Arizona Medicare News
Medicare is basically a federal health insurance program that includes the services such as lab tests, surgeries, doctor visits and medically necessary supplies, such as walkers and wheelchairs. Medicare plan is for those people who are 65 or older. Younger people are also included if they have certain disabilities, and people with End-Stage Renal Disease also called as ESRD, who have permanent kidney failure requiring dialysis or a kidney transplant.
Medicare plan has generally two parts that have different features like Medicare Part A and Medicare part B. In general, Part A covers the services such as home health services, hospital care, nursing home care and skilled nursing facility care. While in general, Part B covers two types of services. First includes medically necessary supplies or services that are needed to diagnose or treat a medical condition, while second includes preventative services, or health care in order to prevent different illnesses. It also covers things like clinical research, mental health treatment, ambulance services, durable medical equipment, limited outpatient prescription drugs and second opinions before a surgery.
The above mentioned features are related to Medicare plan. There is another plan of Azmedicare i.e. Medicare Advantage plan. This plan is available for Arizona residents only. This plan includes a series of Healthcare Plans. These plans are created in partnership between Medicare and Private Insurance companies. They provide cost effective healthcare services to those beneficiaries who are medicare eligible. Medicare advantage plans and Prescription Drug Plan sponsors must have a contract with Medicare in order to sell Medicare insurance plans (such as a Medicare HMO or a Medicare Part D Prescription Drug Plan.
Medicare Advantage plans, also referred to as Medicare Part C plans or MA plans. Approved private health insurance organizations manage and administer these plans. Participants who are selected to receive Medicare benefits through a Medicare Advantage provider must receive all Medicare benefits (including optional Part B and Part D plans) through the provider. Every plan is not accessible in all states or in all service areas but it depends on the terms of the contract between the plan and Medicare. The plan must renew their contract with Medicare every year, so that the availability of a plan in a specific service area is subject to change as a result of the annual contract renewal.
There are five types of plans available in Arizona:
Preferred Provider Organization (PPO) is a managed care plan in which you use hospitals, doctors and providers that belong to the network. People do not need a referral from a primary care physician to go to a specialist. For an additional cost, people can receive services outside of the network.
Health Maintenance Organization (HMO) includes a group of hospitals, doctors and other health care providers who agree to give health care to Medicare beneficiaries for a set amount of money from Medicare each month. In an HMO, people need a referral from a primary care physician to go to specialists and usually get all their care from the providers that are part of the plan.
Medicare Savings Account (MSA)
This type of health plan has two parts:
- First part includes special type of savings account used for health related expenses only. Medicare deposits a set amount per year into customer’s account and the money can remain in the account if customer does not use it by the end of the year.
- High deductible health plan (minimum of $2000): With this type of plan, Medicare pays the premium for the MSA plan and makes a deposit into the MSA established by the beneficiary. The money in the MSA can be used to pay for health services provided before the deductible is met and for services not covered by the MSA plan. After the deductible is met in a given year, Medicare-covered services are covered by the health plan.
Private Fee for Service (PFFS) is a private insurance plan that accepts Medicare beneficiaries. People may go to any doctor or hospital they want. Rather than the Medicare program, the insurance plan decides how much people pay for the services they get. They may have extra benefits the Original Medicare Plan does not cover. They may pay more for Medicare covered benefits.
Special Needs Plan (SNP) is an HMO type plan but it provides membership to only to those people who are eligible for both Medicaid and Medicare or who have chronic disabling conditions or who reside in certain long term care facilities. Special needs plan is designed in such a way that provides medicare health care and services to those people who want benefits from things the most like focus on the care management and special expertise of the plan’s providers.
There is another plan i.e. Medigap which is also known as medicare supplements. It is a health insurance policy sold by few private insurance companies in order to fill the gap in the original or basic medicare plan coverage. Medigap policy covers all the features that are even not included in original basic medicare plan and it helps to pay some of the health care costs. If any customer is registered in the original medicare plan and have medigap policy as well then later will pay both shares of covered health care costs. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs. 80% of the medical bills are paid by medicare while the remaining 20% is paid by medigap or medicare supplements.
Customers don’t need to pay any bills if they get plan F Medicare supplement because medicare pays its part and the supplement pays the rest. Cost varies in all Medigap policies while the benefits in plan A through N are same for all insurance companies.
Azmedicare provides the best services and best rates for Arizona residents. It represents the top insurance companies of the state. It has many plans and all are at affordable prices. Many has zero monthly premiums. Azmedicare empowers customers to take charge of their health.
Some equate ‘the golden years’ as a time of playing with the grandchildren, a time of enjoying walks with your better half, and slowing down a bit. However, aging may bring a lot of discomfort too. This is also the time when different diseases attack you which may require special medical care to fight against.
Living in Arizona, it is not easy for every person to afford the medical expenses when the person is above the age of 65. Our US government health department offers Medicare for people in the age group of 65 or above. This Medicare insurance doesn’t fully cover the medical expenses of hospitalization and other treatment. It only pays a part of the expenses which is not more than a certain percentage in most of the cases. If unfortunately a person suffers from any serious disease, it becomes almost impossible to bear the expenses. The US health department has authorized some private companies to sell supplemental standardized plans.
In Arizona, 12 different supplemental plans are available to enhance the scope of the Medicare insurance coverage. These companies sell these plans to the people who are already enrolled in the Medicare Part A and Part B. The supplemental plans are known as the Medigap plans. The name “Medigap” says is all, it fills the gap of Medicare insurance coverage. The plans are standardized however the premium cost of each company is different. AZMEDICARE offers the best premium packages at the most affordable rates in Arizona.
