Arizona Medicare Advantage plans
Many of us spend a lot of time trying to understanding the difference between Medicare and Medigap plans. Today, you will clearly get to know the difference between these two. This article will also help you to wisely select your plan.
Basically, Medicare supplement plans are also known as Medigap plans or policies and they can cover some of the costs that original Medicare coverage doesn’t include. Originally, the government provides Part A and Part B of Medicare coverage to all the eligible individuals. However, this Medicare coverage might not fulfill your demands at later stage so you will need to decide at some point whether the traditional coverage is enough for you which is provided by the government or you need some other Medicare supplement plans.
Medicare and Medigap plans are federal healthcare programs which is designed to fulfill the needs and to help senior citizens during their golden years. According to the law, any senior citizen who is 65+ and currently enrolled in Medicare can apply for a Medigap plan. There are about 10 Medigap plans available to choose from. According to the Centers for Medicare and Medicaid Services (CMS), all the Medigap plans have to offer the same coverage plans, regardless of the company which is selling it or where they are located. It means that Plan A and Plan B is exactly the same in all 50 states of America.
In recent years, private Medicare plans have become more popular than the traditional plans. It has been observed that more than 10 million senior citizens has enrolled in the Medicare advantage plans. These plans actually help to combine the physician and hospital services into one package. Before selecting the perfect plan for yourself or your loved one, you need to keep in mind few things.
First of all, if there are no Medicare advantage or supplement plans are available in your region than you will be in traditional Medicare, which is administered by federal government. You can select any doctor who accepts Medicare in the traditional Medicare and you will have to pay deductibles of the cost of care. If you had a Medigap policy, those expenses would have been covered by your Medigap plan. So, a Medigap plan covers a vast variety of treatments which Medicare wouldn’t cover. There are multiple types of Medicare supplement plans.
Most plans such as health maintenance organizations and preferred provider organizations, manage to control costs. Other like HMOs and PPO, which is based on a network of doctors, so you want to make sure that your doctor and the hospital of your choice are involved in the network. You can also ask about the policy for referrals, In case of a PPO, you may want to know how much you have to pay to see doctors who are not on the network. Private plans fee-for-service provides more choice because they are not allowed to have a network of doctors and hospitals.
Sometimes, Medicare supplement plans have extra benefits like eye exams, dental care and hearing coverage. For many people, this coverage doesn’t seem to be enough, and this is where private insurance, such as Medicare Supplement plans come in. These plans may offer coverage of health services not covered for Part A and Part B. To participate in a Medicare Supplement plan a beneficiary must be enrolled in Part A and Part B, live in the state where it is offered, and generally be over 65 years. But you must make sure you understand each and every point of the Medicare advantage plan you will be selecting.
One benefit of Medigap plans is that Medigap policies are renewable, as long as you pay your monthly fees and your insurance company doesn’t go bankrupt, you cannot be dropped from your plan. Medicare has a small network of doctors, but Medigap provides access to an extensive network of doctors. In short, Medicare is designed for those on a tight budget and if your pocket allows you then you have to go Medigap.
According to the latest research, Medigap plans are usually more expensive than Medicare Advantage plans. Medigap offers a variety of supplemental insurance to Medicare, while Medicare coverage and Medicare Advantage are almost identical. Furthermore, you also need to keep in mind that if you travel a lot or migrate yearly as per job requirements or you live in an area where there are lack of medical facilities, then you must go for a Medigap policy. No doubt, there are other ways to supplement your Medicare coverage but Medigap offers the best flexibility.
With Medigap, you are free to receive care from any hospital and any doctor which accepts Medicare. If you have a need for vision or dental benefits, then you will also have to buy Medicare supplement plans for that which will be covered by your Medigap policies. Now that Medicare Part D is also here, so all Medigap plans which used to offer prescription drugs are being phased out.
Last but not the least, if you have signed up for a Medigap plan but you later realized that it wasn’t right for you, there’s no need to worry because as long as you make that discovery within a month of coverage, you can cancel the coverage for a full refund.
For Arizona residents who are confused about which plan to choose, visit www.azmedicare.info for all the details and help on Arizona Medicare Supplement plans.
- July 30, 2016
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In Arizona, medical beneficiaries who are in need of help for paying Medicare expenses must consider enrolling in a Medicare Supplement Plan known as Medigap Plan. It must be noted that Medigap plans are available through private insurance companies, not only in Arizona but in every state across U.S.
Medigap plans generally help with the expenses which are incurred under original Medicare plans which are Plan A and Plan B. Medigap plans are now almost same across all of the United States in terms of both policies and cost. For those of you who are not sure about the number of Medigap plans, just know that there are 10 standardized Medigap plans available in all of the states. The plans are labelled from A to N where Plan A and Plan B are the most basic plans which every state offers under the rule of federal administration.
If you are already enrolled original Medicare Plan A and B, then you are eligible to sign up for Medigap Plans. Not many people know but the best time to buy a Medicare Supplement plan is during the Medigap Open Enrollment Period. This period starts as soon as you reach the age of 65 and is also enrolled in Medicare Plan B. Individuals can sign up for any Medigap plans during this time according to the plans available in their state. The important thing to keep in mind is that there are no additional enrollment periods besides each of theirs Medigap Open Enrollment Period.
