Medicare Advantage Private Fee-for-Service (PFFS) plans dropped by Health Insurance Carriers

Health insurance carriers are dropping their Medicare Advantage Private Fee-for-Service (PFFS) plans, according to recent announcements by some health insurance providers, including Coventry and WellCare. A PFFS is a Medicare Advantage (MA) plan that is available through a state licensed, risk-bearing entity, or a PFFS Medicare Advantage Organization (MAO).

As a result of PFFS coverage drops by Coventry and WellCare alone, more than 500,000 Medicare plan holders will have to find new coverage.

At this point, Medicare Advantage plans receive government subsidies so that they can offer beneficiaries more benefits than simple Medicare plans. Medicare Advantage plans are offered to Medicare-eligible individuals by private health insurers. However, analysts are expecting the reimbursement rates for these PFFS programs to fall by approximately 5%, making them less profitable for insurance carriers.

How PFFS Currently Work

PFFS are popular amongst consumer s because they allow Medicare beneficiaries to choose their own healthcare providers, rather than having to select their providers from a limited number of in-network of Medicare-approved providers. Beneficiaries can see any provider, as long as the provider agrees to charge based on the PFFS fee schedule. This fee schedule is the same as the Medicare schedule.

PFFS MAOs have yearly contracts with the Centers for Medicare and Medicaid Services to provide Medicare beneficiaries with their Medicare benefits as well as additional benefits that a company opts to provide. A PFFS provider pays for healthcare instead of Medicare when a beneficiary has such a plan.

The main benefit (which makes PFFS so popular) is that individuals who join PFFS MAOs are not required to use providers within a network and can, therefore, see any provider as long as the provider is able to receive payment from Medicare and the PFFS MAO.

More Changes to PFFS Plans

In addition to the decreased government reimbursement amount for PFFS plans, PFFS plans will be required to develop healthcare provider networks beginning in 2011. The change will force PFFS plan holders to select their healthcare providers from within the plan network, limiting their freedom to see providers that they prefer.

Experts predict that more healthcare insurance providers will follow Coventry and WellCare by dropping their PFFS plans in coming months. Individuals should contact their healthcare insurance providers if they are currently enrolled in a PFFS or are considering enrolling in a PFFS to get more information about how their provider will respond to the upcoming PFFS changes.

More Information About Medicare Advantage Plans

Medicare Advantage plans are specific types of Medicare plans that are in place to cover the cost of healthcare related expenses for Medicare participants. These plans are similar to traditional Medicare plans in that they provide financial support for individuals seeking medical or health-related services. However, Medicare Advantage plans generally have more benefits and lower copayments than other types of Medicare plans. In order to have a Medicare Advantage plan, Medicare participants need to have Medicare Part A and Medicare Part B plans.

One major difference between Medicare Advantage plans and other types of Medicare plans is that Medicare Advantage participants may need to see only doctors that are members of the Medicare Advantage provider plan. However, plans may allow participants to use a wide variety of services, including Medicare Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service providers, and Medicare Special Needs providers.

Medicare participants should be aware that Medigap policies do not provide gap coverage for individuals that participate in the Medicare Advantage program.

Will Health Care Reform Kill Medicare Advantage?

It has been six months since the highly contested Patient Protection and Affordable Care Act, also called health care reform, became law. Polls show that people remain worried about how the law will affect their health care. There is a lot of talk about big cuts in Medicare, and seniors are worried their coverage will be reduced or that their doctors will no longer accept Medicare. Should they be worried?

The worst news is for people who love their Medicare Advantage plans. This program pays private insurance companies to enroll seniors in managed-care networks. Many plans offer more benefits than "plain" Medicare, such as dental and vision coverage and health club memberships.

The problem with Medicare Advantage is that taxpayer's aren't getting their money's worth from the program. Much of the recent increases in Medicare costs can be traced to overpayments to insurance companies offering the subsidized plans.You've heard that Medicare is going broke? Well, Medicare Advantage is a big reason for that.

A Medicare Advantage benefit costs the government 14 percent more than exactly the same benefit offered through regular Medicare. In some parts of the country, the difference is as high as 20 percent. That extra money is being eaten up in marketing and administrative costs, and in profits to the insurance companies.

According to the U.S. Department of Health and Human Services, all Medicare beneficiaries, including those enrolled in regular Medicare, are paying for these overpayments through higher premiums. HHS says that this year these subsidies are adding about $3.60 per month to premiums.

But there is no proof that the program is providing better health care than regular Medicare; just that it's more expensive. And for this reason, most of the cuts to Medicare provided in the health care reform law are cuts to Medicare Advantage, not regular Medicare.

These cuts won't go into effect all at once. In 2011, the subsidy going to private insurance companies will be frozen at 2010 levels. After that, the payments will be reduced an average of 12% per year, until costs are more in line with the cost of regular Medicare. Beginning in 2014, the private insurers offering Medicare Advantage plans must maintain a "medical loss ratio" of at least 85%, which is a fancy way of saying that 85 percent of the subsidies and premiums they receive must be paid out in benefits. On the other hand, companies that meet certain benchmarks for quality of service are eligible for a bonus.

Bottom line: according to the Congressional Budget Office, by 2019 the private insurance companies offering these plans will receive $136 billion less than they would have received at the current level of subsidy.

Naturally, the private insurance companies do not like this one bit, and they say they will drop out of the program if these cuts aren't repealed. And when those Medicare Advantage taxpayer subsidies stop being a cash cow for those companies, they might very well drop out of the program. Companies that stay in the program probably will eliminate some of the extra benefits that make Medicare Advantage popular.

Some seniors will be unhappy about this, but it's important for them to understand why it is happening -- Medicare Advantage as it is has been dragging the entire Medicare program closer and closer to bankruptcy.

Before the Medicare program began in 1965, only 56 percent of people over age 65 had any health insurance. Today, without Medicare, the percentage of seniors with health insurance would be very tiny, indeed. It's a sad fact that in our autumn years, nearly all of us will suffer increasing problems with our health. Some ailments -- arthritis, heart disease -- are common, and some are rare, such as mesothelioma cancer, rarely diagnosed before the patient is 50. Either way, senior health care is expensive, and private insurance companies don't want seniors as customers -- unless taxpayers are supplying the profits.