Your Medicare insurance plan alone does not facilitate much. It doesn’t cover deductibles, co-insurance and other similar costs. Medigap is the solution to cover these deductibles. You can buy a Medigap policy to pay for your Original Medicare deductibles, co-payments, co-insurance, and other costs.
Benefits of buying Medigap insurance:
Medigap policies have four required benefits that must be included and five optional benefits that are only included with some plan options. Each of the Medigap policies present required benefits. These include:
1. Required benefits:
Part A hospital care co-insurance:
Medicare Part A covers in-patient hospital stays. But if your stay lasts longer than 60 days, you have to make a co-insurance payment for each day you are still in the hospital. After a certain point, Medicare stops covering your inpatient hospital costs altogether. If you have a Medicare Supplement insurance policy, it will cover the co-insurance costs e.g., if the co-insurance is $300 per day for days 61 to 90 of your hospital stay. Beyond 90 days, there’s a $600 co-insurance per day. If you have a Medigap policy, it also will cover any in-patient hospital costs after Medicare stops covering them. It will do so for up to 365 days after you use up your Medicare benefits.
Part A hospice care co-insurance or co-payment:
Medicare Part A hospice care covers respite care and prescription drugs for pain relief. However, there is a 5% co-insurance for respite care and a $5 co-payment for each prescription drug. If you have Medicare Supplement insurance, it will pay for the co-insurance and co-payments. It is also noted that Plans K and L cover only a portion of the co-insurance and co-payments.
Part B co-insurance or co-payment:
Medicare Part B covers preventative services and necessary supplies to diagnose and treat medical conditions. Part B only pays 80% of the Medicare-approved amount for a particular service. So if the Medicare-approved cost for a service is $500, Medicare only pays for $400 of it. If you have a Medigap policy, it will cover the remaining 20% and both the Medicare and Medigap pay their own share.
First 3 pints of blood:
Medicare only covers the cost of blood for the 4th pint and beyond for a blood transfusion. It doesn’t cover pints 1 – 3. If you have a Medigap policy, it will cover the first 3 pints of blood and support the Medicare policy.
2. Optional benefits:
These optional benefits are not included in all of the Medigap plans. Here’s the detailed benefits:
Part A deductibles:
Medicare Part A covers a range of hospital costs. But before coverage starts, you need to pay a deductible. In 2016, the deductible is $1,288 per benefit period. 9 out of the 10 Medicare Supplement insurance plan options cover the Part A deductible. The only plan option that doesn’t cover it is Plan A. While the Plans K and M cover 50% of it, and Plan L covers 75% of it.
Part B deductible:
Medicare Part B covers a range of preventative and diagnostic services. Before the initiation of the coverage, you need to pay a deductible. In 2016, the deductible is $166 per year. If you have Medicare Supplement Plan F or Plan C, your policy will cover the Part B deductible. No other plan options include this coverage except the mentioned above.
Part B excess charges:
In some cases, a health care facility will charge up to 15% more than the Medicare-approved amount for a service. If you have Medicare Supplement Plan F or Plan G, your policy will pay for the extra charges. No other plan options include this coverage.
AZMEDICARE and Medigap Insurance Plans:
All these aforementioned plans are offered by AZMEDICARE in Arizona. These plans not only cover senior citizens, it also covers people having certain disabilities. The company offers all these plans at a great premium cost. It doesn’t matter if you buy the Medigap policies in the open enrollment period or not, it will cost the same. You can also visit http://azmedicare.info/medicare-supplements/ or further information. Or call for an appointment.
Keeping the importance of health of elderly people under consideration, US health department has provided an option to choose a health insurance program of managed health care or health care organization. It is basically a substitute of Medicare Part A, and B and known as the Medicare advantage. It offers an extra coverage like health programs, dental, and vision. It also contains the Medicare prescription drug coverage Part D. You might be thinking that what actually is the Medicare plan and what is the difference between Medicare and Medicare advantage plans. Here is the comparison between both:
Difference between Original Medicare and Medicare Advantage Plans:
Original Medicare plans are directly administered by the US federal government. This plan primarily include Part A and Part B. Part A is for the hospitalization while Part B is for medical coverage. The enrolled patients pay deductible and coinsurance when they get the health care which usually reaches up to 20 percent of the Medicare approved cost. The attractive feature of Original Medicare plan is paying for the part B premium only because there is no Part A premium for those who have at least 10 years of work experience in the US. Once you have the Medicare plan, you can go and see any doctor or hospital in Arizona that accepts Medicare. No referral forms are needed to see the specialist because you are pre authorized after enrolling yourself in Medicare original plan. Medicare original plans provide you the basis of buying the Medigap plans that serve as the supplemental coverage. Original Medicare also gives an option to avail Medicare drug coverage but you must have a separate Prescription drug plan from any of the private insurance company.
On the other hand, the Medicare Advantage plans are sold by the private insurance companies that are authorized to provide Medicare benefits. These are state approved private insurance providers. AZMEDICARE is among these insurance companies in Arizona. Besides covering Part A and Part B of the original Medicare, the advantage plans also covers extra benefits which include vision and dental care. Medicare advantage plans have three major types of providers: (HMOs) Health maintenance organizations, (PPOs) preferred provider organizations and (PFFS). If you have a valid Medicare advantage plan while the original Medicare plan has expired then its expiration doesn’t harm you. You can pay a deductible or copay a fixed amount per office visit.
Unlike original Medicare plan, the Advantage plans has a limited network of doctors and hospitals. Besides this, you might need to choose a primary physician and get referrals to see the specialist. Medicare advantage plan restricts you to avail the Medigap supplemental insurance. If you want Medicare drug coverage, opt for a plan that includes both health and drug coverage and is usually known as a Medicare Advantage Prescription Drug Plan. You usually can’t have a separate Part D plan with the Medicare advantage plan, unless you are in a Medicare Medical Savings Account (MSA) or a PFFS plan.
