Medicare Advantage Plans - Advantages to Seniors

Some Medicare Advantage Plans have gotten a bad rap lately, but that may have been because of the overzealous marketing efforts of a few people, rather than the actual plans. All Medicare Advantage plans must be approved by the Center for Medicare and Medicaid (CMS). They must provide services that are equal to, or better than, services provided by the traditional Medicare Part A and Part B. Of course, the point of these plans is to provide services that will provide advantages over Part A and Part B!

What is the Problem With Medicare Advantage?

The recent flak over Medicare Advantage Plans is over the type of plan called PFFS (Private Fee For Service). These plans allowed access to "any doc", or the enrolled person's choice of Medicare care. The problem there was that the doctor or other medical provider had to accept and bill to the plan. Since some of the plans were very new, medical providers like doctors, hospitals, and therapists did not have the plans yet. This caused problems because the enrolled people needed to file the bill with the insurance companies instead of having the medical provider do it. Indeed, this did cause problems for many Medicare recipients.

What about other Medicare Advantage Plans?

Medicare Health Maintenance Organizations (HMO) and Medicare Preferred Provider Organizations (PPO) have been around a long time. Both of these types of Medicare Advantage plans use networks of doctors and other medical providers that have already agreed to participate in the plans. As long as plan members use their identification card, they are not experiencing a lot of billing problems. In general Medicare PPO and HMO members are expressing great satisfaction with their health plans.

A combination of private competition and federal incentives allow private plans to offer health plans that do deliver quality health care and save Medicare recipients money. The networks, once thought to be restrictive, actually ensure that medical providers understand and agree to the system so that system works more smoothly. These plans usually include the Part D or prescription part of Medicare too!

Who is Happiest With Medicare Advantage Plans?

Medicare Advantage plans appeal to people with moderate incomes. Medicare supplements can be a burden for seniors and disabled people on fixed incomes. However, many seniors with larger incomes also participate in Medicare Advantage plans because they come from the same companies that used to carry their old group or individual health plans, and they are comfortable with the medical providers in the network!

Medicare Advantage plans also provide satisfaction to those with specialized or chronic needs. Plans are available that address chronic conditions such as diabetes or heart problems, or those in nursing homes. Some plans even address the needs of caregivers!

You have choices about how to get the most out of your Medicare benefits!

M Katz is a licensed Texas insurance agent, who has been certified to work with many Medicare Advantage Plans. In her experience, the vast majority of her clients who chose Medicare Advantage plans or Medicare Supplements with traditional Medicare were satisfied because they chose the right plan for their own needs.

We have helped thousands of seniors and disabled people make the most of their Medicare benefits. If have questions about Medicare Benefits, consult with the Medicare Health Plan Experts at Trusted Senior Specialists Medicare Plans!

New Medicare Supplement Plans M and N Offer New Lower Premiums For Medicare Recipients

Due to the 2010 Medigap Modernization act which goes into effect on June 1st. 2010, there will be some changes regarding the current standardized Medicare Supplement Plans. These changes will not affect those who are already enrolled in a Medigap Plan prior to this date, and only applies to people enrolling on June 1st or after.

Medigap Plans E, H, I, and J are being eliminated by Medicare, however those who are currently enrolled in these plans will be allowed to remain in them with no changes. Two benefits that are also being eliminated are the At-Home Recovery benefit, as well as the Preventative Care benefit, as these were determined by Medicare to be completely underused by beneficiaries. Those who are enrolled in plans prior to June 1st. 2010 that contain either of these benefits will be allowed to continue using them.Other important changes include the addition of the Hospice benefit to all Medicare Supplement Plans, as it will now be a core benefit of all Medigap Plans.

The new Modernized Medicare Supplement Plans will also include two new plan letters that will likely be very attractive to those currently on a Medicare Advantage Plan. Those two plans are Medicare Supplement Plan M, and Medicare Supplement Plan N. Due to the rising costs of Medicare Advantage Plan premiums, and the growing number of physicians choosing to not participate in them, Medigap Plans M and N offer various cost sharing features that help in offering lower premiums for both compared to Plans such as Medicare Supplement Plan F or Plan G.

Medicare's new Plan M offers unique cost sharing options that are particularly attractive to Medicare beneficiaries who are relatively healthy. Plan M offers to pay 50% of the Medicare Part A deductible, which is $1100 per benefit period in 2010. For example, if you are admitted to the hospital and you have a Medigap Plan M, you would need to pay half of the $1100 deductible, or $550. The current rules still apply to the Medicare Part A deductible, in that if you are admitted and leave for 60 days or more, and then need to return within the calendar year, you must pay this deductible again.

