Medicare Medical Savings Account (MSA) Plans

Jun 15th, 2017     Medicare

Medicare MSA plan is a consumer-directed Medicare Advantage plan, which combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible) can be used for your health care services during the year. This plan will only pay for Medicare-covered services once you have reached your deductible. Before you meet the deductible, you’re responsible for paying the bill for any Medicare-covered services. Once you meet the plan’s deductible, the plan pays for all of your Medicare-covered services. You won’t have to pay a monthly premium.

Parts Of Medicare MSA Plans

Medicare MSA plan is a combination of a high-deductible insurance plan and a medical savings account that you can use to pay for your health care costs. The high yearly deductible can vary by plan.

High-deductible Health Plan: The first part is a special type of Medicare Advantage plan (Part C). The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.

Medical Savings Account (MSA): The second part is a special type of savings account. The Medicare MSA plan deposits money into your account. You can choose to use money from this savings account to pay your health care costs before you meet the deductible.

Simple example: Medicare Medical Savings Account (MSA) Plans

Mr. Jones and Mrs. Martinez are interested in joining Medicare MSA plans. Plans ABC and XYZ are available in their area.

Terms Plan ABC Plan XYZ
Yearly deposit $2,500 $1,500
Yearly deductible $4,000 $3,000
What you pay after the deductible $0 $0
Out-of-pocket maximum $4,000 (same as deductible) $3,000 (same as deductible)

If Mr. Jones joins Plan ABC:

  • Plan ABC deposits $2,500 into his account at the beginning of the year.
  • If he uses the money in his account for Medicare-covered Part A and Part B services, he’ll have to spend $1,500 out-of-pocket before he meets his deductible and before the Medicare MSA Plan will begin paying for his health care.
  • Once Mr. Jones has met his deductible, Plan ABC pays all of his Medicare-covered Part A and Part B health care, and he pays nothing.
  • Mr. Jones must continue to pay the monthly Part B premium.

If Mrs. Martinez joins Plan XYZ:

  • Plan XYZ deposits $1,500 into her account at the beginning of the year.
  • If she uses the money in her account for Medicare-covered Part A and Part B services, she will have to spend $1,500 out-of-pocket before she meets her deductible and before the Medicare MSA plan will begin paying for her health care.
  • Once Mrs. Martinez has met her deductible, Plan XYZ pays all of her Medicare-covered Part A and Part B health care costs, and she pays nothing.
  • Mrs. Martinez must continue to pay the monthly Part B premium.

How To Choose A Medicare MSA Plan?

Once you decide which MSA plan you want, contact the plan for enrollment information and to join. The plan will tell you how to set up your account with the bank selected by the plan. You must set up an account before your enrollment can be processed. During the Open Enrollment Period you can join MSA plan. Here are some points that may help you to know more about Medicare MSA plans.

Who Can Join a Medicare MSA Plan?

People with both Part A and Part B can generally join a Medicare MSA Plan.

Can my Medicare MSA plan ever cancel my enrollment?

Your plan can cancel your enrollment if one of these events happen:

  • You get Medicaid.
  • You enroll in a Federal Employee Health Benefits Program (FEHBP) plan.
  • You get health care benefits from the Department of Defense (TRICARE) or the Department of Veterans Affairs (VA).
  • You get benefits (like an employer or union group health plan) that cover all or part of the yearly MSA deductible permanently.
  • You move outside of the service area of the plan, or are temporarily out of the service area for longer than 6 months.

What’s covered in Medicare MSA plan?

In addition to the Medicare services that all Medicare Advantage Plans must cover, some plans may cover extra benefits for an extra cost like dental, vision, long-term care not covered by Medicare and contact plans in your area for extra benefits they cover, if any.

Do MSA Plans cover Medicare Part D prescription drugs?

If you join a Medicare MSA plan and need drug coverage, you’ll have to join a Medicare Prescription Drug plan.

What happens to the money in my account if I leave the plan before the end of the year?

No more money will be added to your account. You’ll need to pay part of the most recent yearly deposit (based on the number of months left in the current calendar year) back to Medicare.

If I die, will my spouse be able to use the money in my account?

Any funds in your account that were deposited before the current calendar year are part of your estate. Part of the most recent deposit (based on the number of months left in the current calendar year) will have to be paid back to Medicare.

What if my beneficiary isn’t my spouse?