Medicare advantage and AZMEDICARE:
Medicare advantage plans are also known as the Medicare Part C of MA plans. These plans are administered by the state authorized health insurance organizations and AZMEDICARE is one of these organizations. AZMEDICARE offers benefits including optional Part B and Part D plans. Medicare Advantage providers follow the rules provided by the original Medicare. It may also be noted that this policy may cost our-of-pocket expenses in the form of higher premiums and deductibles. Standalone prescription drug plans are also covered by the AZMEDICARE. These plans are offered to the eligible participants. Each Medicare Part D plan provider determines the prescription drugs that are covered by the plan, the cost of the Part D premium, the amount of a participant’s co-pay and/or deductible, coverage limitations and the out-of-pocket cost of a drug to the participant. Medicare part D coverage is only for the participants who either have Medicare Part A and Part B, or have a Medicare Part C plan that includes both Medicare Part A and Part B coverage.
Eligible participants may not elect to carry only Medicare Part D coverage. If a participant has Medicare Part A and/or Medicare Part B, she/he may choose a stand-alone prescription drug plan provider. Medicare Part C plan participants must work with their plan provider to acquire prescription drug coverage; they do not purchase stand-alone prescription drug plans.
The Plan C is offered by AZMEDICARE that contracts with Medicare to provide you with all the hospital and medical insurance benefits. Moreover, Medicare advantage plan includes health maintenance organizations, preferred health service provider organizations, private fee-for-service plans, special needs plans and Medicare medical savings account plans. If you are enrolled in under such program then you may also be offered prescription drug coverage.
Besides all this, full coverage plan is also offered by AZMEDICARE. The full coverage plan is the most wide-ranging. It can pay for all the expenses that are approved but not yet been paid by Medicare. This plan includes all your deductibles, copays and coinsurances that originally Medicare is not supposed to cover. Full coverage plan is typically the most expensive of all the plans, and is well suited for those who think that they will have medical expenses and/or for those who want the peace of mind knowing that all approved expenses will be covered.
AZMEDICARE does not recommend any plan. The company gives you the option to choose the plan which best suits you. You can select the Medicare original plan as well as the Medicare Advantage plan. Once you have enrolled yourself in Medicare plan, you will be able to enhance the scope of the insurance with twelve different standardized sub plans. You can visit http://azmedicare.info/ to learn more about these plans. Compare all the plans and choose the most suitable for you.
When one turns 65, having a reliable healthcare plan becomes a top priority. In fact, people start looking for healthcare plans even before that, so they can take advantage of all the benefits of Medicare and Medigap healthcare plans. Normally, people have basic healthcare plans that provide basic Medicare coverage. However, at times, people also opt for additional supplemental plans for senior healthcare Arizona.
Looking at this need, the Arizona Medicare and private medical insurance companies together introduced different supplemental healthcare plans to meet the healthcare needs, particularly for seniors. These plans, that are 10 in number (A, B, C, D, F, K, L, M, and N) focus only on the elderly; and only someone who is aged 65 or above can benefit from any of these plans.
While the charges for these plans vary from one company to another, it is mandatory that all companies provide the same services under a specific plan. For instance, all of the private medicare companies in Arizona would have to provide basic healthcare and hospitalization coverage under Plan A and B. Similarly, all companies in Arizona would provide Medicare Advantage plans in under Plan D. While the packages and monthly premium may differ from company to company, it is not possible that one company provides certain services under plan C, and some other company provides same services under plan D.
Having a reliable senior healthcare Arizona plan also comes in handy when one travels between different states frequently. Arizona has the largest influx of retired people so the choice of senior healthcare company becomes really critical. Moreover, many seniors are attracted to the idea of spending winters in Arizona, and then move to some other state to spend the summers.
Another reason why one must have supplemental plans is because there is no drug coverage in the basic healthcare plans. Therefore, prescription plans for covering he cost of drugs is often paired with basic healthcare plans.
If you are going to opt for medicare supplement plans, you must do so within the six months starting from the month you turned 65. The advantage of doing so is because if you register during this “open-period”, no company would be able to decline your request. However, afterwards, the companies may simply decline you additional senior healthcare Arizona plans, or ask for extra charges. Let us discuss different services that are covered under different senior healthcare Arizona plans apart from the basic Plans A and B.
This is the plan that you should opt for if you want to be “well covered”. This plan offers coverage above the basic benefits and just by adding a little extra to your basic healthcare plans, you can have the security of knowing that you don’t need to worry about additional out of the pocket costs because you have it all covered.
While you have the knowledge that most of your medicare expenses are covered, it is also important to know that the coverage is limited to Medicare-approved charges. This generally results in paying a little extra out of your pocket if you see a doctor who charges a little extra. However, despite this, Plan C may prove to be very useful in unexpected medical conditions.
Under Plan C, while you have all of your basic expenses covered, the additional services that you get include: skilled nursing facility care for yourself, hospitalization deductible for your Plan A, medical and hospital outpatient expenses for your medicare part B, and emergency help in case you have to travel abroad for a medical emergency.
Only a few people know that the basic medicare plans do not cover the prescription charges. It is because of this reason that people often find a plan D paired with original plans A and B for the coverage of their medicare prescription and drugs. At times, there are some drugs that are very costly, and can prove to be a great financial burden because of out of pocket expenses. However, having a Plan D proves to be very useful in such situations.
Some companies have different sub-packages under Plan D. There are plans that have less monthly premium, but have a limited list of drugs you can use. There are also plans where you have to pay a little extra monthly premium but the list of drugs that are covered is comprehensive.
Depending upon your needs and requirements, you may select a senior healthcare Arizona plan best matches your requirements.
