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Differences Between Medicare and Medigap

One of the benefits of our medicine system is there are tools the elderly can use to take better care of themselves. The main thing which confuses seniors is the difference between Medigap and Medicare and which plan is the best for them.

It is extremely important to realize the fact that Medicare is not sufficient to cover all your medical expenses. This is the reason why Medicare supplements are created to fill the gaps in between the original Medicare coverage. These Medicare supplements are also known as Medigap insurance. Every state can differ in terms of Medigap policies, the Medigap plans in Arizona are regulated by the State of Arizona and the federal government.
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There are basically twelve (12) standardized Medicare Supplement plans naming from (A to L) that is covering the entire United States. These 12 Medicare supplements plans have their own set of basic and extra benefits. All insurance companies are obliged to sell Plan A and B as a rule of law. One thing which is common among the Medigap plans is that you cannot be charged differently from others in a particular state for a Medigap insurance plan. For example, if you pay $200 amount for Plan D in Miami, everyone will be paying the exact same amount everywhere in United States. Your Medicare supplements can only cover your expenses, you will have to buy separate policy even for your spouse.

One thing should be kept in mind is you don’t need to buy Medigap insurance policy if you are covered under a group of health insurance plan. And it is not necessary that all 12 plans may be available in all the areas.

Differences between Medigap and Medicare

Many people confuse themselves with the Medicare and Medigap advantages. Basically, Medigap refers to a bunch of supplemental insurance plans that works with the combination of regular medical benefits. Many medical options such as hospital accommodation or international transport are usually not covered in Medicare plans however they are covered in Medigap plans.

Expensive payments are also often covered in Medigap that are charged to Medicare patients without Medigap. Different insurance companies which sell Medigap plans give the same benefits all over the country. Insurance companies can be different but the policies, terms and conditions and the benefits will be same all across the United States. Another thing to keep in mind is that Medicare advantage plans replaces the original Medicare because these Medicare plans are run by private companies and must be able to provide the same coverage as Medicare A and Medicare B.

Some Medicare advantage plans also offer dental, vision, ENT or prescription coverage. Medicare plans are usually much cheaper than Medigap plans, if you are short on funds or you have planned to settle at one place, than Medicare is the best choice for you.

According to the latest research, Medigap plans are typically more expensive than the Medicare advantage plans. Medigap offers a variety of additional coverage to Medicare whereas the coverage of Medicare and Medicare advantage is almost same. Medicare offers a smaller network of doctors but Medigap allows the access to a larger network of doctors. In short, Medicare is recommended for those who are on a tight budget and if your pocket allows you than you must go for Medigap.

Medigap and Medicare plans have same prices almost across whole of the United States and these prices are set using the below mentioned three methods:

Community-Rated method: This method charges everyone the same premium regardless of their age or sex.

Age-Rated method: This method sets the price based on your age when you purchase the plan.

Attained-Age-Rated method: This method will increase the cost each year as you age.

Before buying any plan for yourself, you should understand the levels of coverage from (A-L). Plan F covers everything that Medicare fails to cover, so you do not have to pay any extra costs for doctor/hospital. Lower levels of coverage involve a corresponding lower premiums but doesn’t fill like the Plan F. Another thing to remember is that only you can determine which is the best plan for you as there several type of “pay now or pay later” plans. For example, Pay Now Medigap plans are the most expensive each month. however they will save you a great portion of money if you need extensive medical treatment or service. If you think that your budget can afford a Medigap plan, than they are the best way to protect your health. Pay Later Medicare will always seem to be less expensive in short run because of their lower monthly premiums. Extra services including hospital accommodation, transport or other prescriptions are much more expensive with Medicare plans than with the Medigap plans.

If you are interested in any of the Medicare or Medigap plans, visit AZ Medicare, the best Medicare insurance for Arizona residents. For senior citizens, Medicare only covers 80% after your deductibles have been paid. Medicare plans usually don’t include Plan D which is the drug plan, but it may be included in your Medigap plans.

Medicare advantage plans further include several types of plans, some of which are:

Health maintenance Organization (HMO) plan: Your choice is restricted for hospitals and doctors in this plan, except for emergencies.

Preferred Provider Organization (PPO) plan: You can choose doctors or hospitals outside the scope but it will cost you more in addition to the medical care within PPO.

Private Fee-for-Service (PFFS) plan: You are free to select your hospital or doctor in any way you want. The plan will determine the sharing of expenses.