If you name a beneficiary for your account who isn’t your spouse, the money in it after your death is counted toward that person’s gross income when he or she files that year’s income tax return. If your estate gets the money in your account, it’s counted as gross income on your final tax return.


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Medicare Zero-Dollar ($0) Premium Plans

Jun 15th, 2017     Medicare

Medicare Advantage Plans are offered by private companies which are approved by the Medicare. They offer, at minimum the same coverage of Original Medicare (Part A & Part B), however in MA plans, members can visit doctors in the plan’s network only (or pay higher co-pay) which help the insurance companies in saving some costs. These savings can be passed on to the members through lower (or $0) premiums and some additional benefits. These kind of plans which do not charge any additional premium (apart from the part-B premium) are called $0 premium medicare advantage plans. These plans could also include additional benefits such as foreign travel emergency care, preventive dental services, routine vision care and fitness benefits.

Who can enroll for $0 premium medicare advantage plan?

  • People who have Medicare Part A and Part B coverage.
  • People who come from the service area of the plan.
  • People who do not suffer form End-stage Renal disease.

How to enroll for $0 premium medicare advantage plan?

  • Visit the plan’s website for any online registration.
  • Contact the plan for offline mode of registration.
  • Search for the contact details of the plan to get enrolled.
  • Use Medicare’s plan finder from the official website Medicare.gov
  • Call at 1-800-MEDICARE (1-800-633-4227).

What is the cost of $0 premium medicare advantage plan?

As the name suggests, $0 premium plans comes without any additional cost (you just have to pay your Part B premium). Just like most medicare advantage plans, $0 premium plans also use a combination of deductibles, co‑insurance and co‑payments to share the costs of care with the member. Deductibles, co-pays and co-insurance, plus all costs for ‘services that aren’t covered’ are called “out-of-pocket costs”.

Other costs associated with $0 premium plans

$0 premium Medicare Advantage plans include out-of-pockets costs such as annual deductibles, co-payments, and coinsurance. For example, most of the Medicare Advantage plans have primary and specialist fee co-payments for the services offered. Apart from that, members can visit doctors within the plan’s network and may also need to get a referral for seeing the specialist (based on the plan’s terms of coverage).

Medicare Advantage plans include maximum out-of-pocket limit to control costs. This is a cap on the amount that the patient pays for the covered medical expenses in a calendar year. However, the patient must continue to pay his monthly Part B premium when enrolled in a Medicare Advantage plan.

  • Original Medicare contracts with Medicare Advantage plans to have private insurance companies cover a member’s Medicare bills. The beneficiary of this plan no longer associates with original medicare.
  • Medicare Advantage plans receive a monthly fee from the government to cover the members’ health-care bills. This amount can change based on age, sex, and health.
  • Medicare Advantage insurance companies associate with a network of doctors, hospitals, and other health providers with a smaller fee rate. This can produce savings, which can, in turn, be passed onto the beneficiary through extra benefits not covered by Original Medicare.
  • Medicare Advantage members must continue to pay for Part B premium.

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What You Pay in a Medicare Advantage Plan?

May 31st, 2017     Medicare

Medicare Advantage Plans provide extra benefits in comparison to Original Medicare (Part A & Part B) and may also have lower out-of-pocket costs. The health insurance premium and out-of-pocket costs will be based on the chosen Medicare Advantage plan and are usually paid on montly basis. Other costs included are co-payments for doctors’ consultation and other healthcare services, and premiums for optional benefits, such as vision, hearing, dental and prescription drugs coverage .

Medicare Part B and Medicare Advantage Premiums

The person has to continue to pay for Medicare Part B premium even if he is enrolled in a Medicare Advantage plan. Medicare Part B premiums must be paid directly to Medicare. The monthly cost may increase based on the patient’s annual household income from two years prior.

In addition to the Medicare Part B premium, Medicare Advantage plans often charge a monthly premium for coverage. $0 premium medicare advantage plans are also available.

Annual deductibles in Medicare Advantage Plans

Health insurance premium depend on the plan’s annual deductible. Few Medicare Advantage plans should meet an annual deductible before coinsurance comes into play. These deductibles vary by plan, with higher annual deductibles often indicate lower monthly plan premiums.

The person should compare and choose wisely between plans with higher monthly premium and plans with higher annual deductible in order to save his Medicare costs. For Example, if the person is ill, a plan with a higher monthly premium and a lower annual deductible may save his most money in long run. He should also consider the plan’s Maximum Out-of-Pocket (MOOP) amount. Once he reaches this spending limit, the Medicare Advantage plan covers 100% of the cost. So choosing a plan with a low MOOP limit reduces his Medicare costs.