Medicare Advantage Plans
These are a series of Healthcare Plans formed by partnership between Medicare and Private Insurance companies to provide cost efficient healthcare services to the elderly.
In Arizona, 5 medicare advantage plans exist:
Health Maintenance Organization (HMO)
Under this plan, you pay a specific sum of money and different doctors and hospitals agree to provide you their services in return.
Preferred Provider Organization (PPO)
Under this plan, you can use doctors and hospitals belonging to a healthcare network. To receive additional service outside the network, you need to pay a little extra. However, you don’t need your physician’s referral to visit a specialist.
Private Fee For Service (PFFS)
This package allows you to visit any hospital and doctor of your choice. The services provider in this case, decides how much you have to pay for your visits. By paying the amount of their choice, you can benefit from additional senior healthcare services as well.
Medicare Savings Account (MSA)
MSA is divided further into 2 parts.
You may have a special savings account for health related expenses. Medicare deposits fixed annual premium into your account that remains there if you do not use it by the end of the year.
Under the second type, you get a fixed deposit into your account from which deductions are made from time to time for your medical expenses. Once the deductions are met, your medicare covered services are covered by your healthcare plan.
Special Needs Plan (SNP)
This plan only provides membership to specific people who reside in certain long-term care facilities, or who have certain chronic or disabling conditions. This plan is generally designed to provide Medicare health care and services to people who require special expertise of the plan’s providers, and focused care management.
Have you ever wondered what diseases are associated with aging? Disease is not something limited only to the elderly. Of course there are healthcare and medical insurance plans that cover people from all age groups. Similarly, even infants and teenagers catch diseases, some of which often prove to be fatal. However, despite all this, there are various health problems associated with old age. there are a number of diseases associated with growing older. Often, we call these the side-effects of aging.
Who are Elderly?
It is an accepted fact all over the world that people with above 65 are known as “elderly”. This group is naturally considered to be very vulnerable to different health problems. That is why, discussing senior healthcare Arizona plans is very important not only due to the burden it gives to the caretakers, also because of its impact on society. Aging is a natural process, one day we all will fall in the same category. So, by understanding senior healthcare Arizona plans, we help ourselves as well as the society we live in.
How is Aging associated with Health
One of the major problems about the disease associated with age is that we cannot tell specifically as to at what age would some particular disease or health condition affect a person. This is mainly due to the difference between the chronological and biological age. Similarly, the physical activities and diet of a person also plays a major role. A person who is in his 40s but doesn’t exercise, has a drinking problem, and doesn’t take care of their diet might have organs that function like that of a 60 year old. Similarly, someone in their 60s who takes a healthy diet and have a healthy lifestyle might be in a better physical shape than those, who are younger than them in terms of chronological age.
Problems associated with Old Age
With the process of aging, certain biological, physiological, and chemical changes occur in our body. These changes naturally affect the functioning of almost all major organs in our body. These results in various diseases and conditions associated with aging.
The most commonly known disease is Alzheimer’s which is a form of dementia. This disease commonly affect our cognitive functions. Common symptoms include impaired reasoning and memory dysfunction. However, it is important to note here that occasional instances of forgetting something are normal, and not a sign of Alzheimer’s disease.
Another system that gets affected with old age is the respiratory system. As you age you have a reduced ability to cough out mucus and other foreign particles from the respiratory system due to poor of damaged lungs. This condition can be very serious if the person happens to be a regular smoker. This can lead to increased risk of infection and bronchospasm.
Muscles and Bones
Age also affects our physical strength as the muscle mass and strength declines with age. This results due to the bones becoming brittle and joints experience wear and tear over time. Strength of ligament and tendon also reduces significantly. Our bones also suffer from problems such osteoporosis because bones start weakening once we turn 40. This problem can be seen more commonly among women.
Another bone problem associated with age is osteoarthritis. In this, the protective cartilage at the ends of the bones wears down, increasing friction and causing pain. This also affects our movement and ability to perform day to day physical tasks. This disease is also very common among the elderly.
However, with proper treatment, adequate intake of calcium and vitamin D, and physical exercise, the osteoporosis can be tackled easily. One must frequently visit a doctor and get regular bone density scans for optimum results.
Reduced Functioning of Tissues
As we grow older, our tissues become less sensitive to the hormones that regulate their function. Apart from these, the hormones themselves are also affected and the blood levels in them change. This affects the regulation of sex hormones. In females, it results in reduced estrogen synthesis, increased risk of osteoporosis and vaginal dryness. Similarly in males, it generally results in erectile dysfunction.
Our overall metabolism slows down, and the cholesterol and fat problems become more common.
Eyesight and Hearing
When we talk about common diseases among the old people, eyesight and hearing are among the first ones that come to our mind. When we turn 40, our eyesight starts weakening. This starts from presbyopia or far-sightedness which is the inability to see close objects. As we turn 60, cloudy areas also begin to form in our eye’s lens, which causes blurry vision. Moreover, our hearing also begins to declines.
However, by using glasses and hearing aids, we can overcome these problems to a great extent.
Lack of Nutrients
As we age, our sensation of thirst and hunger decreases. This results in dehydration as we do not feel thirsty even when our body requires water. Moreover, our digestive system also weakens which results in malabsorption of carbohydrates, vitamins (B12 and D), folic acid, calcium and proteins. This lack of hydration, and poor absorption of the required minerals and nutrients results in an imbalance of electrolyte in our bodies. Malnutrition is also a common problem.
Apart from all these, various others problems, such as prediabetes, type 2 diabetes, heart disease, stroke, and weight loss can also affect the elderly. That is why, it is important to have a reliable senior healthcare Arizona plans provider, especially if you live in Arizona to ensure that your elderly get the attention and care that they deserve. Although the aging process cannot be reversed, with proper care and a healthy lifestyle, you can delay the aging effects of your loved ones and help them live a happy life.