In Arizona and across all of the United States, Medigap plans doesn’t include prescription drug coverage, so you have to enroll in a Part D plan for prescription for separate Medicare to cover the cost of medicines or drugs. Prescription drug plans for Medicare Part D in Arizona are available through private insurance companies.
It has been observed through the survey that Arizona is the most famous destination to retire. Surprisingly, above a million residents of Arizona are dependent on the Medicare for their main source of health insurance.While no revolutionary changes in Medicare supplement insurance is scheduled for 2016, there are some things to keep in mind which may affect the safety and availability of certain plans.
Here is the possible increase in premiums and Part B deductible. For example, Plan C, Plan F, and high deductible Plan F covers Part B deductible, so if the increased rates for these popular supplements may also increase. In Arizona, all the Medicare Supplement Plans must conform to the standards set by the Medicare Organization. Supplement standards include names from A to N. Each supplement offers basic benefits like coinsurance and blood donations. The only thing to remember is that every supplement is identical from one or another insurance company. In order to determine rates, you must compare different insurers providing Medigap plans however there should not be a big difference because of the Arizona Medigap Policy. It is important that you familiarize yourself before with the Medigap plan as well as each and every plan before you make any purchase.
Supplement Plan F is the most comprehensive among the 10 other plans, covering almost 100 % of Medicare related costs. But even for Medicare Supplement Plan F recipients in Arizona can still incur some out – of -pocket expenses such as Medicare Part B premium.
As soon as you reach the age of 65, you need only a phone call to buy Medigap policy and get excellent coverage without question. And if you buy a policy in the first six months of enrolling in Medicare, you do not have to answer questions about your health. Do not worry if your doctors are not in the network, because you will be covered if you see any doctor who accepts Medicare.
Many people don’t realize the fact that how much they will be spending if they will be selecting the plan which covers the entire Medigap plans. There are total of 10 Medigap plans and each one has its own benefit. The four most comprehensive plans are C, D, F and G which account for more than 60% of all the Medigap sales according to Kaiser Family Foundation research. Plan F, the most expensive among all of them and covers every Medicare gap represents 40% of all policies sold. If your health is good than you must consider a plan which is not much comprehensive for e.g. Plan N and L are good choices because they will save you around $200 to $400 a year.
Medicare and Medigap benefits are identical in all 50 states, however policies and pricing rules may differ (Massachusetts, Minnesota and Wisconsin have their own standardized plans). If you know the rules in your state, this may save you money. You can choose when to upgrade an existing plan to switch to another insurer or drop your current Medicare plan during the annual open enrollment to change Medigap policies.
Most of the people become eligible for Medicare when they turn 65, although some beneficiaries can get Medicare even before if they have some kind of disability. You will automatically get Medicare as soon as you turn 65 if you are already receiving Social Security benefits. Otherwise, you will have to enroll in Medicare during the enrollment period.
There are also many private Medicare options available if you are a Medicare beneficiary in Arizona. Medicare coverage like drug prescription and supplemental coverage are only available through private insurance companies. Your private Medicare options will depend on where you live and the plans available in your area. We hope you found this article helpful as we shed light on Arizona’s Medigap policies. If you are an Arizona resident, feel free to contact www.azmedicare.info for further details.
- July 27, 2016
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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.
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.
Health Net, a provider of Arizona Medicare Advantage plans was ordered by the Centers for Medicare and Medicaid Services (CMS) to cease Medicare enrollment in its programs on November 19. 2010. The order is part of a sanction imposed by CMS for the improper administration of Medicare Part D plans offered by the health insurance provider. The sanction affects enrollments in both the company’s Medicare Advantage and Medicare Part D plans, and came just days after the Open Enrollment period began for 2011.
Eligible beneficiaries who are already enrolled in a Health Net Medicare Advantage plan and do not wish to change may remain enrolled in their current plan, but may not elect new plans until the sanctions are lifted. CMS issued an immediate suspension directed toward Health Net because the agency says that Health Net continued to misadminister its Medicare Part D and Medicare Advantage Part D plans, despite having been warned about its faulty practices during a routine audit of the program.
Health Net has more than 660,000 beneficiaries enrolled in Maricopa and Pima counties. Health Net must now demonstrate that it is in compliance with CMS regulations regarding Medicare Part D benefit administration and that it has taken sufficient steps to ensure that it will remain in compliance. Once CMS is satisfied with the company’s changes, Health Net will again be allowed to accept new enrollments in its Medicare Advantage and Medicare Part D plans.
“Health Net takes our obligations to our Medicare members seriously,” said Jay Gellert, president and chief executive officer of Health Net, Inc. “Our priority is to help ensure our Medicare members have access to quality health care, customer service and the prescription drugs they need.”
Gellert added, “We are working closely with CMS to resolve these matters as quickly as possible. We hope in the next months we can demonstrate to CMS that we have successfully addressed the issues they have raised. We are committed to the Medicare program and look forward to serving new Medicare beneficiaries once again.”
The sanctions make it unlikely that Health Net will be available as a choice for Arizona Medicare Advantage enrollees during the 2011 Open Enrollment period, which began November 15, 2010 and closes December 31, 2010.
- December 13, 2010
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