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Prescription Drug Coverage and Medicare Supplement and Advantage Plans

 

If you are close to the age of 65 then you have probably been researching all of the benefits associated with Medicare health insurance. Because there are so many different plans with many advantages, it may be very difficult to decide what plan best fits your needs.

The Medicare Advantage Plan (Part C) is one of four different parts of the Medicare health care system. This plan allows those with Medicare parts A and B to receive coverage from a private insurance company that is government-approved. Medicare Advantage Plans consist of plans such as Preferred Provider Organization (PPO) plans and Health Maintenance Organization (HMO) plans. The largest and most well-known weakness of the original Medicare plan is that is does not cover the cost of prescription drugs. So, if you would like coverage for prescription drugs then you have a few options to choose from.

The Medicare Part D plan is obtainable to anyone who has original Medicare (Parts A and B). This plan is designed to provide coverage for the costs of prescription drugs. This plan is available through private insurance companies that have been approved by Medicare. If you have a supplemental Medicare insurance policy (Medigap), it may actually cover prescription drug costs. If it does not, then you can obtain a Medicare Prescription Drug Plan with Medicare Part D, but you must notify your insurance company if you choose to do so. It is also important to know what benefits your plan covers because supplemental Medicare plans will not always cover prescription drug costs.

Consider Medicare Part C (Medicare Advantage Plan) if you decide not to use Medicare Part D, or supplemental Medicare insurance. At an additional cost, these plans may offer prescription drug coverage through private insurance companies. So, if you obtain one of these plans then supplemental Medicare insurance will only be an alternative. Remember to check for additional coverage choices in your coverage history from past employers. You may have more options if your current or previous employer provided you with prescription drug coverage.

If you already own a Medicare Advantage Plan then it is not necessary to purchase a supplemental Medicare plan. Unless you completely drop the Medigap plan and use the original Medicare, it is illegal to purchase a supplemental plan. In addition, it is very difficult to get a supplemental plan in the future if you ever drop it, so be very careful. Before you ever make a decision that could affect your long-term health coverage, always discuss these issues with your insurance company or your State Health Insurance Assistance Program.

As you age, getting prescription drug coverage is always going to be an important component in any health coverage plan. Because you never know what health situations may arise, it is very important to choose a plan that covers prescription drug costs. So, if you choose Medicare insurance or a Medicare Advantage Plan, make sure to have some form of prescription drug coverage so you will be prepared for any medical situation.

Medicare Supplement Plans – Should You Choose Them Over Medicare Advantage Plans?

 

There are two choices available to individuals seeking Medicare coverage as well as the federal health care program. They are known as Medicare Supplement plans and Medicare Advantage plans. Although these plans are somewhat similar, overall, their benefits differ greatly. You must individually consider each plan and determine which has the best options in your situation. In most instances, when you qualify medically and can afford a supplement, or Medigap plan, it is to your advantage to purchase the plan.

The best rule to follow when trying to understand the differences is to remember that Advantage plans pay as a replacement for Medicare coverage, while Supplement plans pay after Medicare coverage. Advantage plans are known as the privatized form of the federal Medicare program, and they replace it altogether. However, you must still be enrolled in the government program, but they do not pay you benefits. Conversely, Supplement plans are available to fill in the "gaps" of coverage that are not paid by the government's program because they are designed to supplement.

There are several reasons why Supplement plans are generally more useful than the Advantage plans. Here are a few good reasons:

• You can use supplements at any doctor that accepts the federal Medicare program; however, most Advantage plans require that you stay in the network of doctors/hospitals that they are affiliated with. Also, these networks are not fully developed in some areas, so some people may have to drive a ridiculous distance just too see a doctor or go to a hospital in their network. This situation can be very irritating.
  
• Medicare supplements generally do not make use of cost-sharing, or deductibles and co-pays. Most supplement plans cover 20% of costs not provided through the federal program, in addition to one (or both) of the deductibles. On the other hand, Advantage plans make use of cost-sharing with deductibles and co-pays as a component in their plans. A great number of the Advantage plans require a co-pay of $15-$40 when you visit the doctor's office. Also, there is a daily co-pay for hospital stays for the first 5-10 days, plus deductibles and/or co-pays for hospital admission.
  
