Medicare
Advantage Plans
Medicare Advantage, in simple terms, is an outsourced private health insurance plan that pays your Medicare Part A and B benefits instead of Medicare. These plans are available from a variety of private insurance companies that are considered sub-contractors of Medicare. Each of these plans must be approved in advance by CMS (Medicare) before being marketed to Medicare beneficiaries.
Medicare Advantage plans generally offer all of the same benefits as Medicare, but instead of having deductibles and co-insurance, many of these plans have no deductible plus a "co-pay" system. For each type of service you may have a different co-pay. These plans also give you something Medicare doesn't have - an out-of-pocket maximum. So for each calendar year, if your co-pays reach a specified out-of-pocket limit, the company will not require co-pays for the rest of the calendar year.
While these plans have many good features and are generally much cheaper than traditional Medicare Supplement coverage, there are also potential long term risks such as benefit or premium changes by the company from year to year, termination of coverage in certain or all counties on a year to year basis, or if you move out of the area it may be necessary to change coverage.
Each year, we review all Medicare Advantage options for VA and WV and select the plans that we feel will satisfy the needs of the majority of our clients.
Remember, the Annual Enrollment Period (AEP) for Medicare Advantage plans in October 15th - December 7th of each year with a January 1 effective date! Open Enrollment Period (OEP) is available between January 1 - March 31.
Medicare Supplements
Medicare Supplement or "Medigap" coverage is a type of insurance that is secondary or "supplemental" to Medicare Parts A and B. Most people who have Medicare also have this type of coverage for several reasons. First, Medicare Parts A (Hospital) and B (Medical) have deductibles that increase each year as well as co-insurance that is the beneficiary's responsibility. In 2010 for instance, the Medicare Part A deductible is $1132 for the first 60 days, then $263 per day co-insurance from days 61-90 and $566 per day co-insurance for days 91-150. The 2010 Part B deductible is $162 per calendar year, then generally 20% co-insurance thereafter. Second, unlike many private health insurance plans, Medicare has no out-of-pocket maximum. So, if you were to have extremely high co-insurance payments in a given year, there would be no cap at which Medicare would begin paying 100% and waiving your co-insurance payment. With Medicare Supplement plans, most, if not all, of your deductibles and co-insurance amounts are covered. Also, extra benefits for skilled nursing, foreign travel and more can be part of the Medicare Supplement plan that you select.
Now that you know what Medicare Supplement is and why you need it, let's look at the plan options. Most who own a Medicare Supplement policy choose a plan that covers both Part A and Part B deductibles. Of the plans that are standardized by the Federal Government (A-N), Plan E, H, and I have been retired. Plans C and F are the only ones to cover both deductibles as well as most other co-insurances. The primary difference is that Plan F covers 100% excess charges in case your physician does not accept Medicare assignment. Depending on the company, only certain plans may be available. Generally speaking, Plan C is a terrific plan for most. If you want the flexibility though to use Medicare providers who do not accept assignment, Plan F may be a better choice.
Since these plans are standardized for all companies, the premium rate you pay is the primary difference. Additionally, some companies offer automatic rollover of claims from Medicare and waiver of pre-existing conditions when you are first issued a policy. Most of the companies we offer for Medicare Supplement have outstanding premium rates, automatic rollover of Medicare claims and do not impose waiting periods on pre-existing conditions.
Part D
One of the most frustrating insurance options for those on Medicare today is Medicare Part D, or Medicare Prescription Drug coverage. In Virginia alone during the 2010 season, there are 44 stand-alone Part D options! While the debate continues surrounding the complexity and implementation of this coverge, one thing is for certain: Medicare beneficiaries are much better off today with Medicare Part D than without it.
While it may be difficult to sort through the information to find a Part D plan that fits your personalized list of medications, having 44 or more options makes the possibility of finding a good plan, well, very good.
Before the Annual Enrollment Period (October 15th - December 7th) of each year, we sort through the plan benefits and run sample searches on the Medicare system in order to align us with companies that we feel will represent the needs of the majority of Medicare beneficiaries.
If you would like us to assist with your Medicare Part D options during the 2011 AEP, please use the link below and an agent will assist you with your needs. Please be sure to include the drug name, dosage, quantity per day and what plan you currently have (if any) for 2010.
If you would like more information or a free no-obligation proposal for any of these products listed, please feel free to contact us here.