In 2009, while health care reform was being hotly debated in Congress and town hall meetings all over America, some insurance companies deliberately misinformed their customers about what the bill would do to their Medicare Advantage Plans. One major Medicare Advantage provider sent out a letter to its Medicare Advantage customers claiming that Congress and President Obama would cut "important benefits and services" provided by Medicare.

Remember the stories about silver-haired grandmothers marching in protests with signs saying "Keep Government Out of My Medicare"? People laughed at them, but it's possible those were misinformed Medicare Advantage customers.

But the Patient Protection and Affordable Care Act is not cutting any benefit from Medicare. In fact, it is adding a few new benefits. Beginning this week, Medicare patients will not have to pay a co-payment to the doctor for preventive care or for an annual checkup. The health care reform law also will gradually close the infamous "doughnut hole," the gap in Medicare Part D prescription drug coverage that costs some Medicare patients thousands of dollars every year.

Last year, the trustees of the Medicare program announced that by 2017, the part of Medicare that pays hospital bills would be out of money, and Medicare would have to stop paying those bills. This year, the same trustees said the hospital fund should be good until 2029, thanks mostly to the health care reform bill. This tells us the struggle to save the program isn't over, but we're moving in the right direction.

As we get closer to the November midterm elections, watch out for politicians citing the cuts to Medicare Advantage as a reason to repeal the health care reform bill. Without those cuts, Medicare itself is in grave danger.

Barbara O'Brien is a concerned citizen who writes the popular political blog, The Mahablog.

Will Health Care Reform Kill Medicare Advantage?

It has been six months since the highly contested Patient Protection and Affordable Care Act, also called health care reform, became law. Polls show that people remain worried about how the law will affect their health care. There is a lot of talk about big cuts in Medicare, and seniors are worried their coverage will be reduced or that their doctors will no longer accept Medicare. Should they be worried?

The worst news is for people who love their Medicare Advantage plans. This program pays private insurance companies to enroll seniors in managed-care networks. Many plans offer more benefits than "plain" Medicare, such as dental and vision coverage and health club memberships.

The problem with Medicare Advantage is that taxpayer's aren't getting their money's worth from the program. Much of the recent increases in Medicare costs can be traced to overpayments to insurance companies offering the subsidized plans.You've heard that Medicare is going broke? Well, Medicare Advantage is a big reason for that.

A Medicare Advantage benefit costs the government 14 percent more than exactly the same benefit offered through regular Medicare. In some parts of the country, the difference is as high as 20 percent. That extra money is being eaten up in marketing and administrative costs, and in profits to the insurance companies.

According to the U.S. Department of Health and Human Services, all Medicare beneficiaries, including those enrolled in regular Medicare, are paying for these overpayments through higher premiums. HHS says that this year these subsidies are adding about $3.60 per month to premiums.

But there is no proof that the program is providing better health care than regular Medicare; just that it's more expensive. And for this reason, most of the cuts to Medicare provided in the health care reform law are cuts to Medicare Advantage, not regular Medicare.

These cuts won't go into effect all at once. In 2011, the subsidy going to private insurance companies will be frozen at 2010 levels. After that, the payments will be reduced an average of 12% per year, until costs are more in line with the cost of regular Medicare. Beginning in 2014, the private insurers offering Medicare Advantage plans must maintain a "medical loss ratio" of at least 85%, which is a fancy way of saying that 85 percent of the subsidies and premiums they receive must be paid out in benefits. On the other hand, companies that meet certain benchmarks for quality of service are eligible for a bonus.

Bottom line: according to the Congressional Budget Office, by 2019 the private insurance companies offering these plans will receive $136 billion less than they would have received at the current level of subsidy.

Naturally, the private insurance companies do not like this one bit, and they say they will drop out of the program if these cuts aren't repealed. And when those Medicare Advantage taxpayer subsidies stop being a cash cow for those companies, they might very well drop out of the program. Companies that stay in the program probably will eliminate some of the extra benefits that make Medicare Advantage popular.

Some seniors will be unhappy about this, but it's important for them to understand why it is happening -- Medicare Advantage as it is has been dragging the entire Medicare program closer and closer to bankruptcy.

Before the Medicare program began in 1965, only 56 percent of people over age 65 had any health insurance. Today, without Medicare, the percentage of seniors with health insurance would be very tiny, indeed. It's a sad fact that in our autumn years, nearly all of us will suffer increasing problems with our health. Some ailments -- arthritis, heart disease -- are common, and some are rare, such as mesothelioma cancer, rarely diagnosed before the patient is 50. Either way, senior health care is expensive, and private insurance companies don't want seniors as customers -- unless taxpayers are supplying the profits.

In 2009, while health care reform was being hotly debated in Congress and town hall meetings all over America, some insurance companies deliberately misinformed their customers about what the bill would do to their Medicare Advantage Plans. One major Medicare Advantage provider sent out a letter to its Medicare Advantage customers claiming that Congress and President Obama would cut "important benefits and services" provided by Medicare.

Remember the stories about silver-haired grandmothers marching in protests with signs saying "Keep Government Out of My Medicare"? People laughed at them, but it's possible those were misinformed Medicare Advantage customers.

But the Patient Protection and Affordable Care Act is not cutting any benefit from Medicare. In fact, it is adding a few new benefits. Beginning this week, Medicare patients will not have to pay a co-payment to the doctor for preventive care or for an annual checkup. The health care reform law also will gradually close the infamous "doughnut hole," the gap in Medicare Part D prescription drug coverage that costs some Medicare patients thousands of dollars every year.

Last year, the trustees of the Medicare program announced that by 2017, the part of Medicare that pays hospital bills would be out of money, and Medicare would have to stop paying those bills. This year, the same trustees said the hospital fund should be good until 2029, thanks mostly to the health care reform bill. This tells us the struggle to save the program isn't over, but we're moving in the right direction.

As we get closer to the November midterm elections, watch out for politicians citing the cuts to Medicare Advantage as a reason to repeal the health care reform bill. Without those cuts, Medicare itself is in grave danger.

Barbara O'Brien is a concerned citizen who writes the popular political blog, The Mahablog.

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!

Top Carriers Dropping Medicare Advantage Private Fee-for-Service Plans

Top health insurance carriers are dropping their Medicare Advantage Private Fee-for-Service (PFFS) plans, according to recent announcements by some health insurance providers, including Coventry and WellCare. A PFFS is a Medicare Advantage (MA) plan that is available through a state licensed, risk-bearing entity, or a PFFS Medicare Advantage Organization (MAO).

