What Does Medicare Advantage Give You?

A Medicare Advantage plan gives you all the coverage of Medicare, including Part A and Part B benefits, plus coverage for services not covered under basic Medicare, such as prescription drugs and custodial care. Other services that a managed care plan may provide that basic Medicare does not, include eye exams, chiropractic care, and hearing aids.

You Need to Be Careful Considering Medicare Advantage Plans

There are some disadvantages to managed health care, however, that you need to consider when making your health plans. Managed health care providers make money by keeping costs down. The plans discourage unnecessary services, and promote preventive medicine. Many are HMO or PPO plans where the choices you can make for doctors and clinics to receive treatment are limited to those the plan has contracted with for specific fees. If you go out of network, neither the plan nor Medicare will pay the bill. Most will require a primary physician to refer you to specialists, except in certain serious situations. Some plans are not as restrictive, but will require higher portions of the bill to be paid by you than if you remained in-network, or may have higher premiums. So, you will need to be sure there are in-network doctors and clinics in your area that cover treatment you may need. You also may find when you travel, you’ll possibly have to pay out-of-network fees. You should also keep in mind that even if your doctor of choice is in-network, it doesn’t mean that he or she will always stay with the plan, and you may have to change doctors to remain in-network.

Medicare Advantage Is Not for Everyone

You need to consider your medical requirements, what physicians and specialists you may need, and whether the advantage of wider services and lower out of pocket expense outweighs the potential disadvantages. There are several different Medicare Advantage programs, so if it is suitable for your needs, you will need to research which plan gives you the greatest benefit.

Contact an insurance specialist to go over the plans with you and help you discover what will work best for you as you approach Medicare eligibility.

The post Is Medicare Advantage Right for You? appeared first on Affordable Health Insurance.

Don’t Rely on Basic Medicare Alone

Supplemental plans are available to increase the coverage given under Medicare. Part A covers hospitalizations, Part B increases coverage for routine medical care, and Part D covers prescription drugs. In addition, with the Affordable Health Act in place, hospital and doctor costs should come down because efficiency is rewarded.

However, there are costs that still need to be considered in addition to premiums. Some of the supplemental plans require deductibles and none of them cover every cost. Because there are no limit caps, copays and deductibles can add up to be quite sizable. Seniors can cover some of the limitations and gaps in coverage with privately administered plans like Medicare Advantage and Medigap. This means additional premiums that will be out-of-pocket.

Seniors also need to realize that the longer they wait to get coverage under the supplemental plans, the more expensive it becomes. A common mistake is to put off signing up under the open enrollment period because they think they are healthy and will save money by not signing up as of yet. It’s not a savings if you need it later. For example, Part D’s premium goes up 1% per month every month for an eligible person who hasn’t signed up for it, Part B increases 10% for each 12 months delayed. If you are still working after the age of 65 in a job with a health plan, you have a window of eight months after leaving the job to enroll in your Medicare plans.

Plan Ahead

Seniors need to carefully consider their future health plans. They need to be realistic about possible future health issues, types of coverage they can afford, and supplemental plans they may need to have in place. Seniors need to take advantage of free or low-cost preventative care treatments that they are allowed to have under Medicare. This can possibly head off future health problems.

There’s a lot to think about, but talking with an insurance specialist can help you develop a plan that will work for you.

The post Health Costs Can Be a Surprise Even with Medicare appeared first on Affordable Health Insurance.

As an Inpatient in a Hospital

• semi-private rooms
• meals
• routine nursing care
• drugs used for inpatient treatment
• other hospital services and supplies

Hospital facilities include:

• acute care hospitals
• critical access hospitals
• inpatient rehab facilities
• long-term care hospitals
• mental health care
• inpatient care when participating in a qualified

research study

Part A will not cover private nurses, private rooms not considered necessary for your treatment, television or phone as a separate charge, or items used for personal care such as razors.

To receive Part A benefits, the hospital must accept Medicare assignment and your doctor must order your stay because your treatment needs require it. Also, you must stay 2 or more “midnights,” you must be officially admitted by the hospital, and their Utilization Review Committee must approve your stay.

You will have to pay the applicable annual deductibles. You may also be responsible for costs for services Medicare doesn’t cover, including services ordered by your doctor more often than allowed.

As an Inpatient in a Skilled Nursing Facility

Part A will also cover inpatient stays in Skilled Nursing Facilities for a period of time depending upon certain factors. The following lists most, but not all, of the services that might be paid.

