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.
Our bodies have a tendency to grow sick more frequently as we grow older. Although there are various health conditions that are not age specific, our body does become vulnerable to various health conditions, diseases and disabilities as we cross the age 60. This is because of a combination of physical and chemical changes in our body, and the weakening tissues and immune system. That is why, it is recommended seniors have reliable medicare plans. The state of Arizona has introduced several medicare supplement insurance plans which have been designed specifically to help the elderly.
The residents of Arizona can choose whether they wish to have a Medigap policy or the Medicare Advantage. Both of these have been designed to help the beneficiaries manage their medical costs by allowing them access to well respected medical health insurance providers. Each of these have their own way of operating, and provide different packages. Some may provide certain medicare facilities without any monthly premium or recurring costs while others may offer additional services such as dental care while charging the same amount as basic medical coverage. That is why, we cannot say that there is one best plan for everyone, because depending upon the needs and condition of an individual, their preferences may vary.
In the state of Arizona, more than 15% of the population is aged 65 or above (the term ‘seniors’ is used for anyone who is aged 65 or above). Many private healthcare and medicare supplement insurance providers in Arizona exist for the sole purpose of providing additional medicare services to this segment of the population. The question that arises here is why would someone need medicare supplement insurance plans in Arizona when they can avail medicare? The answer is, while one cannot find supplements with no monthly premium or charges (medicare supplement insurance plans are never free), they can be combined with the medicare to provide additional benefits to the beneficiaries. This also helps them by reducing their out-of-the pocket costs by covering their additional expenses, and by allowing them to see specialists of their choice. Normally, seeing a specialist requires a referral from a physician. Depending upon your medicare supplement insurance plan, you might not have to worry about network doctors or referrals to the specialists.
In Arizona, there is no difference between the supplemental plans despite the fact that 10 different plans exist. The difference, however, lies in the premium of the private insurance companies. Depending upon the expenses or services of a company, their charges or monthly premium may differ from what someone else is offering. However, one always has a good choice of a medicare supplement or advantage plan depending upon their medical conditions and prescription needs. This is important because sometimes we face expenses we don’t expect.
For instance, not many people are aware that the cost of prescriptions is not covered in the original medicare or medigap plans. For this purpose, people often need to get the medicare Part D plan. To be eligible for this, one simply needs to be a resident of Arizona aged above 65 and is enrolled in both medicare plans A and B. The amount charged for medicare supplement plans also depends upon the place they live, and their medical condition. This is the reason that some consumers find it quite confusing to search for the right medicare supplement insurance plan providers in Arizona.
The very reason we use the term ‘Medigap’ for medicare supplement insurance plans is because it helps an individual pay the gap between the amount paid by their original medicare providers, and what they have to pay from their own pockets.
If we talk about different Medigap coverage options, we notice that there are 10 different choices. These plans are labeled with alphabet, and are in groups A-D, F-G, and K-N. If you are wondering about the missing letters, it is because plans E, H, I and J are no longer available in Arizona.
The period for Medigap enrollment begins on the first day of the month when you turn 65. Afterwards, you would have 6 months to enroll for the supplement plan provided that you have original Medigap policy. You may choose between plan C and plan D depending whether you require Medicare Advantage plans or prescription coverage.
The important thing that everyone must know is that they must get themselves enrolled for the supplement plans within the 6 month period of open Medigap enrollment. If you do so, the companies would not be able to decline medicare supplement insurance plans to you. Generally, what happens is that companies deny medicare supplement insurance plans to certain individuals when they think that they would incur heavy expenses to the company. At times, the insurance companies also make changes to your monthly premium (by increasing it) if a you enroll outside of the specified 6 month period. However, you would not have to worry about that if you get enrolled within the 6 month period, regardless of your medical condition.
If you enroll for the Plan C (medicare advantage plan), you cannot use a Medigap policy and the companies would refuse to sell you one. However, if you turn back to your original Medicare plan within your first year of joining, you may earn a special right to sign up for a Medigap Supplement plan.