As a result of PFFS coverage drops by Coventry and WellCare alone, more than 500,000 Medicare beneficiaries will have to find new coverage.

Currently, Medicare Advantage plans receive government subsidies so that they can offer beneficiaries more benefits than simple Medicare plans. Medicare Advantage plans are offered to Medicare-eligible individuals by private health insurers. However, analysts are expecting the reimbursement rates for these PFFS programs to fall by approximately five percent, making them less profitable for insurance carriers.

How PFFS Currently Work

PFFS are popular amongst consumers because they allow Medicare beneficiaries to choose their own healthcare providers, rather than having to select their providers from a limited number of in-network of Medicare-approved providers. Beneficiaries can see any provider, as long as the provider agrees to charge based on the PFFS fee schedule. This fee schedule is the same as the Medicare schedule.

PFFS MAOs have yearly contracts with the Centers for Medicare and Medicaid Services to provide Medicare beneficiaries with their Medicare benefits as well as additional benefits that a company opts to provide. Essentially, the PFFS provider pays for healthcare instead of Medicare when a beneficiary has such a plan.

The main benefit (which makes PFFS so popular) is that individuals who join PFFS MAOs are not required to use providers within a network and can, therefore, see any provider as long as the provider is able to receive payment from Medicare and the PFFS MAO.

More Changes to PFFS Plans

In addition to the decreased government reimbursement amount for PFFS plans, PFFS plans will be required to develop healthcare provider networks beginning in 2011. The change will force PFFS beneficiaries to select their healthcare providers from within the plan network, limiting their freedom to see providers that they prefer.

Experts predict that more healthcare insurance providers will follow Coventry and WellCare by dropping their PFFS plans in coming months. Individuals should contact their healthcare insurance providers if they are currently enrolled in a PFFS or are considering enrolling in a PFFS to get more information about how their provider will respond to the upcoming PFFS changes.

More Information About Medicare Advantage Plans

Medicare Advantage plans are specific types of Medicare plans that are in place to cover the cost of healthcare related expenses for Medicare participants. These plans are similar to traditional Medicare plans in that they provide financial support for individuals seeking medical or health-related services. However, the Advantage plans generally have more benefits and lower copayments than many other types of Medicare plans. In order to have a Advantage plan, Medicare participants need to have Medicare Part A and Medicare Part B plans.

One major difference between Medicare Advantage plans and other types of Medicare plans is that Medicare Advantage participants may need to see only doctors that are members of the Medicare Advantage provider plan. However, plans may allow participants to use a wide variety of services, including Medicare Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service providers, and Medicare Special Needs providers.

Medicare participants should also be aware that Medigap policies do not provide gap coverage for individuals that participate in the Medicare Advantage program.

By Wiley Long - President, MedigapAdvisors.com - The nation's leading independent agency specializing in Medigap coverage. Our professional medigap advisors will help you choose the best plan.

A Guide to Medicare Coverage

Signed into law by then-President Lyndon B. Johnson on July 30, 1965, Medicare coverage began as a social insurance program for American citizens age 65 or older. Today Medicare also covers citizens who may not be 65 years old but demonstrate need. Those suffering with Lou Gehrig's Disease, in need of a kidney transplant or have been receiving Social Security benefits for at least 24 months are all examples of people who qualify for Medicare.

Originally, Medicare coverage applied only to Hospital Insurance (known as Part A) and Medical Insurance (Part B). Former President Harry S. Truman was the first recipient of an official Medicare card, which then rarely entitled the holder to prescription drug coverage. As of early 2006, more comprehensive drug coverage was provided.

Medicare Part A

Part A of Medicare is Hospital Insurance, which will cover hospital stays, nursing home or assisted-living home care for a period of time. To receive the benefits of Medicare Part A, there are four main criteria that must be met, the first of which addresses only hospital visits:

The hospital stay must be a minimum of three days and three midnights, not including the day you are discharged
A nursing-home stay is covered only if the problem is diagnosed during the hospital visit outlined above. For example, if a respiratory issue sent you to the hospital, Medicare would cover a nursing home stay to help rehabilitate your lungs.
If you don't need rehabilitation at a nursing home but have an ailment that requires constant medical assistance or supervision, the stay would be covered.
Those caring for you at the nursing home have to be skilled. Part A of Medicare does not cover long-term, unskilled or custodial care.
Regarding nursing-home stays, Medicare will only cover 100 days per ailment. The first 20 days are paid for by Medicare in full; the next 80 days require a copayment of $128 per day (as of 2008). Whenever you go 60 days without using Medicare to help pay for a nursing home stay, the 100-day clock is reset and you qualify for a new 100 day period.

Medicare Part B

Part B of Medicare deals with Medical Insurance. This section covers most outpatient services and medically necessary products that Part A leaves untouched. Everything from doctor's visits to immnuosuppressive drugs for organ-transplant recipients are covered by Part B, including limited ambulance transportation.

In addition to outpatient doctor's services and treatments like chemotherapy, Part B helps you to pay for durable medical equipment (DME). Examples of DME include mobility scooters, prosthetic limbs, canes and oxygen.

Medicare Part C

Part C of Medicare deals with Medicare Advantage plans. After the Balanced Budget Act of 1997 passed, Medicare recipients were given the choice to either keep their original Medicare plan (Parts A and B) or receive their benefits through a private health insurance plan. After the Medicare Prescription Drug, Improvement and Modernization Act was enacted in 2003, those using private health insurance through Part C became known as Medicare Advantage (MA) recipients.

If you choose Medicare Advantage, Medicare will pay a set amount each month toward private health insurance. You're required to pay any additional premiums, and in many cases you'll have to pay a fixed copayment amount (usually around $10 or $20) each time you see a doctor. By law, the private insurance company you choose must offer a benefit package that is at least as good as the one provided by Medicare Parts A and B.

Medicare Part D

Medicare Part D provides coverage for prescription drug plans and went into effect at the beginning of 2006. If you use Medicare Part A or B, you are eligible for Part D. If you're using an MA Plan, you can adjust your benefits to take advantage of Part D, in which case the overall plan becomes an MA-PD.