The recent changes in the U.S. healthcare system have extended the coverage scope of Medicare and the program continues to grow and provide benefits. You can get your Medicare coverage through Original Medicare or the different private Medicare Advantage plans. You can also enhance your Medicare coverage with the Medicare supplements in Phoenix AZ.
The concept of medicare supplements in Phoenix AZ
Medicare is the national health insurance program, administered by the federal government through private insurance companies across the country. The program is available to all U.S. citizens who are 65 years of age or older, including seniors with a permanent resident status of at least 5 years. People under 65 receiving disability insurance benefits and people of any age with certain qualifying conditions (dialysis patients, kidney transplant candidates and ALS sufferers) are also eligible.
How is Medicare structured?
Medicare has 4 parts (A ,B, C and D), each covering a different aspect of medical care. Parts A and B are known as Original Medicare.
Part A (hospital insurance) covers inpatient care in hospitals, skilled facilities and home care.
Part B (medical insurance) covers outpatient care, doctor visits, medical equipment and preventive care.
Part C (Medicare Advantage or MA) offers all the benefits of Original Medicare, but is run by Medicare-approved private insurance companies.
Part D (Medicare Prescription Drug Plan) subsidizes the costs of prescription drugs. Similar to Medicare Advantage, it is administered through private insurance companies.
Seniors aged 65 and older who have paid 10 years of social security taxes can receive their Part A insurance benefits premium-free.
Medicare plans can change the coverage scope, costs, pharmacies or providers in their network annually. You should stay up-to-date with the changes in your plan to make sure it still meets your needs next year.
Types of Medicare Advantage plans
Health Maintenance Organization (HMO) plans: Your choice of doctors and hospitals is restricted to the HMO network, except in emergencies. A referral may be required for certain tests or specialist appointments.
Preferred Provider Organization (PPO) plans: In addition to medical care within the PPO network, you can choose doctors or hospitals outside its scope, but it will cost you more.
Private Fee-for-Service (PFFS) plans: You can go to any doctor or hospital that agrees to treat you. The plan determines yours and their share of the costs.
Special Needs Plans (SNPs): These plans focus on medical care for specific population groups, including people suffering from chronic conditions, nursing home residents and dual beneficiaries of Medicare and Medicaid.
HMO Point-of-Service (HMOPOS) plans: For a higher copayment and coinsurance, you can receive certain services outside the network.
Medical Savings Account (MSA) plans: These plans are a combination of a high-deductible plan and a bank account. Medicare deposits money into the account and the policyholder uses these funds to pay for medical care.
How Medicare Advantage plans work
Medicare Advantage is another way to get your Medicare coverage. If you join an MA plan, you’ll get all your Part A and Part B benefits through the plan, not through Original Medicare.
Part C plans are run by private local or regional plans, approved and regulated by Medicare.
You can join an MA plan when you are first enrolled in Original Medicare or during the annual open enrollment (Oct 15 -Dec 7).
Medicare Advantage plans usually include Medicare prescription drug coverage at no additional cost.
If your MA plan includes drug coverage and you join a Medicare Part D plan, your MA policy will be cancelled and you’ll be returned to Original Medicare.
Note: All Medicare Advantage plans cover emergency care.
In addition to your Part B premium, you usually pay a monthly premium for your Medicare Advantage Plan.
Each month, Medicare pays a fixed amount to your Medicare Advantage provider, regardless of the amount of medical care received. You pay what the plan requires for each service.
All MA providers must follow certain Medicare rules. However, they have the right to set their own out‑of‑pocket costs and rules regarding their services.
These rules can change annually. Your MA plan will keep you updated about any changes in the coverage, costs, provider networks and service area through the Annual Notice of Change.
MA plans have different monthly premiums, co-payments, coinsurance and out-of-pocket limits. The monthly costs and availability of MA plans in Arizona vary from county to county.
Your Medicare Advantage plan can’t charge you more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
Providers can join or leave your plan’s network and your plan can change the providers at any time of the year. If this happens, you may need to choose a new provider.
When to consider a Medicare Advantage plan
Choosing the optimal health coverage option requires careful consideration of each plan’s specifics. Additionally, you have to take into account your current health status, financial stability and potential health concerns. It is wise to consider an MA plan in the following scenarios:
- Original Medicare doesn’t cover prescription drug costs. To get drug coverage, you’d have to purchase a separate Medicare Part D plan. In contrast, the majority of MA plans include drug coverage. The medicare.gov site has online tools where you can compare different plans and check how much you’d pay for your medications.
- Original Medicare has no limit on the costs you’d have to pay out-of-pocket. In other words, you pay a portion of the costs each time you receive medical care. Medicare Advantage plans are required by law to set an out-of-pocket maximum. Once you reach this limit, your plan will cover all your expenses.
- Original Medicare charges a 20% coinsurance. Due to the different cost structure of Medicare Advantage, this amount could be lower or the plan may charge a co-payment instead of coinsurance. Co-payments are fixed amounts you pay for medical care. Lower costs are usually compensated by higher monthly premiums.
- Some Medicare Advantage Plans offer dental care, vision and hearing services, wellness programs, assisted living facilities and nursing home care. These services are not covered by Original Medicare.
- If you want to enhance your Original Medicare coverage, Medicare Advantage is an alternative to the private Medigap supplemental plans. Medigap plans are designed to help with the deductibles, co-insurances and co-payments in Original Medicare. Depending on your particular needs, Medicare Advantage could be better suited for you than Medigap. Familiarize yourself with both alternatives so you can make the right choice.
If you’re using Medicare or planning to join the program, you’re probably wondering if you should get some form of supplemental insurance. Life is unpredictable and an accident or a debilitating illness can result in thousands of dollars spent in treatment costs. If you want additional insurance against life’s unexpected surprises and costs, checking out the different Arizona Medigap plans is a good place to start.
