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Medicare Advantage Plan: Is it the Right Choice for You?

Medicare Advantage Program

Choosing Between Medicare Advantage Plan and Original Medicare

Original Medicare
Medicare Advantage Plan 
(HMO or PPO)
Part A (Hospital Insurance) and Part B (Medical Insurance)
Part C – Comprises of both Part A (Hospital Insurance) as well as Part B (Medical Insurance)
  • Medicare provides the basic coverage.
  • One gets to choose his/her own physician and hospital etc.
  • Usually, you or your supplemental insurance coverage pays coinsurance and deductibles.
  • A monthly premium is to be paid for Part B Medicare.

Medicare Advantage Programs

  • This insurance coverage is provided by Private insurance companies which are approved by Medicare.
  • One gets an option of using plan physicians and hospitals or one might also get other providers at higher costs.
  • One usually pays premium in addition to the premium for Medicare Part B. Also pays coinsurance for covered services.
  • The costs, rules and additional coverage differs from plan to plan.

Medicare Advantage Programs

Make up your Mind if you Need Part D Prescription Drug Coverage
Make up your Mind if you Need Part D Prescription Drug Coverage
  • If you want Part D Prescription Drug Coverage, you ought to select and join some Medicare Prescription Drug Plan. It generally requires paying some monthly premium.
  • These insurance plans are run by private insurance agents who are approved by Medicare.

Medicare Advantage Plans

  • Normally, people get prescription drug coverage through their Medicare Advantage Plan only.
  • If you insurance plan does not provide drug coverage, then you can join a Medicare Prescription Drug Plan.
  • We are the leading insurer when it comes to Prescription Drug Plans.

Medicare Advantage Plans

Do you need Medicare Supplement Insurance Coverage?
Useful Information:
  • You might want to get insurance coverage to receive the benefits which Original Medicare does not provide. For this purpose, you can purchase Medicare Supplemental Insurance (Medigap) policy from any private insurance agent.
  • Cost of the policies may vary.
  • Employers may offer similar insurance coverage.
It must be noted that if you buy a Medicare Advantage Plan for you or your family, you won’t be able to utilize Supplemental Insurance policy to pay out-of-pocket expenses which you need to pay for your Advantage Plan. In case you have bought an Advantage Plan, you cannot be sold a Medigap policy.
  • In addition to Medicare Advantage Plan or Original Medicare, one can also go in for other Medicare health policies.
  • It is possible to save a lot of money and other resources if you have limited income.
  • One can also get additional coverage, like employer, Veterans’ or military benefits.

 

Assessing Medicare Advantage Plans:

Medicare Advantage Plans have gained huge popularity in a short span of time. It all comes down to the point that how easily senior citizens can have access to health care services. They find themselves better connected with the health care system nowadays.

Best Medicare Advantage Plans

Private insurance companies sell Medicare advantage plans across the country. You would find different rates offered by two insurance companies for the same product. It is highly advisable to check all the details separately to figure out the best deal. The premium amount turns out to be a decisive factor in the end.

The freedom to consult any doctor, or visit any hospital throughout the United States is the main USP for Medicare Advantage plan PFFS (private fee for service).  The present 2012 version of Medicare advantage plan has more value in comparison to supplement plan, as judged by many people.

Senior citizens have found HMO Advantage Plans to be extremely beneficial.

Medicare HMO plans offer an option to the members to choose a primary care physician (PCP). A doctor would decide that if the patient should be referred to a specialist or not, depending on the conditions.

Advantage Plan Q&A's

Q: Is there a separate special arrangement for Medicare aged persons who are still employed?
A: There is a special period for enrolling in these circumstances, should you have delayed your Part B plan due to the fact that you or a partner are employed and receive group insurance with work. The fact is that you can apply for Part B whether your spouse is currently receiving these benefits within 8 months of having left a group policy.

Q: I often hear the term ‘Medigap.’ Is a Medigap Policy an Advantage Plan?
A: No. Medigap policies, often referred to as Medicare supplementary insurance, are offered by private companies to compensate for the things that Medicare doesn’t cover (the coverage ‘gaps’). Advantage Plans 'take over' Medicare to provide complete medical care and include all sorts of benefits, such as eye care, hearing, dental and often the Part D prescription drug coverage.

Q: Why should one enroll in Part B of Medicare?
A: Part B is required (along with Part A) if you should want to enroll in a managed care plan or a FFS plan. Most Medicare enrollees sign up to Part B hospital cover as it is a worthwhile and good value investment, considering that over 75% of those aged 65+ are hospitalized at least once before they expire.

Q: Does Medicare Advantage cover long term care?

A: The short answer is no. Medicare doesn’t cover what is largely considered to be ‘custodial care’ which is non-skilled and it is therefore not part of the Medicare field of responsibility. It will however pay for skilled nursing facility (SNF) care, provided it is included in your policy. Your agent will help you choose the right policy if this is what you require.