To get Medicare Part D, you need to enroll in a Prescription Drug Plan (PDP) or change your MA coverage to MA-PD. Costs and benefits vary between the different plans, and medications that you need may not be covered by all plans. Some drugs, such as cough suppressants, benzodiazepines and barbiturates, aren't covered at all.

To get the best Medicare Part D coverage at the best price, you should compile a list of your prescriptions and talk to your pharmacist, MA provider or a Medicare representative. You can get a head start by visiting http://formularyfinder.medicare.gov/formularyfinder/selectstate.asp, which provides a list of Medicare Part D options by state when you provide your prescriptions.

Costs

Each year that you work, 2.9% of your wages are taxed under the Federal Insurance Contributions Act (FICA) and applied to your future Medicaid coverage. This 2.9% is split between employers and employees. Those who are self-employed have to pay the full 2.9% on their own. There is no limit to the amount of your wages that must be paid to FICA tax.

Once you're eligible for Medicare, it works like private health insurance. Your care provider bills Medicare for expenses, and you make up any differences that aren't covered.

Medicare coverage is limited, and while it can provide some protection for routine expenses or a minor injury, such as a broken leg, it's not a solution for long-term care needs. For this reason, it's a good idea to look into supplemental coverage, known as Medigap, to cover additional costs. While the monthly premiums for Medigap insurance can be high, they're still far lower than the medical bills that pile up in the event of a catastrophic illness or if you need long-term care.

For more information on medicare, visit the career and money section of Life123.com.

Understanding Medicare

What Is Medicare?

Medicare is a national, tax-supported health insurance program for people 65 and over and some persons with disabilities. If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A (Hospital Insurance) for free. Medicare Part B (Medical Insurance) is available at a monthly rate set annually by Congress ($110.50 in 2010 for incomes $85000.00 or less for an individual). Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office.

How Does Medicare Work?

Medicare is actually two separate types of insurance--hospital and medical. It is not intended to cover all your medical expenses. Hospital insurance (Part A of Medicare) covers medical treatment and surgical procedures performed in a hospital. It also covers hospice, home health, and limited skilled nursing care. Medical insurance (Part B of Medicare) covers part of the cost of doctor bills, outpatient care, medical equipment, and lab and diagnostic tests. With the Medicare modernization act of 2003, Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage), also became available, through private insurance companies.

How Do I Get Medicare?

If you are receiving Social Security benefits prior to turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday. IT IS BEST TO APPLY DURING THE THREE MONTHS PRIOR TO THE MONTH OF YOUR 65TH BIRTHDAY. If an application is made during that time, coverage will begin on the first day of your birth month. Applying later will delay the start of your benefits. You can also apply for Medicare from January 1 through March 31 every year after your 65th birthday. Your coverage then starts July 1 of the year you signed up and you will pay a 10 percent surcharge on the Part B premium for each 12 months you were eligible but not enrolled.

What If I Am Still Working? If you continue to work after age 65 or your spouse is working and you are covered by an employer group health plan (EGHP), you may want to delay enrollment in Part B of Medicare. Enrolling in Medicare Part B will trigger your open enrollment for Medicare supplement insurance at a time when you do not need supplemental coverage. The penalty for late enrollment in Part B does not apply if you are covered by an EGHP because of your or your spouse's current employment. If you do work after age 65, you may apply for Medicare Part B at any time prior to retirement, but you must apply no later than eight months after your formal retirement in order to avoid paying a premium penalty. Even if your employer offers a retirement health plan, you will want to sign up for Medicare Part A and probably for Medicare Part B when you retire. Most retirement plans assume you are covered under Medicare and will not pay for services that Medicare would have covered. Veterans may be eligible for special medical programs. However, eligibility and benefits are very restrictive and are subject to change. The Department of Veterans Affairs advises veterans to apply for both Parts A and B of Medicare to ensure adequate medical coverage.

What About Costs Medicare Does Not Cover? Medicare pays for only a portion of hospital and medical bills. As with many private insurance plans, the government expects beneficiaries to pay a share of their bills. Medicare Parts A and B both have deductible and coinsurance requirements. The deductibles for 2010 are $1100.00 per Benefit Period, for Part A. The Part B deductible is $155.00 per year. Private insurance is available to cover all or some of these out-of-pocket costs. These insurance plans are called Medicare supplements (also called Med Sup or Medigap plans).

Medicare Supplement Insurance

Medicare Supplements are standardized by the Federal Government. They are lettered A, B, C, D, F, G, K, L, M & N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add further benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. ONLY ONE MED SUP PLAN IS NECESSARY. You should only buy one Med Sup plan. No one should try to sell you an additional Med Sup plan unless you decide you need to switch policies.

Open Enrollment in Medicare Supplement Insurance At age 65, all consumers - including those already receiving Medicare due to disability - have a six-month "open enrollment" period. For six months beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can pick and choose whom they will cover. Other Options If you have an individual or "bank group" insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding what will work best. If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Some Texas residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. There are several Medicare Advantage plans available in several counties in East Texas. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services.

Should I Purchase Long-Term Care Insurance?

In the past, families often stepped in to help when older family members were no longer able to care for themselves. Today, with older people living longer, families often living long distances apart and more women working outside the home, fewer families are able to provide this care. A wide range of long-term care services is now available--day care, respite care, home care, and nursing care. These services are expensive and often exceed a person's ability to pay. People often mistakenly assume that Medicare will cover their long-term care costs. MEDICARE ONLY COVERS LONG-TERM CARE UNDER VERY, VERY LIMITED CIRCUMSTANCES.

Many Texas residents are eligible for Medicaid payment of their long-term care bills. Medicaid is a medical assistance program for people with limited income and assets. Eligibility is determined by the local county social services office. Private long-term care insurance is an option for people to consider, particularly if they have assets they wish to protect. You should not buy this type of insurance unless you can afford to pay the premiums every year. Remember, long-term care insurance premiums can and often do go up. Long-term care plans are not standardized like Med Sup plans. Therefore, it is very important to shop around and compare benefit options and cost.

David Hecker is a Licensed Insurance Agent based in Longview TX. He specializes in Medicare Products. He is licensed in Texas, Louisiana and Arkansas. He can be reached at (903) 918-9091. E-mail: dhecker@cablelynx.com or on the web at: http://www.tx-medicaresupplement.com To receive your "Free" e-mail newsletter about Medicare Supplements, send an e-mail request to: dhecker@tx-medicaresupplement.com Not connected with or endorsed by the United States government or the federal Medicare program.

