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.