Advantage Plans are an Alternative to Medicare

Just in case there is any confusion about the definition of Medicare Advantage plans, here’s the definition from the Centers for Medicare and Medicaid Services (CMS).

The official definition – Same 2012 Medicare Advantage Plans
Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called “Part C” or “MA Plans.” Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. They aren’t supplemental insurance.

Fact about Medicare Rates

There are two fundamental points that you must understand about Medicare Advantage Plans:

Advantage Plans are part of Medicare. Enrolling in an Advantage Plan does not mean that you are leaving or dis-enrolling from Medicare. You are still in Medicare, your Advantage Plan is being administered by a private insurance company that must follow the rules set by Medicare.

A Medicare Advantage Plan is not supplemental insurance. Medicare Supplement insurance (Medigap) is offered by a private insurance company to work in conjunction with original Medicare to supplement or fill in the gaps that Medicare does not pay.

So, the first thing you must know before you join a Medicare Advantage Plan, is that you are not buying supplemental insurance. You are joining an Advantage Plan where your Medicare will be administered by a private insurance company and you are still enrolled in Medicare.

Click here to compare 2012 Medicare advantage plans with over a dozen insurance companies and to see how much they are all priced

Understanding the different types of Advantage plans – Medicare Advantage Plans 2012

When choosing a Medicare Advantage plan, it’s important to understand the different types of plans available and understand the plans rules before joining. Medicare Advantage Plans include the following:

• Preferred Provider Organization (PPO) Plans.
• Health Maintenance Organization (HMO) Plans.
• Private Fee-for-Service (PFFS) Plans.
• Medical Savings Account (MSA) Plans.
• Special Needs Plans (SNP) – Keep reading all of these are explained below.

All Medicare Advantage Plans for 2012 provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. This means they must cover at least all of the services that Original Medicare covers. However, each Medicare Advantage Plans can charge different out-of-pocket costs. These are usually co-payments but can also be coinsurance and deductibles. The following article from AARPMedicare offer some further insight for all shoppers:

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage, sometimes at an extra cost.

PPO Advantage Plans – These plans are fairly predictable making them quite popular among seniors on Medicare. you’ve got a huge network of doctors and hospitals to choose from with a PPO, but using an out-of-network provider is an option for a specific service, it will be at a much higher price. With a PPO plan referrals are not needed and you can see as many different doctors as you’d like. You can get a PPO  with Part D prescription coverage included or without the coverage.

What is covered with a 2012 Medicare Advantage Plan?

• All the benefits of Medicare Part A, including hospital stays, skilled nursing care and home health care, but not hospice care. However, because you must be enrolled in Part A to get a Medicare Advantage plans 2012, your Part A benefit helps cover hospice care – See AARPHealthCare.
• All the benefits of Medicare Part B, including doctor visits, outpatient care, screenings, shots and lab tests.
• Prescription drugs, if Medicare Part D prescription drug coverage is included in the Medicare Advantage plan (many do include this coverage).

Some Medicare Advantage plans may also include coverage for extra services such as a fitness benefit or hearing and vision care.

Getting a Medicare PPO plan may be ideal for you and your family/spouse if you are okay with the network size, but prefer to have the flexibility to see multiple doctors and visit different hospitals for treatment.

Medicare HMO Plans – Cost sharing is more affordable making it perfect for a percentage of seniors. With Medicare HMO plans (no matter the insurer) you have got to stay within the network. There are exceptions which include: emergency care or dialysis services and out-of-network urgent care. Certain HMO plans will allow you to see a physician out of the network as long as you are willing to pay a higher price – see more on medicare plans for 2012 at MostMedicare. Part D is included 99.9 percent of the time and getting referrals are always required as well as selecting a primary doctor, except for certain preventative care services. The following are some top plans (enter your zip code above to compare all plans):

• Anthem Medicare advantage  - Anthem is one of the most popular options.
• Cigna Medicare advantage – Not one of the most popular choices but still great for certain people.
• kaiser Medicare advantage – The differences with Kaiser senior advantage and how it all works.

If your living in a large area a Medicare HMO plan may just be the ideal policy to get your insurance coverage, since its networks are often comprehensive and cost sharing is relatively low – If you are living in California then another terrific provider Western Health Advantage, they offer some of the best plans in the industry. On the other hand, if you live in an area with a pretty small network or you travel extensively, a PPO plan might be the right choice.

Medicare PFFS Plans  - At first glance, PFFS plans give you a great deal of flexibility and independence, but getting covered services can often be unpredictable. You are not required to use a network and can choose your own providers, but the plan decides how much they will pay doctors and hospitals and how much you will pay for services. This said, you can go to any Medicare approved doctor or hospital if they agree to treat you. Not all providers will accept the plan’s payment terms or agree to treat you. In fact, they can decide to treat you on a visit by visit basis, except in the case of an emergency.

Click here to learn about medicare advantage dis-enrollment periods.

How do I enroll?

You can join a Medicare Advantage plan as soon as you become eligible for Medicare, or during your initial enrollment period. You’ll also need to enroll in Part A and Part B at this time.

Once you’ve joined Medicare Part A and Part B, you can’t be refused coverage by any plans in your area that are accepting new members. However, special rules apply to people with end-stage renal disease.