Medicare Reimbursement Cuts - A Policy Perspective

This article will evaluate the challenges associated with Medicare reimbursement cuts. The amount of expenditure in this program has skyrocketed since its inception in 1965 despite various measures to control growth. Short-term legislative fixes have been buying time for the development of long-term solutions while various stakeholders stand to win and lose as they are faced with forthcoming reimbursement cuts. Among these stakeholders are the federal government, politicians, third-party payers, Medicare recipients, and healthcare providers. Foreseeable problems exist in implementing reimbursement cuts including barriers to patient care and the financial viability of healthcare providers who rely on Medicare patient revenues. Continual debate over short-term Medicare cuts will be eclipsed by policy changes related to the viability of the program and long-term sustainable healthcare funding and delivery systems.

Introduction

Health care spending currently accounts for 16% of the gross domestic product of the United States (Getzen, 2007). New technology and higher incomes have increased overall healthcare spending and driven up costs. The question raised, is how health care expenditure will be controlled within government programs like Medicare. The formation of Medicare and Medicaid by the Social Security Acts of 1965 established the government as a major payer in health care. Regular reimbursement through government funding allowed hospitals and other institutions to grow in size, capacity, and capital. Controlling growth and costs has become a major concern as proportional expenditure on healthcare has increased. Of the various cost-containing measures employed to control expenditure, reimbursement cuts are some of the most contentious issues.

Background and Significance

Medicare has evolved in numerous ways since its inception in 1965. Physicians were initially reimbursed by the program for services covered and were able to bill patients for non-covered costs. Hospital reimbursement methods also followed similar patterns until a change was made in 1983 from "reasonable cost" to the prospective payment system based on diagnostically-related groups. In 1992 the physician fee schedule replaced the charge-based system. The Sustainable Growth Rate (SGR) of 1998 was created to control spending even further. Annual targets for spending are established and physician payments are reduced if spending exceeds these limits.

The bulk of today's Medicare costs are different than those of the past. A larger portion of expenditure is attributable to outpatient services covered by Part B of Medicare. This expenditure has consistently exceeded the established formula as specified in the SGR. Forthcoming adjustments in the form of reimbursement cuts propose major problems for physicians receiving reimbursements for services rendered to their Medicare patients. "Whereas over the next several years the SGR formula will cut doctors' reimbursement by an estimated 25 to 35 percent...[and] deep cuts in physician reimbursement will force many doctors out of the Medicare program and leave many patients without access to a physician (H.R. 863 IH, 2007)." These cuts will have a significant impact on physicians and hospitals, and may exacerbate healthcare access barriers to Medicare recipients. New reimbursement cuts are especially troubling in light of evidence that the expansion of Medicare reimbursements to new areas of care can benefit patient health (Gross et al., 2006). The types and amounts of cuts to be made are largely dependent on legislation and actions on Capitol Hill.

Legislation

Legislative action on Medicare cuts is ongoing. A recent (February 14th, 2008) amendment was proposed in the House of Representatives to adjust conversion factors in Part B of title XVIII of the Social Security Act, increasing Medicare payments for physicians' services through December 31, 2009. These adjustments are temporary fixes in the challenge to create long-term solutions: "The purpose of this Act is to allow adequate time for Congress to determine an appropriate long-term solution for Medicare physician reimbursement rates (H.R. 5445 IH, 2008)." Legislative fixes are influenced by the various groups that are potentially affected by these cuts. Language in these resolutions seems to indicate this. A resolution on December 11th, 2007 in the House expresses the sentiment "...that the Medicare physician payment system must be immediately reformed in a long-term manner in order to stabilize Medicare payment to doctors, return equity to the program, and ensure that Medicare patients have access to a doctor of their choice (H.R. 863 IH, 2007)." Congress is continuously tuning reimbursement-related legislation to slow uncontrolled growth while appeasing powerful constituencies and interest groups.

The executive branch also plays a major roll in the determination of alternate Medicare cuts. The Bush Administration recently proposed a measure to control the explosive growth in the program. On February 18th, 2008, "the Bush administration...submitted a measure to Congress to reduce Medicare spending by increasing prescription drug plan premiums for higher-income beneficiaries and by increasing the use of health information technology, such as electronic health records, among other provisions (Carey, 2008, p.1)." This move was triggered by a condition of the 2003 Medicare law. When a financial warning is issued by Medicare trustees the administration is mandated to submit legislation reducing program spending or increasing revenue. "The warning is issued when trustees for two consecutive years predict that federal general fund revenue must be used to pay for 45% or more of total Medicare costs within seven years (Carey, 2008, p.1)." Monies required to pay for Medicare exceed allotted funds and the program's encroachment on other fund sources is closely monitored.

Stakeholders

Among the major stakeholders in this issue are the federal government, politicians, third-party payers, Medicare recipients, physicians and hospitals.

The federal government stands to win by moderating uncontrolled growth in the Medicare program. In recent years total expenditure and federal reimbursement has exceeded target rates. "By the 2000-2004 period, society was willing to devote over 20 percent of the cumulative increase in GDP and the cumulative increase in Federal outlays towards health care (Hartman, Smith, Heffler, & Freeland, 2006, p.41)." The growing size of Medicare threatens to encroach on other fund sources and programs. It is in the best interest of the federal government to reform Medicare and keep expenditure within manageable boundaries. Despite the benefits involved in implementing cuts, the types of cuts which are made have the potential for backlash. Cuts to reimbursements are exceptionally contentious in the healthcare community. The federal government must seek and implement responsible controls to mitigate harm while effectuating reform.

Politicians are another group affected by policies on reimbursement cuts. Their role is fairly complex as their duties and functions are reflective of the competing interests of different populations, groups, and political parties. Expenditure reduction and reimbursement cuts affect a wide range of constituents in different manners. The role of Medicare reimbursement cuts in political decision-making depends on how these groups are impacted. Politicians may win or lose depending on how the effects of these cuts unfold. The amount of healthcare lobbying that takes place on Capitol Hill speaks to the magnitude of interests involved.

Third party payers are heavily influenced by Medicare reimbursement methodologies. Medicare reimbursement cuts may likely equate to reimbursement cuts by other third-party payers, thus exacerbating many of the problems experienced by healthcare providers. Significant resentment already exists from problems associated with current reimbursements models and additional cuts may hurt payers in the short-run. In the long-run payers will benefit from moderated expenditure and more stable growth rates.