Co-payments in Medicare Advantage plans

Medicare Advantage co-payments vary extremely among plans. Few plans have co-payments for doctors’ visits, hospital stays, ambulance rides and emergency room visits. Co-payments are figured on a two or three tier system. For Example, a primary care physician’s visit may have lower co-payment (say $10 per visit) than a specialist’s visit (say $20 per visit). Emergency care co-payments are expensive.

Prescription drug costs in Medicare Advantage plan

Medicare Advantage plans with prescription drug coverage will have a formulary, which is a list of covered prescriptions. The formulary structures prescriptions into tiers, with generic ones located in the lowest tier. The lowest tiered ones are typically cheaper than the ones located in the highest tier.



Medicare Advantage Vs Medicare Supplement

May 23rd, 2017     Medicare

There are multiple types of plans available in medicare and it can be difficult to understand the meaning of the plan from its name. Medicare Advantage Plan (also called Part C) and Medicare Supplement Plan (also called Medigap) are the most confusing of these plans. Although these two plan types differ greatly from each other but many people get confused due to similar names. In a nutshell, Advantage Plan (or Part C) is replacement of Original Medicare (Part A & B) while Supplement Plan (Medigap plan) helps you cover the out of pocket expenses under Original Medicare.

Medicare Advantage Plan

Medicare Advantage Plan (Part-C) includes all benefits and services covered under Part A and Part B. Sometimes it also includes Medicare prescription drug coverage (Part-D) as part of the plan. Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and other health and wellness programs and are run by Medicare-approved private insurance companies that follow rules set by Medicare. Most Advantage Plans have a yearly limit on out-of-pocket expenses (deductibles, co-pays, co-insurance etc.) for medical services. In addition to your Part B premium, you may have to pay a monthly premium for the Medicare Advantage Plan.

Medicare Supplement

Medicare Supplement Insurance policies are also called Medigap policies. Medigap policies, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles (commonly referred to as out-of-pocket expenses). A person must be enrolled in part A and B of Medicare before they can enroll in a Medigap plan. Refer to our guide on medigap policies for complete information.

medigap vs medicare advantage

You may either choose Original Medicare (Part A & B) path or Medicare Advantage path.

How does Medigap work with Medicare Advantage Plans?

Simple Answer: Medigap doesn’t work with Medicare Advantage.

  • If you have a Medicare Advantage Plan (like an HMO or PPO), it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare.
  • If you have a Medigap policy and join a Medicare Advantage Plan, you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums. Also, in most cases, if you drop your Medigap policy to join a Medicare Advantage Plan, you won’t be able to get it back.
  • If you join a Medicare Advantage Plan for the first time, and if you want to change the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining.

Comparison of Medicare Advantage and Medicare Supplement

Factors Medicare Supplement Plan Medicare Advantage Plan
Networks There is no network restriction. You can have the choice of hospitals and doctors. You may have network restrictions, emergency care is covered for travel with-in United States and sometimes abroad.
Medical Care and Coverage Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Medical Advantage Plan cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
Doctors and Referrals You can select Doctors and Hospitals as per the need. You can see specialists without Referrals. Selection of Doctors will be done according to plan network. You may need Referrals if required.
Costs Medigap plan has no Out-of-pocket costs and no need to pay co-payments, deductibles. MA Plans have an limited out-of-pocket annual maximum. You still need to pay your Medicare Part B premium.
Drug (Part-D) Part-D is not included in the plan. If you want this coverage, you need to enroll in a stand-alone Medicare Part D prescription drug plan. MA plan itself consists Part-D coverage. If your Medicare Advantage plan does not include drug coverage, you can enroll in a Medicare prescription drug plan.
Enrollment Must have Original Medicare, Part-A and Part-B. Benefits don’t generally change. You can enroll during Open Enrollment Period.
You cannot use Medicare Supplement plan if you are enrolled in MA plan. No Annual Election Period (AEP) for Medigap plans.
Must have Original Medicare, Part-A and Part-B. Benefits may change yearly. You may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period.
You usually remain in a plan unless you dis-enroll policies during the Annual Election Period.
Standardized Policies Medicare Supplement Plans are standardized. Medicare advantage Plans are not standardized.