Arizona Medigap plans in the USA
The US healthcare system is multi-leveled and complex. More than half of all coverage is delivered through programs such as Medicare, Medicaid, the Children’s Health Insurance Program and the Veterans Health Administration.
The majority of US citizens under 65 are insured through their employers. Some have private insurance, while the rest are uninsured. Public sector employees are ensured through the government.
Before you decide if Medigap is the right choice for you, familiarize yourself with all your health insurance options. It’s the only way to make an informed decision about your healthcare future.
You can do research on the topic online or consult insurance providers. You can also talk to people already using the choices you are considering.
What is Medicare?
Medicare is the federal health insurance program serving seniors over 65, regardless of their current health, medical history and income.
Individuals under 65 may be eligible for Medicare if diagnosed with end-stage renal disease (ESRD) or a qualifying long-term disability.
Medicare eligibility is linked to a person’s social security benefits. The program is available to people over 65 that have worked for at least 10 years, with social security and Medicare withholding tax deducted from their pay during that time.
Medicare is structured as follows:
Medicare Part A covers inpatient hospital care, limited skilled nursing care and hospice care. It’s premium free for people who have paid into social security for at least 10 years.
Medicare Part B covers non-hospital expenses, like doctor visits, blood tests, X-rays, diabetic screenings and outpatient care. Part B is available for a monthly premium.
Medicare Part C i.e. Medicare Advantage is offered by private companies as an alternative to Original Medicare. It often bundles all the coverage aspects of Medicare into one plan.
Medicare Part D covers the costs of prescription drugs. It’s available as a stand-alone plan through private companies. You can also get your Part D through Medicare Advantage.
Medicare enrollment is mandatory. As long as you have Medicare Part A, you can consider yourself covered. However, if you only have Part B, you may be subjected to a tax penalty for not having essential coverage.
What is Medigap designed to do
Medicare does provide a lot of coverage, but its scope is nonetheless limited. The purpose of Medigap is to help cover some of the costs left out by Original Medicare, like copayments, coinsurance, and deductibles.
This extra coverage allows beneficiaries to better control and predict their annual medical expenses.
Original Medicare and Medigap work together to provide better coverage. First, Medicare pays its share of the Medicare-approved amount for your healthcare services, after which Medigap covers its share.
A few points to remember:
Medigap plans are available as stand-alone policies from private insurance companies, for a monthly premium.
There are 10 standardized Medigap plans available in Arizona, identified by letters (A – D, F – G and K – N). The word standardized means that same-letter plans must offer the same benefits regardless of the insurance provider.
Premiums for same-letter plans vary greatly between providers, so you’ll have to do some research before choosing a plan.
Plan rates can vary depending on your age, place or residence, provider and plan type.
The most comprehensive and popular plan in Arizona is Plan F. This plan covers pretty much all out-of-pocket costs for Parts A and B. The other plans cost less, but allow more gaps to remain open.
Medigap policies are renewable. As long as you pay the monthly fee, your provider cannot terminate your insurance even if you have health problems.
The best time to buy a Medigap policy is when your Medicare coverage begins. If you join Medigap within the first six months of enrolling in Medicare Part B, insurance companies are obligated to sell you a policy regardless of your health status.
After this deadline, you can be denied coverage based on health issues, at the provider’s discretion.
Medigap policies don’t include prescription drug coverage. For this purpose, you will need a Medicare Prescription Drug Plan (Part D).
Reasons to buy a Medigap plan
When contemplating additional insurance, make sure to ask your doctor if Medicare will cover the services and supplies you need. Overall, Original Medicare doesn’t cover many services and items required by many seniors.
According to experts, you should get a Medigap policy if you can afford one, even if you’re currently in good health and don’t need additional insurance.
You won’t need a Medigap plan if you qualify for Medicaid, have an employment-based medical retiree option, if you’re already using a Medicare Advantage plan, and of course, if you are extremely wealthy.
Depending on the plan, Medigap will either pay all or some of the costs not covered by Medicare.
Your Medigap policy is designed to protect you against excessive out-of-pocket costs, especially if you are ill or severely injured, require prolonged hospitalization or require more care as you age.
For instance, if you are hospitalized and you only have Original Medicare, you’ll be required to pay a hospital deductible of $1,216 for each benefit period. For inpatient stays exceeding 60 days, you’ll be responsible for a portion of the daily costs from the 61st day onwards (coinsurance).
These costs will go up the longer you remain hospitalized. Once your lifetime limits are exhausted, you will have to pay the inpatient costs in full.
The same applies to doctor appointments and medical procedures. Your deductible is $147, after which you’ll have to pay 20% of the Medicare approved amount for doctor services and medical equipment. Depending on the bill, this can be a substantial amount.
Also, keep in mind that:
- Even if you finish this year without needing your Medigap policy, the situation may change next year.
- You should do your homework and check the provider’s reputation, including the claims-paying ability, service and customer care quality.
- If you move to another state after you retire, you may need to change your Medigap plan.
- One Medigap policy covers only one person.
The US health insurance system offers a variety of coverage options, designed to give citizens a peace of mind and reassurance when it comes to their healthcare costs. Medicare is the national health insurance program for seniors, instituted in the mid 1960s. You can get your health coverage through Original Medicare. You can also consider the Arizona Medicare Advantage plans as your coverage choice.
How do Arizona Medicare Advantage Plans and Medicare work?
Medicare addresses the needs of senior citizens aged 65 and above who have worked and paid their social security benefits and taxes. It’s administered by the federal government through around 30 private insurance providers across the country.