With a Medicare Supplement Plan M, you are also responsible for paying the Medicare Part B deductible, which is $155 for 2010. Beyond this deductible there are no doctor's office co-pays and the 20% coinsurance will be paid by the plan.

Another new plan being introduced on June 1st. 2010 is Plan N. This plan also offers cost-sharing options to the beneficiary much like Medicare Supplement Plan M, however with Plan N they are in the form of co-pays.

If you are admitted to the hospital and have a Medicare Supplement Plan N, you are required to pay a $50 co-pay. For doctors visits there is a co-pay of up to $20 per visit, after you meet the Medicare Part B annual deductible ($155 in 2010). These co-pays allow for the premiums of Medigap Plan N to be lower than the current Medicare Supplement Plans available, also making it an outstanding choice for those who are coming off of a Medicare Advantage Plan (Whether the plan is leaving your area, or you are in the enrollment period and wish to make a change).

With lower premiums and cost sharing options such as co-pays and deductibles, Medicare Supplement Plans M and N should be an excellent option for people on Medicare, particularly those who do not mind paying portions of deductibles or co-pays.

Russell Noga is the owner of http://www.Medisupps.com an online independent agency and Information Center people can visit to learn about Medicare Supplement Plans and Rates in their area.

Paying For Home Health Care - What Do Medicare and Medigap Cover?

Prescribed only by a physician, home health care is skilled nursing care that aids in the recovery from illness, injury, or surgery in the patient's home. And fortunately for many seniors who are now opting for care at home, Medicare insurance covers most costs related to home health care.

The government, however, has set some limitations on payouts - you are only eligible if you need intermittent care (usually defined as seven days a week or less than eight hours a day over 21 days or less) (1), physical/occupational therapy or speech language pathology; you are homebound; and the home health care agency providing care is approved by your Medicare insurance program.

In addition to medication administration, general supervision, and therapy services, the Medicare home health benefit covers a number of other necessities, including medical aids and supplies to aid in recuperation. On the occasion, though, you may be required to cover some of the costs associated with home health care. But what can you expect to pay out-of-pocket that's not covered by Medicare dollars?

Medicare Insurance: Part A and Part B

Hospital Insurance (Medicare Part A) helps cover the costs of your inpatient care at hospitals, skilled nursing facilities, or religious non-medical health care establishments. Part A can also help cover hospice and home health care services. Individuals aged 65 and older are usually automatically enrolled in Medicare Part A and do not have to pay a monthly premium if Medicare taxes were paid while working. If you did not pay taxes, you are still eligible, but you will be required to pay a monthly premium.

Medical Insurance (Medicare Part B) helps cover services such as those offered by your physician and outpatient care. Many seniors maintain their enrollment in Part A, but elect not to use Part B, which requires a monthly premium that is dependent upon income, the requirements of which change yearly. Unfortunately, if you didn't sign up for Part B when you were first eligible for insurance, your premium may be slightly higher (2).

For questions on your Medicare insurance benefits, you should contact 1-800-MEDICARE or read the handbook mailed to you each year entitled "Medicare and You."

What's Covered and What's Not

Medicare insurance pays for physical and occupational therapy and speech language pathology services, counseling, some medical supplies, durable medical equipment (which must meet coverage criteria), as well as general assistance with daily activities which include dressing, bathing, eating, and toileting. For most other medical equipment, Medicare insurance will cover 80% of its cost (3).

However, Medicare will not cover twenty-four hour care at home, meals delivered to your home, and services unrelated to your care such as housekeeping. Of course, as mentioned above, you will be required to pay 20% for medical equipment not fully covered by Medicare insurance such as wheelchairs, walkers, and oxygen tanks (4).

In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse - the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.

Medigap and Other Out-of-Pocket Expenses

Medigap, a supplemental insurance policy, is sold privately and covers the services and supplies not paid for by Medicare insurance. When used in conjunction, Medigap and Medicare can often cover a large majority of the costs of your home health care. Insurance companies offer a variety of different Medigap policies (A through L), but since each one comes with specific benefits, you'll need to compare the highlights closely. Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).