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How Medicare Advantage Plans Differ from Original Medicare

May 19th, 2017     Medicare

Almost all people who want to enroll with medicare have to decide whether they want to keep original medicare or want to go with medicare advantage plans (Part C). Each of them have some tradeoffs against each other (in terms of cost, coverage and convenience) and it’s important to understand the difference between the two to select the best suitable plan for you.

Original Medicare (Part A and Part B)

Original Medicare is a coverage managed by the federal government. It includes Part-A (hospital insurance) and Part-B (medical insurance) coverage if you enroll in both. You pay a deductible and/or coinsurance when you receive healthcare services. Most people get Part A free of cost and pay a monthly premium for Part B. If you want prescription drug coverage, you must buy a separate prescription drug plan (part D) from a private insurance company. Also, separate medigap policies are available to cover the out-of-pocket expenses.

Medicare Advantage Plan (Part C)

Medicare Advantage Plan includes all benefits and services covered under Part A and Part B. Many times it also includes medicare prescription drug coverage (part D) as part of the plan and it is run by Medicare-approved private insurance companies that follow rules set by Medicare. You pay Part B premium and additional premium to private insurer. To understand how to choose the best MA plans, refer Choosing Best Medicare Advantage Plans.

Differences Between Original Medicare And Medicare Advantage Plan

Original Medicare Plan and Medicare Advantage Plan differ greatly and it is important to know these differences. Let us check out the comparison guide so you can decide which Medicare plan is better as per your needs.

Factors Original Medicare Medicare Advantage Plan
Costs? You pay medicare premiums, deductibles, and co-insurances. There’s no yearly limit for what you pay out-of-pocket. You usually pay a monthly premium for Part B, if you opted for medical insurance. You pay Medicare part B premiums and Part C premium (if any), deductibles, and co-insurances. However, most MA plans have max-limit on Out-of-pocket expenses.
Should I get a supplemental policy? You may already have employer or union coverage that may pay costs that Original Medicare doesn’t. If not, you may want to buy a Medicare Supplement Insurance (Medigap) policy if you’re eligible. You can’t buy a Medigap policy to pay your out-of-pocket costs in a Medicare Advantage plan. In most case, there is a max-limit on OOP expenses.
Do I have to get a referral to see a specialist? In most cases, no, but the specialist must be enrolled in Medicare. You often need to get a referral from your Primary Care Physician if you want to see a specialist.
Covers drugs? No, but if you want medicare prescription drug coverage, you can buy a separate Part D plan. Many MA plans include Part D drug coverage.
Out-of-pocket limit? There’s no max limit on the out-of-pocket expenses which you may need to incur. MA Plans have a max-limit on the out-of-pocket expenses which safeguard you in case of expensive medical care. The plan pays the full cost of your care after you reach the limit.
Covers extra services like vision and dental? Doesn’t cover certain services such as routine vision, hearing or dental care. MA plan cover services like routine vision, hearing and dental care.
Do the services are provided nation wide? Yes, you can go to any doctor or hospital in the U.S. that accepts Medicare. Usually not. Most people have HMOs or PPOs, which provide coverage through their network of healthcare providers. You may need to take additional coverage if you need to travel.

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Medicare Advantage Plans

May 19th, 2017     Medicare

Medicare Part C plans are also referred to as Medicare Advantage plans. These plans are offered by private insurance companies and allow you to get all the coverage Original Medicare (Parts A and B) offers, plus additional benefits and services all in a single plan. Many Medicare Advantage plans include prescription drug coverage (Part D), often for no additional premium or for small premium amount. Some plans also include extra benefits such as:

  • Routine vision, hearing and dental care
  • Wellness programs

Different Types Of Medicare Advantage Plans:

Most Medicare Advantage plans are built on the idea of a network of doctors and hospitals working together to provide care. Each MA plan creates its own network of doctors and other health service providers. In most cases, you will pay most or all costs if you see a provider outside of the network.

  1. Health Maintenance Organization (HMO) Plans: HMO plans require you to seek care from providers in your network. Many require you to get a referral from your primary care physician to see a specialist.
  2. Point Of Service (POS) Plans: A type of HMO plan that allows you to see doctors and hospitals outside the network for some covered services, usually for a higher co‑pay or co‑insurance.
  3. Preferred Provider Organization (PPO) Plans: PPO plans typically don’t require a referral to see a specialist and allow you to see providers outside the network without having to pay the entire cost yourself.
  4. Special Needs (SNP) Plans: SNPs are designed for people with a range of special needs, including those with chronic diseases, nursing home residents, and people who are eligible for both Medicare and Medicaid.
  5. Private Fee-For-Service (PFFs) Plans: PFFS plans allow enrollees to see any providers in the U.S. who accept Medicare’s payment terms and conditions.
  6. Medical Savings Account (MSA) Plans: MSA plans combine Medicare Advantage plan coverage with a special savings account you can use to pay for covered expenses tax‑free.

