Changes to Medicare Advantage Plans
Last month I received a call from a woman concerned about her father’s UHC Medicare Advantage plan. A letter came in the mail informing her father of provider cuts, including his primary physician, which would be occurring shortly. UHC suggested her father find new providers, as most of his would be dropped. Upset and confused, this woman did not know what to do, and I suggested a Medicare Supplement versus finding another Medicare Advantage plan.
Unfortunately, her father had only recently left the hospital, leaving him medically unqualified for the time being. Insurance carriers need only give 30 days notice to their beneficiaries, but for many this 30 day notice is not enough.
The father would be losing 8 of his doctors in the provider cut. By January 1st, he will not be able to afford any of his current providers.
After learning about this phenomenon, I began to research Medicare Advantage cuts for 2014, my thought being UHC had a reason for giving some doctors the boot.
I was right. Due to changes in government funding to Medicare Advantage plans, the company has taken measures to streamline their network of providers for solely MA plans. UHC Medicare Supplement policyholders will not be affected by these cuts.
The “Doctor Fix” is part of a ten-year plan to strip down the spending on Medicare Advantage plans by $156 billion. For those who have MA plans, you know that funding is already tight. While premiums will only increase slightly, there will be other cuts down the road for MA plans.
These include new plans concerning provider payment. There is new legislation (well, new to me and you) that will stall doctor cuts for now, but will contain a new formula. This formula will be the method of which Medicare determines payment to individual providers. Doctor’s will be judged on multiple areas that are meant to assess provider quality. Currently, doctor’s make a flat rate on seeing patients and flat rates for different services they provide.
With less funding to their Medicare Advantage plans, UHC was “forced” to reorganize their provider network, which means the 14 million UHC Medicare Advantage beneficiaries might have to find new providers. In a news article from USA Today, Susan Jaffe of Kaiser Health News writes that Medicare officials are currently reviewing UHC provider networks, which might result in another reconfiguration, hopefully for the better. Jaffe also urges that “losing a doctor does not constitute an exception” to the special enrollment period.
An enrollment period available for extraneous situations only. For example, moving from your network or the insurance carrier filing for bankruptcy are situations in which you would qualify for a special enrollment period outside of open enrollment.
Unfortunately, for many Americans, Part C is the only supplemental insurance they can afford. There are also many Medicare beneficiaries who are stuck with their Advantage plans due to health reasons. I wish I could say that I see these plans turning around in the future, but it doesn’t look promising. Hopefully things will change for the better.
As for those people who can afford to switch from your current Advantage plan, now might be a good time. Of course you will have to wait until the Annual Dis-enrollment Period (January 1st to February 14th for 2014).
Medicare Supplement plans are currently not going to be impacted by this legislation or the Affordable Healthcare Act– Medigap beneficiaries will be able to keep using current providers and their coverage will not change.
Medicare Advantage Plans
Medicare Advantage Plans, also known as Medicare Part C, are health insurance plans offered by private insurance companies that contract with Medicare to provide Medicare benefits. These plans combine the coverage of Medicare Part A (hospital insurance) and Part B (medical insurance) into a single plan. Some Medicare Advantage Plans also include prescription drug coverage (Part D).
Here are some key points about Medicare Advantage Plans:
- Coverage: Medicare Advantage Plans must provide at least the same level of coverage as Original Medicare (Part A and Part B), but they often offer additional benefits, such as vision, dental, hearing, and wellness programs. Each plan can have different rules and coverage, so it’s important to review the specific plan details.
- Network: Medicare Advantage Plans typically have a network of doctors, hospitals, and other healthcare providers that you must use to get the full benefits of the plan. In most cases, you will need to select a primary care doctor and get referrals to see specialists.
- Costs: While Medicare Advantage Plans are required to cover all Medicare-covered services, they can have different costs and cost-sharing requirements. This can include premiums, deductibles, copayments, and coinsurance. Some plans may have lower out-of-pocket costs than Original Medicare, but it’s important to compare the costs of different plans.
- Prescription Drugs: Some Medicare Advantage Plans include prescription drug coverage (Part D), while others may require you to enroll in a separate Part D plan. If you need prescription drug coverage, make sure to check if it’s included in the Medicare Advantage Plan you’re considering.
- Enrollment: To join a Medicare Advantage Plan, you must be enrolled in both Medicare Part A and Part B. You can generally enroll in a Medicare Advantage Plan during your initial enrollment period when you first become eligible for Medicare or during the annual Medicare Open Enrollment Period, which typically runs from October 15th to December 7th each year.
It’s important to carefully review and compare different Medicare Advantage Plans to find one that best meets your healthcare needs and budget. You can use the Medicare Plan Finder tool on the official Medicare website (medicare.gov) or speak with a licensed insurance agent to help you navigate the options and make an informed decision.