Medicare also provides coverage for people under 65 with certain qualifying disabilities and people with permanent kidney failure and amyotrophic lateral sclerosis of any age.
Different parts of Medicare cover different healthcare aspects. Original Medicare has two parts – A and B.
Medicare Part A (hospital insurance) covers inpatient care in hospitals, skilled facilities, hospice and home healthcare.
Medicare Part B (medical insurance) covers the costs of doctor visits, outpatient care, durable medical equipment, certain preventive services and eligible home health services.
Medicare Part C (Medicare Advantage or MA) is designed as a substitute for Original Medicare. It includes all benefits and services covered by Parts A and B. Medicare Prescription Drug Coverage (Part D) is usually bundled into the plan. MA is run by private companies approved by Medicare.
Medicare Part D subsidizes the costs of prescription drugs and drug insurance premiums for Medicare beneficiaries. It’s administered through Medicare-approved private insurance companies.
You can get your Medicare coverage through Original Medicare or you can join a Medicare Advantage Plan.
Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) plans: Your choice in most HMOs is limited to doctors and hospitals within the plan’s network (except in case of emergency). You may need a referral for specialist visits.
Preferred Provider Organization (PPO) plans: Using doctors and hospitals within the plan’s network will cost you less. However, you do have the option to receive medical care outside the network at a higher cost.
Private Fee-for-Service (PFFS) plans: As a plan beneficiary, you can use the services of any healthcare provider or hospital willing to treat you, similar to Original Medicare. The plan sets the costs it will cover for doctor visits and treatments, as well as the amount you will pay for your care.
Special Needs (SNPs) plans: SNPs provide care solely to people with specific conditions and characteristics, so that their needs can be met in the best possible way. This includes people suffering from severe or disabling chronic conditions, nursing home residents, or people eligible for both Medicare and Medicaid.
HMO Point-of-Service (HMOPOS) plans: These plans offer certain services outside the network for a higher copayment or coinsurance.
Medical Savings Account (MSA) plans: These plans combine a high-deductible plan with a bank account. Medicare deposits money to the account and beneficiaries use this amount to pay for healthcare services. Medicare drug coverage is not provided under these plans.
Important facts about Medicare Advantage
If you choose to join a Medicare Advantage plan, you will still be in the Medicare program. The difference is that you’ll be getting your Medicare Part A and B coverage from the Medicare Advantage Plan instead of the Original Medicare.
Medicare Advantage Plans cover all services available under Original Medicare, with the exception of hospice care. For Medicare Advantage beneficiaries, this type of care is covered by Original Medicare.
All Medicare Advantage plans cover emergency care.
In addition to the Part B premium, Medicare Advantage beneficiaries usually pay a monthly premium. Each month, Medicare transfers a fixed amount for your coverage to the Medicare Advantage providers.
Keep in mind that each MA Plan can have different out‑of‑pocket costs and rules regarding its services. These rules can change every year.
Your provider is obligated to notify you of any changes prior to the start of the next enrollment year (Annual Notice of Change).
Providers can join or leave your plan’s network anytime during the year. Also, your plan can change the providers in the network. In such a case, you may need to choose a new provider.
Medicare Advantage Plans can’t charge more than Original Medicare for certain services. This includes chemotherapy, dialysis and skilled nursing facility care.
Once you reach the yearly limit on your out-of-pocket costs for medical services set by the plan, you won’t pay anything for services. This limit may differ between Medicare Advantage plans and may be subject to annual changes, so make sure you do your research on this issue.
You can join or leave a Medicare Advantage Plan at certain times during the year. There are specific windows and rules, for example when you first become eligible for Medicare or if you get Medicare due to a disability. Between October 15 – December 7, anyone with Medicare can join, switch or drop a Medicare Advantage Plan.
Each year, MA Plans can choose to leave Medicare or make changes to their costs and services. If your plan decides to withdraw from Medicare, you’ll have to join another MA Plan or return to Original Medicare.
What are the benefits of Medicare Advantage
- Comprehensive coverage from a single source.
- MA plans have the potential for lower premiums compared to the total sum you would pay for Part D and a Medigap plan combined.
- Some Medicare Advantage plans include benefits not covered by Medicare, such as dental, eye care and wellness.
What are the drawbacks of Medicare Advantage
- Your healthcare choices may be limited to the doctors and hospitals within the plan’s network.
- If you choose to get medical care outside the network, you may be responsible for 100% of the costs.
- There may be a copay required each time you get medical treatment.
When choosing healthcare coverage, check if your area of residence is covered by the MA plan you’re considering.
If you have doctors or specialists whose care you prefer, check to see if they’re in the network.
Also, make sure to consult independent sources, since many sites are sponsored and therefore not objective. It’s best to consult the Medicare websites or those of non-profit organizations supporting the interests of seniors.
Medicare is one of the social insurance programs run by the Health Department of the United States. All citizens of America aged 65 or above, people with end-stage renal disease, motor neurone disease or younger people with disabilities are eligible for Medicare insurance. Read on if you want to learn more about medicare and medicare supplements in phoenix az.
Medicare constitutes of four main parts: hospital insurance, medical insurance, health plans, and prescription drugs. One might think that the four insurance parts would be enough to cover the needs of a person qualified for Medicare.
Sadly, often enough that is not the case. It’s quite common for a Medicare insured person to have additional out of pocket expenses in maintaining and protecting their health. That’s why there are things about Medicare and additional Medicare supplements that you must know about.
Understanding Medigap and its advantages compared to Medicare
They say that people don’t appreciate their own health until they get sick. With that in mind, we should be wise enough to be prepared for anything. What better way to prepare than with an advanced health insurance plan?
Traditional Medicare insurance plans obviously don’t cover as much as we might need them to when the going gets rough. What more can we do to obtain additional protection? How can you stay safe and healthy without burning a hole in your pocket? The answer to that question is relatively simple.