Generally, companies determine the premiums on three basis, that are: non-age-rated, entry-age-rated and attained age rated. Depending upon your needs, you may find a company that offers the best medicare supplement insurance plans in Arizona. You must invest in the right place because a good choice can cover a lot of healthcare costs for you.
Pima County, AZ residents will have an additional Medicare Advantage plan option for 2011. SCAN Health Plan Arizona will expand its coverage area to include Pima County residents, beginning January 1, 2011. Currently, the SCAN Health Plan Arizona only offers coverage in Maricopa County.
The current plan offers Medicare Advantage coverage to about 8,000 beneficiaries and has provided Medicare Advantage coverage in Arizona for three years. SCAN Health Plan Arizona says it has agreements in place with most of the leading hospitals and health care providers, and will focus its MA coverage on “affordable and accessible senior health care.” The SCAN Health Plan Arizona Medicare Advantage plan earned 3.5 out of 5 stars on its Medicare Part D (prescription drug coverage) but the Medicare Advantage plan itself does not yet have star ratings. The company’s California-based Medicare Advantage plan earned 3.5 out of 5 stars for its health care coverage and 4 out of 5 stars for its Medicare Part D coverage.
Eligible beneficiaries are those persons who are eligible for Medicare Part A and Medicare Part B, and who live in either Maricopa or Pima County. Updated plan information will be posted on the SCAN Health Plan Arizona Web site prior to the open enrollment period. Premiums for 2011 have not yet been determined, but in 2010, SCAN Health Plan Arizona did offer $0 premium plan options, exclusive of the Medicare Part B premium, which every enrollee pays. In 2010, the Medicare Part B premium was about $100 per month.
SCAN Health Plan is the nation’s fourth largest Medicare Advantage provider and serves about 130,000 enrollees in California and Arizona. To enroll in the program, eligible Medicare beneficiaries must choose the SCAN Health Arizona plan during the open enrollment period, which runs from November 15, 2010 to December 31, 2010. Coverage will begin January 1, 2011.
- February 5, 2011
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A survey conducted by the American Academy of Family Physicians (AAFP) shows that about 13% of family physicians who have an ownership stake in their practices may close their practices if Congress does not halt planned drastic cuts in reimbursements in January 2011. Congress has announced planned cuts of 30% in the Medicare reimbursement rate beginning January 1, 2011. Initially the cutbacks were set to take effect December 1, but Congress recently voted to delay implementation by one month.
Nearly two-thirds of survey respondents said they would have to stop accepting new Medicare patients and nearly three-fourths said they would have to reduce the number of appointments available to Medicare patients if the cuts are enacted. According to the AAFP, more than one-quarter of rural family physicians depend on Medicare reimbursements to keep their practices open, and the closure of a medical practice would affect not only Medicare recipients, but also healthy adults and children who require routine healthcare services.
The proposed cuts are the result of the application of the sustainable growth rate (SGR), which ties Medicare reimbursements to economic growth. In periods of negative economic growth, the SGR formula calls for payment reductions. Since its inception in 2002, the SGR has indicated reimbursement reductions, but Congress has voted to override the SGR in favor of modest increases in reimbursements. Without continued Congressional intervention, the accumulated reductions, which now total nearly 30%, will take effect January 1.
In the past, Congress has briefly allowed the SGR to take effect. During the brief lapses, CMS withheld Medicare and Medicaid reimbursements while waiting for Congress to act. The resulting reductions of as much as 20% required practices to take loans to make their payroll and continue providing services to patients.
- December 11, 2010
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A recently announced bonus plan designed to reward outstanding Medicare Advantage Plans will also give a boost to average Arizona Medicare Advantage plan providers. The original design for the bonus structure offered additional incentive payments for plans that achieved a four- or five-star ranking from the Centers For Medicare and Medicaid Services (CMS) beginning in 2012. Changes to the bonus structure will enable three star plans to receive some incentive payments as well.
- December 6, 2010
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