• Medicare supplements will not annually modify coverage because they have not changed and they have been federally standardized since 1992. However, Advantage plans are always modified each year, and in recent years, every change has been against the favor of the insured person.

For those over 65, the two insurance choices are Supplements and Advantage plans and there are specific benefits offered in each plan. However, if you are medically qualified and can afford a supplement plan, it is in your favor to choose the supplement for comprehensive insurance coverage for those over 65. Make sure to examine each plan and recognize what coverage you will need in your current situation before you finalize your decision. Insurance coverage is a necessity, so why not make the best choice for your health coverage?

New Changes to Medicare Supplements Coming in 2010

 

Medicare supplemental insurance has been available for awhile but many people in the White House believe it is time for some health care changes. In 2010, there are many new changes being made to Medicare supplements. It is obvious that not everyone will want to accept the new changes, but hopefully these changes will benefit a large portion of those with Medicare health care coverage.

There are a few changes that have already been discussed. One of these changes is that plans A through G are being phased out into new plans also labeled A through G. However, the old plans will not be totally phased out because those currently under the old plans will be grandfathered in and they will still be covered under those plans.

You must know that those that are just signing up for plans A through G will not necessarily receive the "new" Medicare supplement plans. This is due to the fact that they will be the same as the "old" plans. As you can see, this process is quite confusing, so make sure to have your questions answered before the new changes go into effect. Do your best to keep up to date with reports if you are currently under a Medicare supplement plan by researching on the Internet and reading medical news publications.

Another confusing aspect of the new changes to Medicare supplements is that those currently enrolled in plans A through G by June 1, 2010 will be placed in "closed risk pools." A closed risk pool means that people in the group will probably have to pay higher costs for Medicare supplement insurance.

Obviously, having rates go up may be very difficult for some people-especially those on a fixed income. In any case, after May 31, 2010, the insurance rates will be reset and the new plans will be available. For those that receive the "new" versions of the plans after June 1, 2010, there will be strong competition among insurance companies bidding for Medicare supplement business.

With increased competition, it generally means lower rates, and these lower rates have the possibility to stay in effect longer than we may expect. Frankly, it is difficult to predict how well the Medicare supplement insurance market will do in relation to premium costs. But, we can assume that in order to attract more customers, the rates will be lower in the beginning of these Medicare supplement changes.

Because of the radical policy changes occurring in the White House, we have no idea what else may change in Medicare health insurance. Just remember to stay up to date with policy and rate changes in the Medicare health care system and know that the medical news publications and Internet articles are a quick and easy way to obtain information about new Medicare changes. To avoid the confusion, just stay well-informed and educated on the subject of new Medicare supplement changes.

More Information:

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Learn the Differences between Medicare Supplements and Medicare Advantage Plans

 

Insurance company health plans that have a contract with CMS (Center for Medicare and Medicaid) are known as Medicare Advantage Plans. Anyone with Medicare Part A and B is eligible to receive a Medicare Advantage plan. For people with certain health conditions, Medicare also offers specialized plans; but the general plans are not allowed to reject a person based on a health condition except for very specific reasons.

If an individual is enrolled in a Medicare Advantage plan, they will not lose their Medicare. If they want to end their Medicare Advantage plan then they can re-apply for original Medicare after a month has passed. Instead of using a Medicare card, they must use the insurance card that is provided by the Medicare Advantage plan while they are enrolled.

Having a Medicare Advantage plan may cost recipients nothing, or a small fee; although many require the Part B participation amount. Instead of having a portion of tax money go to original Medicare, the plans receive a payment from CMS every month. This tax money pays for a high percentage of the Medicare Advantage Plans.

By tradition, Medicare Advantage Plans were believed to be like HMO plans, where an insured person could only use certain doctors, hospitals, and other medical providers under the plan in order for expenses to be covered. Surprisingly, many Medicare Advantage Plans are actually HMO plans; however, PPO plans are also available with Medicare Advantage. Often, Fee for Service Medicare Advantage Plans are marketed aggressively because these plans will cover any medical providers that accept the insurance.

