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.
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”.
$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.
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 (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 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.
You may either choose Original Medicare (Part A & B) path or Medicare Advantage path.
Simple Answer: Medigap doesn’t work with Medicare Advantage.
|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.|
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 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 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.
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.|
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:
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.
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”.
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.
Renewal: Your plan renews automatically each year as long as you pay the premium and the plan is still available in your service area.