Democrats and Republicans are proposing many changes to the Medicare Program. It is important that you understand the implications of these proposed changes. The purpose of the blog is to attempt to sort through the different options. Stay tuned as we make future posts.
As you well know, Open Enrollment is upon us, and will be until December 7th of this year. Many seniors take advantage of this time of year to better control health care costs by deciding which version of Medicare to enroll in or switch to. Those that play their cards right can save hundreds, even thousands of dollars every year. But not everyone does play their cards right.
Unfortunately, many stand before the vast variety of options regarding Medicare, don’t understand the different coverage each plan offers in comparison with the others, feel overwhelmed, and make bad decisions. So we are here to give you a more comprehensive breakdown than what you’re probably used to seeing.
Deductibles, coinsurance and restrictions apply to each type of Medicare, but coverages and costs can change yearly, which can contribute to the confusion. Every year, you must check what your existing plan includes or excludes for the upcoming year.
- Medicare Part A covers hospital care, and usually does not require you pay a premium.
- Medicare Part B covers doctor’s visits and outpatient services, and premiums in 2019 will be between $135.50 – $460.50 depending on your income.
- Medicare Advantage serves as an alternative to Original Medicare and is offered by private insurers. These plans cover the same services, but can offer extra benefits like eyeglasses, dental care, or drug coverage. Pay differs person-to-person depending on the coverage received.
- Medicare Part D is prescription drug coverage.
Ultimately, your choices are three:
- Original/Traditional Medicare which consists of Parts A and B
- Medicare Advantage (sometimes referred to as Part C), or the private insurer version of Parts A and B, often with Part D mixed in
- Medigap, or supplemental coverage that can help lower out-of-pocket costs for Original Medicare
So which coverage is right for you? 5 Steps you can take to see which plan best meets your medical needs are listed below:
1. Make a list of all your drugs and their dosages. This will make it easier to compare costs.
2. Carefully read your Annual Notice of Change letter. If you already have coverage, you should have received a letter around the end of September, informing you what will be covered by your existing plan in 2019, as well as what changes may be taking place. This is a good way to find out if your plan is dropping coverage that you need.
3. Compare Original Medicare and Medicare Advantage. Advantage plans may offer extra benefits. Thanks to the Trump Administration it may be able to offer in-home health-related renovations such as bathroom handlebars, or hot meals delivered to the home. Medicare Advantage plans also cap your out-of-pocket expenses.
4. Figure out whether you need Medigap supplemental coverage. Medigap is private insurance that applies to that which is covered by your Original Medicare plan but picks up more of the cost. It is not compatible with Medicare Advantage. Most seniors who have a multiplicity of health care needs find they can better control their costs with Medigap.
5. Decide whether you should switch from Original Medicare to Medicare Advantage. If you would prefer having additional coverage that Original Medicare does not provide, it might make sense to make the switch over to a Medicare Advantage plan available in your state.
If you still want more tools to compare plans, use the Plan Finder at Medicare.gov, which allows you to compare plan features, premiums, co-pays, etc. depending on where you live.
And if you require any further assistance, reach out to SeniorQuote Insurance Services for free at 1-800-992-7724.
Original article first published in Investor’s Business Daily
Original Author: Paul Katzeff
Wording changed for reposting purposes
One of the most popular private insurance alternatives to traditional Medicare is Medicare Advantage. Covering more than 20 million people means 1/3rd of all Medicare beneficiaries are enrolled with Medicare Advantage. Unfortunately, recent reports say that it has been improperly denying many medical claims to both patients and physicians alike, denying claims in an attempt to increase their profits.
It is currently Medicare’s annual open enrollment period (Annual Election Period, or AEP), providing beneficiaries the opportunity to join Medicare Advantage plans, switch plans, or return to traditional Medicare, usually having access to 10+ private plans. But with recent findings regarding denials of care and payment in Medicare Advantage, consumers have a right to be concerned and hesitant to enroll.
Medicare Advantage has its appeals though, such as its including a doctor who can coordinate care, and an annual limit on out-of-pocket expenses. It is expected that Medicare Advantage plans will rise 22.6 million next year. The growth of Medicare Advantage is due in part to the policies set in Washington, including an increase in payments to private plans for 2019 and tax relief issued to health insurers, which allows them to reduce premiums and add the following benefits:
- Transportation to the doctor’s office
- Home delivery of hot meals
- Safety features in the home like wheelchair ramps and bathroom grab bars.
So with all of these benefits coming down the pipeline, what is there to be concerned about with Medicare Advantage? Currently, patients of Medicare Advantage seem to be experiencing barriers to timely access to necessary care because of superfluous prior authorization requirements. Insurers defend the requirements saying that they “protect patients from unnecessary and inappropriate care” and help reduce costs. If treatments or payments are denied, very few people ever appeal the denial of claims, but of those that do, 75% of them are successful after their first level of review.
To shed more light on the topic, Medicare plans receive fixed monthly payments from the government, and in return, those plans are supposed to provide the full range of services needed by the patients. One way plans try to keep costs down is simply by keeping their patients healthy, reducing the need for hospitalization, keeping costs below what they are paid by Medicare.
Unfortunately, another way the plans can save money is by denying services. To put it in perspective, Medicare has imposed more than $10 million in fines against private plans for overcharging beneficiaries, denying coverage for prescription drugs, failing to respond to complains, etc. within the last two years. But this is nothing new; insurers have been accused of using similar strategies in the past, saving money when they don’t provide care.
Insurers say that 90% of people in Medicare Advantage are satisfied with their plans, but administration officials plan to step up the supervision of Medicare Advantage plans, providing beneficiaries with clear and easily accessible information about serious violations of Medicare requirements.
For questions or concerns regarding your plan in particular, contact SeniorQuote Insurance Services by calling 1-800-992-7724.
Originally Published in the New York Times, Oct. 14th, 2018
Original Author: Robert Pear
Original wording edited for reposting purposes.