Monthly Archives: January 2018

Are Medicare Advantage Plans Supplements?

Are Medicare Advantage Plans Supplements?

This is a question that is asked by majority of the people, especially those who are to choose the right type of Medicare plan to sponsor their healthcare expenses. There are many who mistake Medicare Advantage Plans to be Medicare Supplements.

Know about Supplement plans

Supplement plans are also called Medigap plans and are standard insurance policies meant to fill up the gaps that exist with Medicare Part A & B plans. Part is to provide hospital coverage, while Part B is to cover physician and medical services. The government is known to pay for sixty days of hospital day under Part A Medicare except for some deductible. A small amount of deductible is present for Part B, which then is said to pick around 80% of all approved medical services. Supplement can be found in various designs with majority of them paying up for Part-A deductible and Part B 20% gap.

About Medicare Advantage Plans

Enrolling in one of the Medicare Advantage plans in 2019 you replace Medicare Part A & B. Rather, they tend to replace Medicare with that of private insurance plan. The plans generally offered as PPO or HMO coverage have hospital and doctor network registered to provide services to policy holders against co-payments from insurance provider and members. Only network providers can be accessed with HMO plans except for true medical emergency. Reduced benefits outside of the network are allowed by PPO plans.

Know the difference

When compared to Medicare Advantage Plans, Medicare supplements are found to be more expensive. Most are noticed to fill up completely the gaps present, thus leaving the member with little out of pocket expenses. Lower monthly premium expenses are to be borne on Advantage plans. But more needs to be paid while availing medical services.

By having Medicare Advantage Plans, the person gets covered technically under Part C Medicare, while Part A & B coverage gets deactivated. Medicare card will no more be available to be used for availing Medicare services. Although not active, Part B premium will be deducted from social security check. This payment will be used by the government as part of Advantage plan funding mechanism. As a matter of fact, the government is said to pay more to private insurance plan to cover full financial risk and offer proper healthcare.

Prescription coverage exists within the Advantage Plan package at no additional costs, which again is not covered by Supplements.

Medicare Advantage Plans: 9 essential things to understand

It is necessary for every senior to avail the most appropriate Medicare plans to get good health coverage. But one should undertake proper and thorough research to ensure that the decision and selection is made.

Essential things to know to make the right selection

  • Identify plan regulations prior to enrollment: Since not every Advantage plan is said to work equally, the plan’s regulations are to be clearly identified. Rules of the plan are to be followed, such as getting referral for viewing the specialist or receiving prior approval for availing specific procedures, thus avoiding high costs. Out of network healthcare provider might not be covered in the plan or the costs could be much higher, which again depends upon the Advantage plan type taken.
  • Even if the person suffers from pre-existing disease, it is possible to enroll with Medicare Advantage Plans, unless he/she has End-Stage Renal Disease.
  • Enrollment, Switching or cancelling the plan is possible only during a specific time period. In majority of the cases, the person gets enrolled in the plan for about a year.
  • Some plans might pay fully or part of Part B premium.
  • In case, the person has limited income, then he/she can contact Medicaid (State Medical Assistance Office) to check if assistance is provided to pay Part B premium expenses or for the Part D premium along with other prescription drug costs.
  • While enrolling with any of the Medicare Advantage Plans, it is necessary to provide Medicare number along with start date of Part A &/or Part B coverage.
  • Part D (prescription drug) coverage is available through the plan. If the person avails a plan which includes prescription drug coverage and he joins Prescription Drug plan, then he/she is dis-enrolled automatically from the Advantage plan to be returned to traditional Medicare.
  • On selecting a plan, enrollment is possible by completing paper application, online application or by phone. The health insurance specialist or plan provider is to be contacted to identify how the selected plan can be enrolled with.
  • If there exists Union or Employer coverage, then it will be necessary to discuss with the Union benefits administrator or the employer to know about the rules prior to enrolling in Medicare Advantage Plans. Joining Advantage plans in few cases may cause the person to lose union or employer coverage. However, in other cases, the union or employer coverage can still be used in conjunction with the enrolled plan.

Click HERE to learn more about the benefits offered by Medicare Advantage Plans in 2018