.

But 2012 Medicare Advantage Plans are not perfect. Many people who were originally enrolled in Medicare Advantage have since switched back to traditional Medicare. The most common complaint of former Advantage Plan holders was that the quality of Medicare was less than satisfactory. If you think that Medicare Advantage sounds like the right plan for you, be sure to talk it over with your healthcare provider and, if you can, an insurance professional to make sure that you understand the differences between traditional Medicare and Medicare Advantage and the effects that each plan will have on your healthcare.

Click here here to learn some more about medicare advantage plans.