For seniors with both Part A and Part B Medicare, your home health care situation is usually covered, save for the 20% out-of-pocket expenses for medical equipment. Just remember to keep track of your Medicare insurance benefits (and Medigap if applicable) by verifying with your physician, home health care agency, and insurance representative. Paying for home health care does not have to cost you an arm and a leg, but do be prepared for the occasional (but necessary) out-of-pocket medical expenses.

Sources

1. Centers for Medicare and Medicaid Services, Medicare and Home Health Care, page 6

2. Medicare website: "Your Medicare Benefits."

3. Ibid.

4. Ibid.

5. Medicare website: "Medigap (Supplemental Insurance) Policies."

Jill Gilbert is the President and CEO of Gilbert Guide, a comprehensive website helping seniors and their loved ones find a senior care provider along with extensive tools and resources to solve the challenges of aging. She is the author of "Leading by Example," a monthly column in McKnight's Long-Term Care News, the chief industry publication for long-term care providers. Jill has been interviewed for a CBS News special, was a key presenter at the Pennsylvania Assisted Living Association's annual conference, and was recently interviewed on San Francisco TalkBack.

Gilbert Guide was founded on the concept that quality matters, and its primary goal is to educate consumers on a breadth of senior care issues. Visit http://www.GilbertGuide.com for a comprehensive provider database, expert advice, and quality assessment tools that help consumers conduct their own "expert" evaluations of providers.

Medicare Supplement Insurance Helps to Make Sense of Medicare

Many of those over 65 who saved for retirement have retained greater economic flexibility than those hit by layoffs while still trying to amass savings. That makes seniors a very desirable market for several industries. In fact, senior marketing is the fastest growing marketing segment today.

In sharp contrast, one of the biggest marketing failures that can have seriously harmful complications for those over 65 surrounds Medicare. With multiple parts, two deductibles, partial coverage (only 80 percent) for doctors' services, no coverage at times (such as when you travel outside of the U.S.) and no reconciliation when doctors charge above what Medicare will pay, Medicare is a maze of contradictions. How do seniors calculate and plan for their health care costs?

In truth, both people under and over age 65 find Medicare often to be obscure and some simply give up in confusion. It's a sad comment on the "information age" that we haven't explained Medicare's coverage in a way that allows many seniors to estimate their expected health care costs and plan accordingly.

Medicare Supplement Plans Help to Translate Medicare's Coverage

Private insurers marketing Medigap insurance must explain Medicare, at least in part, to show the need for their plans to protect seniors from all the health care charges that Medicare won't cover. For many, private insurance companies discuss Medicare in ways that are more direct and more comprehensible to give seniors a better overall understanding of where the holes in Medicare's coverage put them at risk. The risk is real because hefty doctor and hospital bills far too often devour retirement savings forcing seniors to reduce their standard of living. Health care costs may be the single biggest concern for many seniors because their need for health care grows as they age and because health care prices are spiraling out of control.

A Medicare Supplement Can Cut Seniors' Medical Bills down to Size

With existing Medicare benefits in jeopardy (Medicare was extended beyond it's predicted bust in just eight years), baby boomers and seniors are exploring alternatives, such as Medicare Advantage plans and Medicare Supplement plans.

In the face of the new health care laws, Advantage plans are beginning to lose their subsidies. It's expected that these plans will become increasingly expensive with the decline of government subsidies. Medigap insurance, often called Medicare supplement insurance, is a viable alternative. With 10 different plans, each one fills the gaps in Medicare in a slightly different way so seniors are free to choose only the benefits they need without paying for any extras. Medigap plans cover Medicare's Part A and Part B deductibles to make seeing the doctor and going to the hospital when you need more affordable. These plans can also cover Medicare's co-pays and co-insurance charges, and certain plans expand Medicare's coverage to services beyond Original Medicare, such as emergency medical care when you're out of the country.

Confusion over Medicare Has Left Seniors Unprepared for Health Care Debt

Although millions are now enrolled in Medicare in order to pay for their health care needs, many remain unprotected simply due to a lack of understanding about the intricacies of the Medicare system. One of the biggest misunderstandings involves the Medicare "pre-approved" amount. Medicare only pays for 80 percent of a standardized amount for procedures. That doesn't stop doctors from charging more; it just shifts the burden of payment onto the patient. Doctors can continue to charge their regular fee, Medicare can continue to pay its standard payment and it's up to you to make those ends meet. Getting the right information is crucial to getting the most out of Medicare, and Medicare supplement insurance is one key to bridging the gaps in Medicare coverage.