Q: What happens when it comes to pay for a Medicare claim?
A: Your provider is legally required to file the claim on your behalf within that calendar year, however if you go to a provider or pharmacist that is not involved in the Medicare scheme, you must cover the costs yourself as, for instance, Medicare D would only work with those outlets. Those who receive Medicare through managed care, i.e. an FMO or FFS plan, then Medicare pays those insurance companies and the recipient isn’t involved in the process.

Q: Does my family qualify for Medicare on my policy?
A: Medicare policies are issued on an individual basis. That is to say that they only cover the individual who buys the policy and who qualifies for Medicare coverage. If you are unsure about your own eligibility, contact your local licensed agent.

Information on Medicare Advantage 2012

Medicare Advantage Plan
Monthly Payments (Average)
Number Of MA Contracts
Advantage Plan Penetration
 
United States $734 United States 428 United States 17.5%
 
Alabama $692 Alabama 41 Alabama 15.2%
Alaska NA Alaska 39 Alaska 0.5%
Arizona $651 Arizona 50 Arizona 30.1%
Arkansas $640 Arkansas 39 Arkansas 8.23%
California $652 California 52 California 30.7%
Colorado $649 Colorado 37 Colorado 28.2%
Connecticut $681 Connecticut 40 Connecticut 9.1%
Delaware $658 Delaware 37 Delaware 2.23%
District of columbia $776 District of columbia 41 District of columbia 8.12%
Florida $840 Florida 74 Florida 23.1%
Georgia $680 Georgia 49 Georgia 8.1%
Hawaii $639 Hawaii 41 Hawaii 34.4%
Idaho $647 Idaho 40 Idaho 18.2%
Illinois $680 Illinois 56 Illinois 7.22%
Indiana $641 Indiana 45 Indiana 9.5%
Iowa $618 Iowa 42 Iowa 11.8%
Kansas $675 Kansas 44 Kansas 6.2%
Kentucky $653 Kentucky 45 Kentucky 8.4%
Louisiana $855 Louisiana 42 Louisiana 16.1%
Maine NA Maine 38 Maine 2.23%
Maryland $815 Maryland 41 Maryland 5.5%
Massachusetts $737 Massachusetts 42 Massachusetts 14.2%
Michigan $816 Michigan 44 Michigan 14.1%
Minnesota $645 Minnesota 40 Minnesota 26.2%
Mississippi NA Mississippi 38 Mississippi 6.51%
Missouri $663 Missouri 45 Missouri 15.2%
Montana $591 Montana 38 Montana 11.2%
Nebraska $650 Nebraska 37 Nebraska 8.21%
Nevada $757 Nevada 41 Nevada 29.1%
New Hampshire $653 New Hampshire 33 New Hampshire 2.1%
New Jersey $807 New Jersey 42 New Jersey 8.2%
New Mexico $651 New Mexico 41 New Mexico 20.1%
New York $811 New York 64 New York 21.2%
North Carolina $647 North Carolina 40 North Carolina 13.3%
North Dakota $591 North Dakota 37 North Dakota 5.51%
Ohio $674 Ohio 54 Ohio 17.1%
Oklahoma $666 Oklahoma 42 Oklahoma 11.3%
Oregon $647 Oregon 53 Oregon 34.3%
Pennsylvania $778 Pennsylvania 59 Pennsylvania 31.1%
Rhode Island $655 Rhode Island 37 Rhode Island 30.2%
South Carolina $646 South Carolina 43 South Carolina 8.22%
South Dakota $591 South Dakota 36 South Dakota 3.2%
Tennessee $655 Tennessee 47 Tennessee 16.1%
Texas $742 Texas 57 Texas 13.0%
Utah $644 Utah 40 Utah 16.5%
Vermont NA Vermont 34 Vermont 1.1%
Virginia $671 Virginia 43 Virginia 8.7%
Washington $644 Washington 47 Washington 19.1%
West Virginia $707 West Virginia 40 West Virginia 6.23%
Wisconsin $618 Wisconsin 46 Wisconsin 18.2%
Wyoming NA Wyoming 35 Wyoming 2.3%
Medicare Advantage Plans 2013

 

• The demand for Medicare Advantage Plans has grown by many folds. The official reports show that numbers have increased to 8.2 million (as per 2007) from 5.4 million in just two years.

• Medicare Advantage Plans would provide coverage for Medicare-approved services for the remaining part of the year, once the out-of-pocket limit is reached. The condition is that members should use the approved list of doctors provided in the network.

•Recipients of Medicare should be aware of the fact that there will be maximum expense from the pocket even at the time of poor health. Even if the recipient does not see any doctor, he or she is still required to pay $1,500 to $2,500 towards Medicare supplement policy.

• There are other plans like Preferred Provider Organization (PPO) and Private Fee-For-Services (PFFS) where members can move in and out of the network depending on the requirements. You must read each plan separately to know its merits.

• End Stage Renal Disease (kidney failure) can even qualify for the advantages of an Advantage Medicare plan. In some counties we even have companies specifically for people with end stage renal disease.
Our Medicare Supplement agents are proud to be leading pioneers in the Medicare Advantage industry and it would be our pleasure to present you with the best plan that is available in your area.

Click below to read more about the Medicare Advantage Plan:

Read Complete Guide to Medicare Insurance

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