Medicare recipients are another prime group affected by cuts. A major concern associated with reimbursement cuts is the reduction of benefits and programs to these recipients. Technological advancement has provided patients with a vast array of services, procedures, and pharmaceuticals. Benefit and program cuts may translate into a reduction of these features which they have become reliant on. Reimbursement cuts may also contribute to barriers in accessing care. Lower reimbursements from Medicare may lead providers to be less inclined to accept new Medicare patients. Studies have already been conducted on barriers associated with general and specialized care related to payer type. In a study conducted on appointment setting for dermatology patients, "...some access limitations in hot spots where Medicare payments are low relative to commercial insurers suggest that patients in these areas may be most sensitive to further payment reductions (Resneck, Pletcher, & Lozano, 2004, p.85)." The case can be made that additional reimbursement cuts may further expand these "hot spots" for Medicare recipients. Additional barriers may emerge as the expected cuts related to the SGR come to fruition. In the short-term seniors stand to lose from reimbursement cuts but may benefit in the long-run from a more sustainable delivery system that can result from Medicare reform.

Physicians and hospitals stand to lose in the short-term. The healthcare community is at odds with current reimbursements models and believes that further cuts will significantly erode revenues. A study featured in Pain Physician acknowledges that "physicians in the United States have been affected by significant changes in the pattern[s] of medical practice...and escalating healthcare costs have focused concerns about the financial solvency of Medicare (Manchikanti & Giordano, 2007, p.607)." The payment rate cut which was released on July 12th, 2007 includes a 9.9% reduction. Many physician practices and hospitals will be drastically affected but may benefit in the long-run from programs that are moderated in growth and can remain solvent.

Implementation issues

Various groups are involved in seeking solutions to this problem including the Medicare Payment Advisory Commission (MedPAC), the Government Accountability Office, physician and hospital organizations, economists, and other interest groups. The U.S. Senate and House of Representatives are separately working on two different ways to alleviate the inconsistencies in costs and corresponding reimbursements while trying to establish long term sustainable solutions. One of the most significant implementation challenges is the financial fallout to providers relying on reimbursements (physicians, hospitals, and other affected providers). Medicare accounts for a sizeable portion of revenues to some health facilities and healthcare providers. Further reducing reimbursements for services will have a major financial impact and the healthcare community has been especially active in resisting additional cuts. Some of the most vocal groups have been providers and their affiliated interest groups. It is common to find multiple reimbursement-related articles in trade journals and specialty magazines. Certain specialties will be impacted more heavily than others and this is reflective in payment changes by CPT code.

Impact to Medicare recipients is another major implementation issue. Cost-containment may have negative effects on patient access to services and resulting health outcomes, though this is not generalizable across the board. At least one study has shown that health outcomes were not impacted for patients receiving treatment in hospitals affected by past reimbursement cuts (Volpp et al, 2005). Counterintuitive results from studies like this make implementation even more intricate and perplexing. Legislation must be drafted based on truly measurable effects to recipients, providers, and cost-containment goals.

Future direction

Medicare reimbursement reduction is a major policy issue affecting large strata of interests. Within government it is recognized that more time is required to generate sustainable strategies. Balancing long-term objectives with the immediate effects of cuts is a delicate matter. Policymakers will need to make difficult and calculated decisions about efforts to reduce healthcare spending. Some believe that a greater focus on preventive care has the potential to alleviate expenditure trends. A significant portion of current expenditure in Medicare and other programs comes from long-term maintenance of chronic conditions. This trend accounts for a large portion of uncontrolled growth. Medicare reimbursement cuts are merely stop-loss strategies in a losing equation rather than robust long-term solutions. A greater focus on preventive care has the potential to extend the viability of U.S. healthcare systems.

Chris Majdi
Transition Consultants
The practice sales and financing company
http://www.transitionconsultants.com/

Bloomberg Analysis Finds 'Doughnut Hole' Deal To Cost Drugmakers Less Than 1% Of Profits

News outlets report how closing the Medicare 'Doughnut Hole' affects drugmakers and seniors.

Bloomberg: "Drugmakers led by Pfizer Inc., AstraZeneca and Bristol-Myers Squibb Co. may provide more than $2 billion in drug discounts to senior citizens next year under a deal pharmaceutical companies made with the White House, according to data compiled by Bloomberg." The data came from a recent report released by Medicare. "Pfizer, the world's largest drug company, will cede less than half of 1 percent of its $50 billion in annual revenue under the arrangement." Les Funteyder, a health care analyst in New York, calls it "a good deal for pharma."

The arrangement "provides Medicare beneficiaries who fall into a coverage gap known as the 'doughnut hole' 50 percent off brand-name medications. Worldwide sales by brand-name drugmakers in 2008 totaled $288 billion, according to data from the drug industry's trade association." As part of the deal struck between Democrats and drugmakers, "In return for providing the price breaks and other concessions, pharmaceutical companies avoided policies such as allowing importation of drugs and having the government negotiate drug prices for Medicare beneficiaries" (Armstrong, 10/1).

In a reported column, NorthJersey.com explains the seniors' perspective: "Over time, the Affordable Care Act will close the doughnut hole entirely. In 2011, pharmaceutical companies will provide a discount of 50 percent on brand-name drugs to low- and middle-income beneficiaries who find themselves in the gap. Then, the doughnut hole itself will shrink a bit every year, ultimately disappearing entirely in 2020. But for starters, doughnut-hole victims get a one-time, tax-free $250 rebate check this year" (Miller, 10/1).

Meanwhile, in a second story, Bloomberg reports that "Wal-Mart Stores Inc., the world's largest retailer, said it will team with health insurer Humana Inc. to offer the cheapest prescription drug plan in the U.S., as the companies seek to take sales of medications from rivals. The companies will begin marketing the plan today to Americans in Medicare ..., William Fleming, a Humana vice-president, said in a conference call yesterday. The policies, which take effect Jan. 1, will cost $14.80 a month, less than half the average premium this year, and will boost sales for both companies" (Nussbaum and Boyle, 10/1).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

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Now That You're Turning 65, You Need a Medicare Policy - Do You Even Know Where to Begin?