Premiums and other Costs:

Medicare Advantage plans can reduce the costs and the hassle for patients who need to buy three policies (Part A, Part B and Drug Plan) for comparable coverage in traditional Medicare, and a supplemental policy that covers out-of-pocket costs. Read our guide to understand differences between Original Medicare and Medicare Advantage Plans.

Only private insurance companies that are approved by Medicare can provide Part C coverage. Insurance companies decide what services the plan will cover, so monthly premiums vary from plan to plan (and state to state) and they are only allowed to make changes to the premium rate once a year. Part C premiums are billed through the private insurance company. You will have to pay a monthly premium (in addition to your Part B premium, although many MA plans comes with $0 monthly premiums). Most Medicare Advantage plans use a combination of deductibles, co‑insurance and co‑payments to share the costs of your care with you. Deductibles, co-pays and co-insurance, plus all costs for ‘services that aren’t covered’ are called “out-of-pocket costs”.

  • Co-insurance: The costs that you and the health insurance plan pay are split on a percentage basis.
  • Co-payments: The fixed amount you pay at the time you receive a covered service.
  • Deductible: A set amount you pay out of pocket for covered services each year before your plan begins to pay.

Out-of-pocket: The maximum amount you pay during a policy period (usually a year). This amount does not include your premium or the cost of any services that are not covered by your plan. After you reach your out‑of‑pocket maximum, your plan pays 100% of the allowed amount of covered services for the rest of the policy period.

When can You Join or Switch to a Medicare Advantage Plan:

  • If you have Part A coverage and Part B coverage during the General Enrollment Period, you can also join a Medicare Advantage Plan.
  • Between Oct 15 – Dec 7, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on Jan 1, as long as the plan gets your request by Dec 7.
  • Between Jan 1–Feb 14, if you’re in a Medicare Advantage Plan, you can leave that plan and switch to Original Medicare.
  • You may lose your prescription drug coverage if you move from a Medicare Advantage Plan that has drug coverage to a Medicare Advantage Plan that doesn’t.
  • In certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan during a Special Enrollment Period. You can only use this Special Enrollment Period once during this time-frame.

Renewal: Your plan renews automatically each year as long as you pay the premium and the plan is still available in your service area.

How To Choose A Type Of Medical Advantage Plan:

  1. Convenience: Check the network of the MA Plan – Where are the doctors’ offices, which pharmacies can you use, whether your favorite doctor is part of the network, whether you’ll require a referral to visit a specialist etc.
  2. Costs: How much are your premiums, deductibles, and other costs? Is there a yearly limit on the out-of-pocket expenses?
  3. Costs: How well does the plan cover the services you need?
  4. Prescription Drugs: Do you need to join a Medicare drug plan? Are your drugs covered under the plan’s formulary?
  5. Travel: Will you have coverage in another state or outside the U.S.?

Important Points To Be Considered:

  • If you’re in a Medicare Advantage Plan, review the Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) your plan sends you each year. If you don’t get these important documents before the start of Open Enrollment, contact your plan.
  • If you go to a doctor, other health care provider, facility, or supplier that doesn’t belong to the plan’s network for non-emergency or non-urgent care services, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.
  • Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.
  • Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year.
  • If your Medicare Advantage Plan includes prescription drug coverage and you join a Medicare Prescription Drug Plan, you’ll be dis-enrolled from your Medicare Advantage Plan and returned to Original Medicare.
  • You can’t use (and can’t be sold) a Medicare Supplement Insurance (Medigap) policy while you’re in a Medicare Advantage Plan. You can’t use it to pay for any expenses (co-payments, deductibles, and premiums) you have under a Medicare Advantage Plan. If you already have a Medigap policy and join a Medicare Advantage Plan, you’ll probably want to drop your Medigap policy. If you drop your Medigap policy, you may not be able to get it back.

Resources:

  • Medicare.gov can show you the plans available in your area.
  • The Medicare Helpline can answer your Medicare questions. Call 1-800-MEDICARE (1-800-633-4227).

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.