Each private insurance company that offers a Medicare Advantage plan handles the enrollment process for its plans. You’ll need to contact the company directly and ask how to enroll. Original here.

In some rural areas, PFFS plans may be your only choice (though your choices are fewer in 2011) because credible networks are difficult to put together by Advantage Plan carriers. Because of legislation to be effective in 2011, many carriers have ceased to offer PFFS plans in certain areas.

This legislation requires PFFS plan sponsors to offer a provider network to members in service areas where two or more network plans already exist. Assembling a credible network in less populated areas is more of a challenge than some plan sponsors are willing to under take. This has resulted in less Medicare Advantage options in those service areas.

Medicare MSA Plans – Not as popular as other 2012 Advantage Plans, MSA Plans have two parts; a high deductible and a bank account. Medicare gives the plan a sum of money and a portion is deposited into the bank account. Because the sum is usually less than your deductible, you will have out-of-pocket costs until you reach your deductible. Money spent for covered services counts toward your deductible and once the deductible is met, the plan pays for your covered services for that year. Unused funds in your bank account roll over to the following year. MSA Plans do not include drug coverage and a stand alone plan will need to be purchased. You do not need a referral and can choose your own providers. See the rest at AffodableMedicarePlan.

Choose a MSA Plan if you are extremely healthy and can cover the out-of-pocket expenses.

Medicare SNP Plans - Membership in these plans is generally limited to specific groups of people. A SNP may be right for you if you’re eligible for both Medicare and Medicaid (dual enrolled), or you are a resident of certain types of institutions, (such as a nursing home), require nursing care at home or if you have one or more specific chronic health conditions such as congestive heart failure, diabetes, HIV/Aids, among others. Medicare Part D is always included and you generally need a referral and must use the providers in network except for emergency care and certain preventative services.
Consider a SNP if you meet the criteria for enrollment, as these plans are designed to best meet your needs by offering a higher degree of coordinated care and case management.

Understanding the different types of plans available and how they relate to your circumstances can go a long way towards a fulfilling experience in your Advantage Plan membership and usage.

Medicare Part C is an alternative to Parts A and B, delivered through a private managed care plan, such as an HMO. Also called Medicare Advantage, Part C combines Part A and Part B in one plan. If you enroll in a Medicare Part C plan, you don’t separately use or pay for Medicare Parts A or B. People enroll with Part C Medicare because it may cost slightly less than care with traditional Medicare Parts A and B, and because it sometimes offers a few minor extra services. Some Part C plans also have drug coverage (with one of these, there’s no need for a Part D plan). Part C plans limit the choice of healthcare providers from whom you get your care.

Are there limits to Medicare advantage coverage?

Coverage limits vary by plan, so you’ll have to look at the specific Medicare Advantage plan’s details to see if there are any coverage limits or exclusions.

Plans that include prescription drug coverage may have additional restrictions, such as the cost-sharing amounts you pay for your medications.

The advent of Medicare changed medical insurance for Americans over sixty-five. It was a much-needed program for those who were older and could no longer work to pay for medical insurance. It allowed America’s senior citizens to receive affordable medical care so that they could be healthier and live longer. Since 1965, when Medicare was signed into law, the program has undergone some significant changes and welcomed some additions in the quest to improve the quality of care that people receive under the program. One of the most popular recent additions to the program has been the Medicare Advantage Plan. You should now understand all about:

• Medigap vs Medicare advantage – the differences between the two.
• Medicare replacement plans – plans that can replace Original Medicare.
• Medicare advantage enrollment – The best times of the year to enroll in a plan.

Part of the Balanced Budget Act of 1997, the Medicare Advantage Plan allows Medicare beneficiaries to receive their benefits through private health insurance plans, as opposed to the original Medicare Plans (Parts A & B). Medicare Advantage allows beneficiaries the option of receiving insurance through the private plan of their choice. While these plans are often limited to a specific network of doctors, most companies allow you to pay an additional fee to see a doctor outside of the specified network. This allows beneficiaries to receive the care they want from the doctors they want and still receive their Medicare benefits, albeit in a different way.

• Medicare advantage news – Exactly what’s happening with 2012 Medicare advantage plans

The Medicare Advantage Plan also allows for a little more flexibility than traditional Medicare does. Medicare Advantage includes prescription drug coverage, and beneficiaries can choose Advantage plans that include dental and vision care as well as health club or gym memberships. Medicare Advantage places a heavy emphasis on preventive care. These advantages come with the condition that you must stay in-network for your care, but many beneficiaries find this trade-off more than reasonable. Overall, those who decide to participate in Medicare Advantage generally do so because they see the Advantage Plan as a better value than traditional Medicare.

But 2012 Medicare Advantage Plans are not perfect. Many people who were originally enrolled in Medicare Advantage have since switched back to traditional Medicare. The most common complaint of former Advantage Plan holders was that the quality of Medicare was less than satisfactory. If you think that Medicare Advantage sounds like the right plan for you, be sure to talk it over with your healthcare provider and, if you can, an insurance professional to make sure that you understand the differences between traditional Medicare and Medicare Advantage and the effects that each plan will have on your healthcare.

Click here here to learn some more about medicare advantage plans.

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