9 good reasons why a Medicare Advantage plan might be right for you
Medicare Advantage plans have gained popularity since first being introduced by the Balanced Budget Act of 1997. Here are nine reasons why.
1. Low or $0 monthly premium payments
Medicare Advantages plans often have low-cost or even $0 premiums. Costs will vary by plan, so it’s important to shop around. You will continue to pay the Part B premium to Medicare.
2. Financial protection
Medicare Advantage plans provide a financial safety net due to a set annual out-of-pocket limit. If your costs reach the limit, then your plan covers 100 percent of your Medicare-covered health care costs for the rest of the year.
Medicare sets a maximum out-of-pocket limit each year, and plans can set their limits at this amount or lower. There is no out-of-pocket protection with Original Medicare (Parts A & B).
3. Dental, vision, fitness and hearing coverage
Original Medicare doesn’t provide coverage for dental, vision, hearing care or fitness. For a simple solution and added health and wellness, most Medicare Advantage plans cover these items as part of their benefit packages.
4. Extra benefits to support your health and well-being
Plans are always expanding the benefits they offer that Original Medicare does not. You may find plans that provide total health and wellness packages, in-home medical visits, transportation to medical appointments, coordinated care, virtual tele-health doctor visits and more.
5. Built-in prescription drug coverage
You don’t need a separate Part D plan with most Medicare Advantage plans because drug coverage is a built-in benefit.
6. The simplicity of one plan
With Medicare Advantage, you have one complete plan to cover your health care needs – doctor visits, prescription drugs, hospital care and more. One plan, one premium and one point of contact for your Medicare questions.
7. Easy referrals to providers and specialists
Oversight by your primary care provider and access to an extensive network allow you to quickly see providers and specialists for the care you need. Your primary care provider can easily refer you to the services you need.
8. Emergency care nationwide
You can rest assured that you will get the care you need should you have a health emergency – no matter what state you’re in. All Medicare Advantage plans are required to provide coverage for urgent and emergency medical care throughout the United States.
9. Comprehensive care coordination
Most Medicare Advantage plans are coordinated care plans. That means that all your care is brought together under one umbrella so that it can be seen as a whole. The goal is to improve your health outcomes, avoid overlapping tests and procedures and promote clear communication.
Medicare Advantage may be a great choice for you if you are wanting more than the basics that Original Medicare provides. But most importantly, you need to pick a plan that fits your personal needs. You can do this by using this zip code search tool to find and compare Medicare Advantage plans and benefits in your area.
Medicare
Medicare is a government-funded healthcare program in the United States that provides health insurance coverage for eligible individuals who are 65 years of age or older, as well as certain younger individuals with disabilities or end-stage renal disease. It was established in 1965 under the Social Security Act and is administered by the Centers for Medicare and Medicaid Services (CMS).
Medicare is divided into several parts that cover different aspects of healthcare:
- Medicare Part A (Hospital Insurance): Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home healthcare services. Most people receive Part A coverage automatically without paying a premium, as long as they or their spouse have paid Medicare taxes while working.
- Medicare Part B (Medical Insurance): Part B covers outpatient medical services, including doctor visits, preventive care, medical supplies, and certain diagnostic tests. Part B requires the payment of a monthly premium, and the amount is based on the individual’s income. It is optional, but most people choose to enroll in Part B.
- Medicare Part C (Medicare Advantage): Part C, also known as Medicare Advantage, offers an alternative way to receive Medicare benefits through private insurance companies approved by Medicare. These plans must provide at least the same coverage as Original Medicare (Part A and Part B) and often include additional benefits like prescription drug coverage (Part D) and dental or vision services. Medicare Advantage plans usually have network restrictions and may require cost-sharing.
- Medicare Part D (Prescription Drug Coverage): Part D is a standalone prescription drug coverage plan that helps pay for prescription medications. These plans are offered by private insurance companies approved by Medicare. Part D plans usually have a monthly premium and may involve copayments or coinsurance for medications, depending on the plan’s formulary.
It’s important to note that while Medicare covers a significant portion of healthcare costs, it doesn’t cover all expenses. There may be deductibles, copayments, or coinsurance that individuals are responsible for paying out of pocket. Some people choose to supplement their Medicare coverage with Medigap (Medicare Supplement Insurance) policies, which are sold by private insurance companies and help cover certain out-of-pocket costs.
The specifics of Medicare can be complex, and eligibility, coverage, and costs can vary depending on individual circumstances. It’s advisable for individuals approaching Medicare age or seeking more information to visit the official Medicare website (medicare.gov) or contact the CMS or local Social Security Administration office for personalized guidance.
Prepare and write by:
Author: Mohammed A Bazzoun
If you have any more specific questions, feel free to ask in comments.
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