Upgrade your Medicare insurance plan with Medigap, the ultimate Medicare supplement. No one can argue that Medicare can be of big help as it is, but let’s look at the options. Of course you won’t lose your initial Medicare insurance. In fact, you need to have Medicare in order to receive Medigap.
By all means, Medicare is a national insurance program. Still, the U.S. Health Department has authorized certain private providers of health insurance to sell Medicare supplemental plans. These plans are labeled with the letters A through N and cover different sets of services.
Medicare supplements in Phoenix AZ
As you probably already know, Medicare consists of four parts. In order to obtain Medigap insurance, you have to be enrolled in parts A and B of Medicare. As a matter of fact, these are the parts in which Medigap provides the most support.
| ➔ Part A – Hospital insurance;
|| ➔ Part B – Medical insurance;
|| ➔ Part C – Medicare Advantage plans;
|| ➔ Part D – Prescription drug plans.
Medigap will cover additional costs for ambulance, hospital stays, health care at home, doctor charges, and medical equipment. Most Medigap plans offer relatively similar benefits, but are subjected to regulations within a state. Although Medicare supplement plans are designated A – N, not all of the plans are available in cities in every state.
- Aetna Medicare Supplement Insurance Plans
The Aetna plans are available in 15 states, including Arizona. Aetna plans enhance parts A and B of the basic Medicare insurance plan. They are designed to help cover extra costs, such as co-payments or deductibles.
A, B, F, G, and N are the plans provided with Aetna. Some of the benefits include 20% of approved medical expenses, coverage for hospitalization, and hospice. The first 3 pints of blood in a year are also covered.
- Blue Cross – Blue Shield Medicare Supplemental Insurance Plans
This supplemental insurance plan serves to cover charges that Medicare or even Medicare Advantage don’t cover. It also covers emergency services while traveling anywhere in the world. The Blue Cross Blue Shield works with Medicare Part A as well as Medicare Part 2. This plan however does not work with Medicare Advantage plans.
The Senior Security plans provide plans A, C, F and N, and the Senior Preferred plans provide plans C and N. There is a discount for the early enrollment of participants aged 65 through 67. A reduced discount applies for those aged 67 through 75.
- Mutual of Omaha Medicare Supplemental Insurance Plans
The Mutual of Omaha Medigap plans available in Arizona are plans A, F, G, M, and N. These plans also add to Medicare’s part A and part B. Basic benefits are usual, but the additional benefits vary with each plan. The most extensive are plans F and G. Part A deductibles are included in plans F, G, and N, and 50% in plan M. All of the Mutual of Omaha plans offer assistance in foreign travel emergencies, with the exception of plan A.
- United Healthcare AARP Supplemental Insurance Plans
These plans can assist in covering expenses in Medicare parts A and B – coinsurance, copayments, deductibles, and the like. Plans offered in Arizona and the rest of the U.S. are plan A, B, C, F, K, L, and N. All of the United Healthcare AARP Supplemental Insurance Plans
are guaranteed as renewable. A rare feature is the Medicare Part D that covers prescription drugs and can also be incorporated in a plan.
Upgrading basic Medicare with a Medigap Supplement Plan – is it worth it?
It’s hard to find the perfect balance between the most basic and the unnecessarily excessive insurance plans. Medicare is the obligatory fundamental health insurance, but is that enough on its own?
No one wants to spend an unreasonable amount of money on a health insurance plan. Overspending on insurance is counterintuitive, too. If you feel like Medicare might not cover enough, instead of straying away from it – upgrade it!
Your primary resource in your life is actually your health and wellbeing. Medigap Supplemental plans are specially designed to take care of whatever you deem most important. Basically, the simplest plan is plan A; plan B offers all that plan A does, plus additional benefits and so on.
It’s obvious why anyone would prefer Medigap Supplement Plans over many other types of insurance. Medigap plans are not absurdly expensive, and they go along hand in hand with basic Medicare insurance. By choosing one of the plans, A through N, you can not only advance your insurance, but also tailor it to your personal preferences.
There’s nothing more important than good health, so yes, upgrading to Medigap is definitely worth it.
When you become age-eligible for Medicare, you will be offered a one-time special enrollment period, which includes the three months before your 65th birthday, the month of your 65th birthday and the three months following your 65th birthday. You can enroll in Medicare at any point after you become age-eligible, but you may incur a lifetime premium penalty if you do not complete your enrollment during your special enrollment period. The longer you wait to enroll in Medicare after you become eligible, the higher your lifetime premiums will be.
To enroll in Medicare, you must have met the basic eligibility criteria. You must be age 65 or older, a US citizen or qualified non-resident and you must have worked for at least 10 years in a position where Social Security taxes were collected/paid on your behalf. You also qualify for Social Security benefits if your spouse worked for 10 years and accumulated enough work credits to qualify for Social Security benefits, as long as you meet the other program requirements.
You may apply for Medicare benefits in person at your local Social Security office, or you may apply for benefits online, if you have access to a computer and the Internet. The online application form takes approximately 10 minutes to complete. You will need your date of birth and Social Security number; banking information; income and employment information for the most recent tax year; income estimates for the upcoming year; military service dates; the names and birthdates (or ages) of your current and/or former spouse(s); and your most recent Social Security statement. The Social Security statement is mailed to you annually in the months preceding your birthday.
The Social Security Administration may also ask you to provide documentation, such as your birth certificate; naturalization papers; military service records, and current/recent income tax returns. After your application for Medicare benefits is processed and approved, you will receive a Medicare card in the mail. You will give the information on this card to your health care providers when they render health care services on your behalf.
For more information about Medicare enrollment and Medicare Advantage plans in Arizona, please call (480) 706-1702.