By Wiley Long - President, MedigapAdvisors.com - The nation's leading independent agency specializing in Medicare Supplemental Insurance. Our professional MediGap advisors look forward to the opportunity to help you get the best insurance for your Medicare needs.

Medicare and Medicare Insurance - A Beginner's Guide to Understanding the Parts of Medicare

Turning 65 or going on Medicare for the first time can be an overwhelming experience in one's life. Coupled with that, most make an attempt, sometimes futile, to understand the complex world of Medicare and Medicare insurance. This article is to serve as a primer of the "parts" of Medicare, of which there are currently four, and what they do.

Part A

Part A is the part of Medicare that everyone gets from paying into the social security system during their working life (as long as they meet the minimum work amount requirements). The primary thing that it covers as inpatient hospital care, and you will sometimes here it referred to as the "hospital" part of Medicare. However, it does also cover skilled nursing facility care, home health care and hospice facility care.

Part B

Medicare Part B is optional - most people who have employer coverage that works with Medicare coverage do not necessarily need Part B until or unless their employer coverage ends. Medicare Part B has a monthly premium associated with it, that is typically paid out of one's social security check.

Part B covers "services" primarily, and it is sometimes called the "doctor's office" part of Medicare. Some of the primary things that it covers include doctor's services, diagnostic tests, outpatient services and physical therapy and some preventive-type screenings.

Part C

Part C is the portion of Medicare that was created in the last 10 years. It is sometimes referred to as "privatized Medicare", but is primarily known as Medicare Advantage. In Part C, a private insurer that has a contract with the government takes over management of all of your Medicare benefits. Your benefits are all provided through this private insurer - you pay premiums directly to this company and they pay claims on your behalf.

This is an optional part of Medicare. You still have to pay the Part B premium and you do not altogether "lose" Part A and Part B, but Part C does provide your benefits in place of A & B. Also, you can not have (or do not need) a Medicare Supplement plan and Part C - most elect to either have one or the other. Supplements pay AFTER Medicare pays; Medicare Advantage pays INSTEAD of Medicare.

Part D

Part D is the part of Medicare that you may hear about the most. This is the portion of the Medicare program that covers prescription drugs. It is offered through private companies, which must be certified and approved by the Centers for Medicare & Medicaid Services on an annual basis to offer this prescription coverage (Part D).

You pay premiums directly to the private companies, although most offer the ability to deduct it automatically from your Social Security check. This is an optional part of Medicare - not everyone signs up for it when they are first eligible or at all.

Secure Medicare Solutions is a leading, independent resource for South Carolina Medicare Supplement insurance and South Carolina Medicare Insurance. Our web site contains a bevy of resources for those Turning 65, including information about South Carolina Medicare Supplements.

Get Medicare Supplement Quotes to Compare Prices

If you are enrolled in Medicare part A and part B, you also qualify for Medigap, which is a supplementary Medicare insurance. Medigap is not going to be administered by the federal government in the same way as Medicare. It is offered by individual insurance agencies on a state to state level. It would be necessary for you to make your premium payments to these agencies, along with paying your premium for Medicare as well. Since there are differences in the amount of money that you will be spending for these premiums, getting a Medicare supplement quote can really benefit you by making sure that you're not paying too much.

One thing that you need to understand about Medigap insurance is the fact that it is completely standardized across the board. Each insurance company that offers Medigap insurance will offer the same exact policies as any other insurance company that offers those policies as well. There is not going to be a variation in the coverage whenever you're talking about the same policy. This can help you to make your choice easily as to which policy you need. All that is really necessary at that point is to get a Medicare supplement quote.

More than likely, you have already received a Medicare supplement quote from your insurance agency of choice. That doesn't mean, necessarily, that you need to stick with them. The Internet makes it very easy for you to get quotes on all of your insurance needs, regardless of whether it is for auto insurance, life insurance or even for Medicare supplement insurance. All that is needed is for you to fill out a simple form online and within minutes, you will be comparing these various Medicare supplement quotes, side by side.

Of course, you would want to check out any insurance company carefully before you decided to go with them. Just as you would not go with the fly-by-night automobile insurance company, you should not choose one for your Medigap insurance. You're going to want to make sure that the insurance company is approachable and that you will be able to go to them with any questions that you may have at any time. If you choose wisely, you not only be able to save money with this Medicare supplement quotes, you will also have an insurance policy that you can live with.

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