• Semi-private room
• Meals
• Skilled nursing care
• Physical and occupational therapy if medically necessary
• Speech therapy, if medically necessary
• Medically necessary social services
• Medicines
• Medical supplies and equipment
• Ambulance service (must be medically necessary)
• Dietary counseling

To be paid, admission must follow a qualifying stay in the hospital and you must have days remaining in your benefit period. It must be a Medicare certified Skilled Nursing Facility, and your stay must be for a hospital-related condition or for one that occurred while in the Skilled Nursing Facility for a qualified stay.

As an Inpatient in a Long-term Care Hospital (LTCH)

Long-term care hospitals treat those with multiple serious medical conditions who may improve with longer treatment and be able to return home. Usually the costs are no more than those for an acute care hospital. However, a second deductible could be applied unless it has been no more than 60 days since you were discharged from an acute care hospital.

There is a lot to learn about your Medicare benefits, but a conversation with an insurance specialist can help you make the right insurance decision for your needs.

The post What Hospital Care Does Medicare Part A Cover? appeared first on Affordable Health Insurance.

Medicare is divided into four parts. Part A covers hospital benefits, Part B covers provider (doctors, etc.) benefits, Part C – Medicare Advantage Plans*, and Part D provides prescription drug benefits.

There are exceptions, but in general, Medicare Part A coverage is free, but you will pay a premium if you elect to receive Medicare Part B coverage.

*Medicare Advantage Plans, available in many areas, allow those who have Parts A and B to receive all of their health care benefits, including prescription drug benefits, through one of the Medicare Advantage providers rather than directly through regular Medicare.

How Much Does Medicare Pay?

Please note that this is a general explanation and there are often exceptions to what will or will not be covered by Medicare.

Medicare has established an “allowed amount” for each of the qualified services you might receive as an in-patient in the hospital or as an outpatient through other providers. In general, Medicare will pay 80% of this “allowed amount.” If your hospital or other provider has agreed to accept Medicare assignment, they cannot charge you more than the remaining 20% of the “allowed amount.” They must “write off” the difference between the original charge and the “allowed amount.”

You can purchase supplemental insurance to help pay the 20% that Medicare will not pay, and you can also purchase a prescription drug plan to cover part of the cost of drugs that are not covered by Medicare. You will pay a monthly premium for each plan.

What About Deductibles?

You will be responsible for a deductible amount for Medicare Part A and Part B, which occurs annually each January.

The supplemental plans you purchase will also have deductibles, depending upon which you purchase.

Deciding what to do can be difficult! You can find a lot of information on the medicare.gov website, and you are wise to talk with a professional about the best supplemental plan for your situation, you can call us at (818)996-0662 and we’ll answer any questions you have.

The post What is Medicare? appeared first on Affordable Health Insurance.

Don’t Confuse Medicaid with Medicare

First of all, keep Medicare and Medicaid separate in your mind. Most people only qualify for one or the other. Medicaid is based on income, while Medicare is based on age. Medicaid covers far more than Medicare, including the cost of prescription and co-pays.

Make Sure Medigap is Right for You

Keep in mind that Medigap plans are meant for people who are paying more for out of pocket medical care than they can afford on top of the Medicare payments. Therefore it stands to reason that before you can qualify for Medigap, you have to qualify for Medicare. However, there are other plans to choose from, so you need to learn about all of your options before trying to enroll in a Medigap plan.

Medigap and Medicare Advantage

One reason that you need to be careful about the plan you choose is that you can’t combine all plans. Medigap works with Medicare to reduce your costs. However, if you are enrolled in Medicare Advantage, you won’t be able to enroll in Medigap because your costs are already reduced. That’s why you really need to speak with a professional who can interpret your medical and financial needs to combine what they learn with the available plans to find the right combination for you.

Don’t Forget Prescriptions

In some cases, Medigap isn’t what you need at all. Perhaps you have one doctor’s visit a month to refill your prescription. In that case, a prescription plan may be more along the lines of what you are looking for than a Medigap plan. When your prescriptions cost more than your visits or other treatments, you need to at least consider a Medicare prescription plan.

Reading through all the jargon that defines each plan, benefits, and costs can be difficult enough without trying to compare your current costs on top of it. Talk to an insurance professional who can help you determine what plan or combination of plans will best serve you.

The post How to Choose the Right Medigap Plan appeared first on Affordable Health Insurance.

Since the Affordable Care Act was signed 3 years ago, more than 370 innovative medical practices called “accountable care organizations” have sprung up all over the USA , with over 150 more planned.

Several of these organizations are located in Los Angeles and surrounding areas and they are doing something very unique in the health industry.  At these centers, Medicare or private insurers reward doctors financially when their patients stay healthy.  The doctors actually make money when their patients require fewer hospital stays, emergency room visits and surgeries.  This is the opposite of what doctors have traditionally been paid to do.  The more money the organization saves, the more money its participating providers share.