1. Now that you are about to go on Medicare even though you will have Medicare you need to know that Medicare A and Part B only covers 80 percent of "their" approved amount. Which leaves you paying the other 20 percent. That is why you will need to seek out a Trusted Insurance agent or preferably a Trusted Broker. Especially now that the new Health care bill passed, as the government plans on paying for the new health care program by taking over 500 Billion dollars from Medicare over time to pay for the new plan. This can and probably will adversely affect yours and my future Medicare benefits.

2. If you are just turning 65 you should know that you do not have to qualify medically to obtain a Medicare supplement plan or a Medicare Advantage Plan. (Please look for my other articles on the differences between Medicare supplements and Medicare Advantage plans), this would be very important information to know!

3. If an agent/broker has sold for a long time in my opinion over ten years, and they have been able to make a comfortable living doing so then they have to know what they are doing and are taking good care of their clients. You would want to deal with someone that you can reach easily by email or phone when a question or problem comes up.

4. One way you can check on how long they have been licensed is to contact your local Department of insurance. They have all the licensing records on all agents as well as any complaints or sanctions. I shouldn't have to tell you that if you check and find out they have a complaint even one or sanctions stay clear of that person!

5. Does he/she seem more concerned about pushing a certain product on you before they have qualified your needs? If so, move on fast! In fact RUN! If an agent cannot give you the respect and time to get to know you and your needs then they only look at you as a dollar sign. Pure and Simple, but one that will insist on a sit down appointment to take the time to ask important questions so they know where and what companies that will fit your needs, that is an agent you want in your corner!

6. You want "your" broker/agent to take the time to ask questions about your life style, your family, your future goals, then that is someone that probably is trying to get to know you well enough to suggest some good plans that will fit you, your needs, and lifestyle.

7. Because Medicare Advantage plans and Drug plans change each year, you need an experienced agent that keeps up with all of the changes in Medicare regulations. You will also want a company that your doctors and clinics in your area will accept. Of course this can change daily, "golden rule", remember that any doctor any time can choose to not take Medicare patients or certain Medicare plans. So always check with your main doctor to be sure the plan your are leaning towards will accept the plan. A good Insurance Broker will usually check this out for you.

Find your Free Newsletter here for more valuable Insurance tips before you buy: http://www.trackingyourfuture.com/
Jacque Smith has been an Independent Insurance Agent for over 16 years. She has helped thousands of people including Seniors choose the right Insurance plan for them. Whether it be Life Insurance, Health, or Medicare Insurance she has always put the clients needs before her own.

Jacque also has done a great deal of voluntary work in the Senior community in her city. The experiences and joy of being able to meet new people every day is what has kept Jacque in the Insurance Industry.

For help in finding an Experienced agent- broker like Jacque in your area go here: http://www.myinsurancetrack.com/

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How Much Does Medicare Part A Pay?

Most of us know that The Part A program provides compensation for healthcare or medically needed services for hospitalization, however there are certain caps in benefits you should be aware of in order to make precautionary arrangements. To conceptually grasp and understand Part A, you need basic information about the programs payment allocation, for hospitals, nursing facility, or home health care, as well as benefit periods and coinsurance amounts. How much Medicare Part A pays depends on how many days of inpatient care you have during what is called a benefit period or spell of illness.

A benefit period or spell of illness refers to the time you are treated in a hospital or skilled nursing facility, or some combination of the two. The benefit period begins the day you enter the hospital or skilled nursing facility as an inpatient, and continues until you have been out for 60 consecutive days. If you are in and out of the hospital or skilled nursing facility several times but have not stayed out completely for 60 consecutive days, all your inpatient bills for that time will be figured as part of the same benefit period.

Hospital Reimbursement.

Medicare Part A pays only certain amounts of hospitalization for any one benefit period.

The Deductible.

For each benefit period, you must pay an additional amount before Medicare will pay anything. This is called the hospital insurance deductible. The deductible is increased every January.

First 60 Days.

For the first 60 days you are an inpatient in a hospital during one benefit period, Part A hospital insurance pays all of the cost of covered services. However, non-essentials, such as televisions and telephones, are not covered. You pay only your hospital insurance deductible within this time frame. If you are in more than one hospital, you still pay only one deductible per benefit period and Part A covers 100% of all your covered cost for each hospital.

Days 61 - 90.

After your 60th day in the hospital during one spell of illness, and through your 90th day, each day you must pay what is called a coinsurance amount toward your covered hospital cost. Part A of Medicare pays the rest of covered cost.

Reserve Days

Reserve days are a last resort coverage. They can help pay for your hospital bills if you are in the hospital more than 90 days in one benefit period, however the payment is quite limited. If you are in the hospital for more than 90 days in any one spell of illness, you can use up to 60 additional reserve days of coverage. During those days, you are responsible for a daily coinsurance payment. You do not have to use your reserve days in one spell of illness, however you can split them up and use them over several benefit periods. You have a total of only 60 reserve days in your lifetime. Whatever reserve days you use during one spell of illness are gone for good. In the next benefit period, you would have available only the number of reserve days you did not use in previous spells of illness.

Psychiatric Hospitals.

Medicare Part A hospital insurance covers a total of 190 days in a lifetime for inpatient care in a specialty psychiatric hospital. If you are already an inpatient in a specialty psychiatric hospital when your Medicare coverage goes into effect, Medicare may retroactively cover you for up to 150 days of hospitalization before your coverage began. In all other ways, inpatient psychiatric care is governed by the same rules regarding coverage and co-payments as standard hospital care. There is no lifetime limit on coverage for inpatient mental health care in a general hospital. Medicare will pay for mental health care in a general hospital to the same extent as it will pay for other inpatient care.

Skilled Nursing Facilities.

Despite the common misconception that nursing homes are covered by Medicare, the truth is that it only covers a limited amount of inpatient nursing care.

For each benefit period, Medicare will cover only a total of 100 days of inpatient care in a skilled nursing facility. For the first 20 of 100 days, Medicare will pay for all covered cost, which will include all basic services excluding television, telephone, or private room charges. For the following 80 days, the patient is personally responsible for a daily co-payment; Medicare pays the rest of covered cost. Reserve days, available for hospital coverage, do not apply to a stay in nursing facility. After 100 days in any benefit period, you are on your own as far as Part A hospital insurance is concerned. However, if you later begin a new benefit period, your first 100 days in a skilled nursing facility will again be covered.

Home Health Care.

