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.

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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

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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.

Talk to Your Doctor about Alternatives

Many doctors take a look at insurance plans before offering a prescription, but not all of them do. Even if they do, there is no guarantee that your doctor knows what is covered and what isn’t covered. In some cases, you can get a different prescription that is better covered by Medicare. Talk to your doctor about your options, but realize that you may need to take more than one alternate medication to do what the original one did on its own. There might also be side effects that your doctor was trying to avoid.

Buy Generic

The price of medication is out of control and not looking like it’s going to get any better any time soon. Many people have turned to generic forms of medication in order to be able to afford what they need. When you go to the pharmacy, ask your pharmacist about generic options that may be more affordable for you.

Use Supplemental Insurance

Did you know that buying supplemental insurance could cost you less than your medications? You don’t have to rely on Medicare for everything, especially if you are having a hard time getting your medical needs met by using Medicare alone.

There are different types of supplemental insurance to go along with Medicare. Some versions cover doctor visits, co-pays, or even stays in the hospital. Other versions cover the cost of prescriptions that Medicare doesn’t cover at all or that Medicare only partially covers. With a supplemental plan, you can make a budget that you can work with because you don’t have to worry about the rising cost of prescriptions. You know what you have to pay out to the supplemental insurance plan and you relieve yourself of a lot of the worries that you experience now.

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