Just how exactly are they doing this?  These organizations are using information technology to monitor the patients most at risk.  Using patient records, they are looking for patients who are overdue for checkups and finding out which patients have not been filling their prescriptions.  Then, using teams of doctors, health coaches, care coordinators and nurse practitioners, they work with the patients and encourage them to live healthier lives.

At one center in North Carolina, patients with a history of congestive heart failure get a daily phone call from a nurse asking them to step on a scale and report their weight (a good, early indicator of an impending emergency).  Another provider in California offers Medicare patients free dance lessons, healthy cooking classes and other fun activities.  A Buffalo clinic is building a gym and a teaching kitchen for its patients.

These organizations are setting the trend for the future – preventative health care.   Now, having health insurance coverage isn’t just about help for medical emergencies anymore.

The post Reforming the Health Care System appeared first on Affordable Health Insurance.

In Los Angeles, as well as the rest of California, “counselors” are now being prepared to help the flood of applicants who will be signing up for health care coverage.  Many of these “counselors” will have no health insurance background.  How much sense does it make to have an inexperienced person advise you on what type of insurance is best for you and your family?

Individuals have until December 15^th, 2013, to be signed up for coverage, starting January 1.   They will not the only ones to be fined for not having insurance.  Many companies will also have to make health care available to all full-time employees.  Businesses will have until 2015 to comply or face fines.

Now is the time to speak to a qualified insurance agent and get all the facts.  Don’t wait until last minute when the insurance industry is flooded with applicants.

The post Think Health Insurance Too Expensive? – Think Again appeared first on Affordable Health Insurance.

• No more denial of insurance because of pre-existing conditions.  This does not go into effect until 2014, but anyone who would like coverage now, can apply to the state to get temporary health insurance coverage.
• Insurance companies must get “OK” from the state government before raising premiums.
• Obama Care says that insurance companies must spend at least 80% of premiums on providing actual medical services.  If they spent it elsewhere (i.e. salaries or marketing), they have to pay it back to the policy holder.
• Most families will no longer have to make co-payments on wellness or pregnancy exams.
• If an insured member gets sick, they cannot be dropped from their plan.
• Parents can add their adult children, up to age 26, to their plans.
• If a child is chronically ill, a new insurance company cannot deny coverage for the child.
• Obama Care requires that 50 procedures recommended by the” U.S Preventative Services Task Force”, be covered as preventative services.    These include well-women visits, domestic violence screening, and support for breastfeeding equipment and contraception.
• Maternity and Newborn Care is categorized as preventative care, and must be provided at no cost.
• Though most plans currently provide services and devices to help with injuries, disabilities or chronic conditions, Obama Care will also cover goods and services  to help  maintain a standard of living if a person contracts a chronic disease.
• Obama Care plans cover 100% of preventative lab tests.  This does not include tests that have been ordered if a person has already been diagnosed with a disease.

A new era for health insurance is about to begin.  Talk to one of our insurance expert about your options

The post Obama Care’s Impact on ALL Insurance Plans appeared first on Affordable Health Insurance.

Take Los Angeles as an example.  It is estimated that at least 20 percent of the population is living below the poverty level.    In a city of several million people, that is a considerable number of people who will not be able to afford health care for themselves, or their family.

What are lower income people going to do?

There is good news.  People with low to medium incomes may qualify for federal subsidies to help offset monthly premiums and deductibles.  Anyone earning 400% of the poverty line will be eligible for a subsidy which is up to $45,960 for an individual and $94,200 for a family of four.

The Kaiser Family Foundation estimates that 48% of Americans who buy individual insurance today would be eligible for subsidies.  They would receive an average of $5,540, which would cover 66% of the price.

Though premiums will vary significantly across the country, right now it is estimated that a 25 year old making 25k a year, will pay about $62 a month for health insurance.

Of course, the lower the income, the larger the subsidy for Obama Care.  For instance, let’s take someone who makes about $17,235 a year.  That individual will pay about 4% of their income, or $57a month.  A person who makes between $34,470 and $45,960 will pay a maximum of 9.5% of their income, or $364 a month.  The balance is covered by the federal government.  Anyone who earns above $45,960 a month will pay the full premium.

There are various subsidies available at various income levels.  When a person applies for Obama Care they can apply for an advance subsidy by estimating their income.

Call us and find out what subsidies you might be eligible for.

The post Don’t Have Money for Health Insurance? appeared first on Affordable Health Insurance.