To figure out which plan works best for you, you must assess your own medical needs and preferences. If your current medical providers have a contract with a Medicare Advantage Plan's HMO, then you may be very pleased with comprehensive coverage that has few extra payments. If you would like to have more choices, and doctors in your area will accept a Fee for Service plan, then an "Any Doctor" plan would be a good fit for you. Keep in mind that not all doctor's offices will work with the Fee for Service plans, although many insurance companies claim that all offices accept the plan. With PPO plans, you can receive the greatest coverage at a low price inside your insurance network, and you will still be covered even if you use a different medical provider.

The Part D plan of Medicare (prescription drug coverage) is included in most, but not all, Medicare Advantage plans. Also, beyond their normal Part B premium, most Medicare Advantage plan recipients may have a minimal, or nonexistent, monthly premium. Some Advantage plans will even refund the Part B premium altogether. If you are an applicant in poor health, you must know that Medicare Advantage Plans are not permitted to do a lot of risk selection based on health condition, so one of these plans may be the best choice for you.

Medicare Supplement Plans

The traditional Medicare Supplement plans are very different from Medicare Advantage plans. With Medicare Supplements you are able to still use your original Medicare card, in addition to the health card provided by the Medicare Supplement plan. Also, these plans are provided through insurance companies, but the insurance companies only supplement the coverage "gaps" and deductibles that original Medicare Part A and B do not cover.

If you already have Medicare Part A and B, then by having a Medicare supplement plan you will be able to pay any portion of your medical bill that is not covered by Medicare. Obviously, each Medicare supplement plan will differ from one another so you need to understand exactly what a Medicare Supplement plan will cover before you sign up. For example, Medicare may pay 80% of your hospital bill and the supplement plan will cover the remaining 20%. Medicare supplements generally provide the widest access to health care.

Choosing a Medicare health plan can be one of the most important decisions anyone eligible for Medicare can make. Because this decision is so important, choose someone skilled to help you find the right plan to fit your needs, lifestyle, and budget.

The Many Different Types of Medicare Advantage Plans

Medicare Part C, also known as the Medicare "Advantage" Plan, is a recent addition to Medicare health insurance. It is full of additional options for those receiving healthcare coverage through Medicare. Because it is "privatized," your insurance company takes over and manages all of your Medicare benefits while following government regulations.

For those receiving Medicare, Part A pays for in-patient care at hospital, hospice care, nursing home care, and in-home medical care. Medicare Part B covers most of a patient's medical expenses, while Medicare Part B covers nearly all of a patient's medical expenses for general care by a doctor. Medicare Advantage plans combine everything that Parts A and B cover while also covering the cost of prescription medicines.

Thanks to all of the benefits Medicare Advantage plans offer, they have become very popular. With these plans, Medicare recipients can stay longer in hospitals, pay lower fees for doctor's visits, and receive prescription drugs at a lower price. Also, recipients no longer need to be referred by a primary physician - you can receive care from the doctor or hospital of your choice without a referral.

Medicare Advantage plans are available throughout the United States through private insurance companies. Under government laws, Part A and Part B are always included in Advantage plans. Medicare Advantage plans can be HMO plans, PPO plans, or Private Fee for Service plans. The most popular choice is the HMO Advantage plan because it allows Medicare recipients to pay low or zero monthly premiums, and the lowest out-of-pocket expenses. Keep in mind that HMO Medicare Advantage plans are only available in metropolitan areas where a large number of Medicare recipients reside.

Conversely, a Medicare PFFS or Private Fee for Service Advantage plan permits the Medicare recipient to see the doctor of their choice as well as any hospital of his or her choice in the United States. Naturally, this type of Medicare Advantage plan is extremely popular among Medicare recipients because of the freedom it allows.

In the United States, Medicare Advantage plans are now offered in 98% of counties. Back in 1996, only a meager 15% of American counties offered these plans. According to the 2007 statistics reported on Medicare Advantage plans, the average American pays $736 in monthly premiums, although the actual monthly payments between states can vary from $500 to over $800 per month.

You should be advised that Medicare plan holders, who do not have End Stage Renal Disease (ESRD), or kidney failure, can qualify for a Medicare advantage plan. For anyone that is suffering from kidney failure, there are some counties that offer plans specifically for those that have kidney failure. Your Medicare plan must cover at least what traditional Medicare does, and it may cover more.

As you can see, the Medicare Advantage plan really does include many advantages. Your doctor visit co-pays are cheaper, prescription drugs cost less, and you have more freedom to choose the doctor and hospital that is right for you.

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