Medicare Part A pays 100% of the cost of your covered home health care when provided by a Medicare approved agency, and there is no limit on the number of visits to your home for which Medicare will pay. Medicare will also pay for the initial evaluation by a home care agency, if prescribed by your physician, to determine whether you are a good candidate for home care. However, if you require durable medical equipment, such as a special bed or wheel chair, as part of your home care, Medicare will pay only 80%.

Hospice Care.

Medicare pays 100% of the charges for hospice care, with two exceptions. First, the hospice can charge the patient up to $5.00 for each prescription of outpatient drugs the hospice supplies for pain and other symptomatic relief. Second, the hospice can charge the patient 5% of the amount Medicare pays for inpatient care in a hospice, nursing facility, or the like every time a patient receives respite care. There is no limit on the amount of hospice you can receive. At the end of the first 90 day period of hospice care, your doctor will evaluate you to determine whether you still qualify for hospice, meaning your disease is still considered fatal and you are still estimated to have less than 6 months to live. A similar evaluation is made after the next 90 day period, and again every 60 days thereafter. If your doctor certifies that you are eligible for hospice care, Medicare will continue to pay for it even if it exceeds the original six month diagnosis. And if your condition improves and you switch from hospice care back to regular Medicare coverage, you may return to hospice care whenever your condition warrants it.

By knowing exactly what Medicare Part A pays, an educated decision can me made as far supplementing the gaps.

If you would like more information on supplemental Medicare plans, please visit our website at http://www.health-insurance-buyer.com/ and leave your contact info. One of our licensed agents will contact you and provide assistance on this matter.

Carlos Diez is a senior benefits consultant for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. He holds life, health, and annuity licenses in 48 states and is appointed with over 88 carriers. For contact information please reach him at http://www.health-insurance-buyer.com/

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My Medicare Advantage Plan is Not Renewing For 2011 - What Should I Do?

Insurance companies that offer Medicare Advantage plans engage in a familiar ritual every fall. Beginning in early October, they introduce their plans for the coming year. This is also the time, if plans are not being renewed for the following year, that notices are sent to those plan members informing them of their plans renewal status and detailing the options that they have available.

If your Medicare Advantage plan is not renewing for 2011, there are certain things that you need to be aware of and several steps that you need to take to make sure that you are properly protected in the coming year.

Understanding the realities of your plans renewal status and knowing what steps to take can give you the piece of mind required to make an informed decision for the following year.

Why do insurance companies choose not to renew their plans?

Often, when Advantage plan members receive a notice from their insurance company informing them that their Medicare Advantage plan will not be renewed, the first response is anger. Most of us like some degree of certainty. Having the rug pulled out from under our feet, especially when it comes to our insurance and health care, is unsettling.

If we understand the reality of how an Advantage plan works, we should be able to anticipate possible changes. When an insurance company contracts with CMS (Centers for Medicare and Medicaid), they agree to an annual contract in a defined County or service area. By design, you should be aware that things can change from year to year. Understanding this can alleviate any anger.

Beginning in January 2011, companies that offer PFFS (private fee-for-service) Advantage plans, will be required to allow those members access to a provider network should they decide to utilize it. A PFFS plan is not a network based plan, but rather members are able to visit any provider that accepts Medicare assignment. The provider must agree to accept the plans payment terms and conditions, as well as having the right to accept the plan on a visit-by-visit basis.

If a company decides not to renew your Medicare Advantage plan for 2011, this could be due to not having a credible network in place for your County or service area. If an insurance company only has one plan available, and it is a PFFS plan, it may be an easier and a more cost efficient solution for them to merely pull out of the market.

What do I need to know?

First, you need to be aware that the insurance company has a contractual obligation to honor their commitment to you. Your plan is still a valid plan for you to use for the remainder of the calendar year. Claims will still be paid and customer service will still assist you with any issues that may arise.

In addition, you now have a guaranteed enrollment period to apply for a Medigap insurance policy. If you decide to apply for a Medigap policy, which is also known as a Medicare supplement, the company cannot refuse to sell you any plan that they offer. Health conditions will not prevent you from purchasing a Medicare supplement during a guaranteed enrollment period.

What do I need to do?

If your Medicare Advantage plan is not renewing for 2011, you need to assess you options. It is comforting to know that you have several choices.

Return to traditional Medicare and purchase Part D drug coverage. Enroll in another Advantage plan. Purchase a Medicare supplement and Part D drug coverage.

If your Medicare Advantage plan is not renewing for 2011, start exploring you options early. Your current Advantage plan will end at midnight December 31st. You are not required to stay with the same company should they have an alternative plan available. It is in you best interests to take this time to look at all available options. Armed with knowledge, you can choose the right coverage and be protected for the following year.

David Forbes is President of Alliance Marketing Associates, Inc. David enables older adults to make informed decisions to protect their health and wealth. He also offers helpful advice on topics related to insurance for seniors, including finding an affordable Medicare Plan.

Sign up for your Free Mini-Course on Medicare Plans at http://www.affordablemedicareplan.com/

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What can I do when my Medicare Advantage premium goes up?

The primary reason why health care premiums and out-of-pocket cost rise is that medical costs increase at a faster rate than government payment increases to health insurers.

If your Medicare Advantage Plan premium just went up you can compare other Advantage Plans to find a more economic option. However, costs should not be the only issue when selecting a plan, so research the benefits, the provider networks and drug coverage available under Part D of each option before making a final decision.

To compare Medicare Advantage plan premiums, you can visit websites like Medicare Advantage Supplement Info.

Note: For seniors worried about their ability to cover their insurance and medical expenses, your insurance agent should also help determine if you are eligible for federal and state programs and help you apply for these funds.

What Can I Do If My Medicare Advantage plan gets canceled in 2010?

Health insurers withdraw plans for different reasons, e.g. when they introduce a new similar plan or because of their inability to meet CMS enrollment thresholds.

For 2010, many Medicare Advantage Plan providers canceled their private fee-for-service (PFFS) plans in anticipation of the termination of all PFFS plans after December 31, 2010.

When insurers cancel plans, the plan members may be automatically enrolled in a similar plan. This automatic roll-over however does not mean that the insured cannot select other plans that are more suited to their needs, even if that means opting for another carrier.

Contact a local health insurance broker or visit plan comparison sites like Medicare Advantage Supplement Info to obtain information on other Medicare Advantage Plans available to you.