Senior Healthcare Insurance Plans in Arizona

There is no doubt that everyone needs medical attention at some point in their life. The younger generation has the ability to stay strong and fight small medical issues. Older people don’t have the stamina and persistence and power to fight back. They need proper medical attention and if they don’t insure themselves, then, they may be spending plenty of money on medical bills. old-660831__180

Federal government has already introduced Medicare Plan A and Plan B long time ago, now for people older than 65 there are variety of supplement plans which add to traditional Medicare. Basically Medigap or Medicare supplement insurance plans covers the gap between the traditional Medicare and your medical costs. These Medicare supplement plans are sold by private companies separately. These plans are perfect for senior citizens who have expenses that will not be covered under traditional Medicare Plan A and Plan B. If the original Medicare does not cover your medical needs, you may want to look to supplement that coverage with a Medigap or Medicare Advantage plan. Both of these plans can be further supplemented with Part D drug coverage.

 Different insurance companies are allowed to sell the same Medigap plan for different amounts. Therefore, you will have to look around a little to get the best offer. If you are looking for a Medigap than you must already have Medicare Plan A and Plan B. It should be kept in mind that drug coverage is not a part of Medigap insurance plan. You will have to get the Medicare Part D separate to cover you drug prescriptions. Regarding Medicare, you must know that only Medicare Part A (hospital insurance) and Medicare Part C (Medicare Advantage) count as minimum essential coverage. If you have the minimum essential coverage you will not owe a fee for not having health insurance. Medigap itself is nothing, but it provides a lot of benefits when combined with original Medicare Part A and Part B.

In Arizona, there is a wide range of senior health insurance plans readily available. There are many options available which include health insurance plans for people who have certain health conditions, health insurance plans for people who like to travel in the US and abroad, health insurance plans for those who want to seek the best treatment from doctors in the United States accepts Medicare and health insurance plans for people with low incomes.

Arizona is the only state where majority of the people like to retire and it has the best senior citizen health insurance, Medicare, life insurance and retirement planning options. Not many people know that if you are eligible for Social Security retirement benefits, you will be automatically eligible for Part A of the Medicare as soon as you turn 65 years of age. If you receive a pension of social security benefits, you are automatically enrolled in Medicare Part B at the time you became entitled to Medicare Part A. All the Medicare Advantage plans are approved by Medicare but they are all offered through private insurance companies within the state. Sometimes these plans can be more beneficial, but might cost you a little more than the original Medicare plan.

These plans vary widely in costs and benefits from state to state, so go through your options carefully before you plan to choose one.Benefits of Medicare Plan A include hospital stays, skilled nursing and home health care. Medicare advantage plans also cover all Medicare Part B benefits, including doctor visits, outpatient care and preventive services. Many of them are also benefits as a routine hearing and vision care, fitness program, wellness service or helpline.If you plan to enroll Medicare advantage prescription drug plan than you will also get Part A and Part B coverage along with this combine in one plan. This plan is a good choice for many of the prescribers. In order to get fully insured, you may want to supplement your Medicare coverage to Medicare supplemental insurance i.e. Medigap, which generally pays the deductibles and extra payments which are not covered by Medicare Part A or B.

Medicare allows a small network of doctors but Medigap provides access to a broader network of doctors. In short, Medicare is recommended for those on a tight budget and if your pocket allows you to go for Medigap.Medigap policies are sold by private insurance companies to fill gaps in original Medicare plan. Most states have already adopted legislation restricting the sale of Medigap insurance for no more than a standard policy. The main difference between Medicare advantage and Medigap is that Medigap is used to supplement the original Medicare. These advantage plans are used to get more Medicare benefits, while a Medigap policy is only used to supplement the cost of your original Medicare benefits. Choosing the right Medigap plan depends on your medical needs and costs. If the original Medicare does not cover the actual cost of medical expenses and you have plenty of options. In most countries these options indicated by the letters A through N.

Each standardized Medigap policy must offer the same basic benefits, regardless of the insurance company selling. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. According to the latest research, Medigap plans are typically more expensive than Medicare Advantage plans. Medigap offers a number of additional coverage for Medicare while Medicare and Medicare Advantage are almost the same. Medicare allows a small network of doctors but Medigap provides access to a broader network of doctors. In short, Medicare is recommended for those on a tight budget and if your budget allows you to go for Medigap.

How Do Medicare Supplements in Phoenix AZ Help?

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.

Make sure you are eligible to apply for Medicare supplements in Phoenix AZ

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.

Doctor and patient with prescription at office

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.

Caduceus with First-aid Kit

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

Senior Healthcare Arizona: Here’s What You Need to Know

Ill health is not something reserved for the elderly and diseases can strike young and old alike. Still, the geriatric population is affected by conditions that are almost exclusively age-related and (more or less) expected as a natural side-effect of aging. Talking about the senior healthcare Arizona offers is important. This issue deserves thorough consideration due to the inherent vulnerability of said population group, the burden on the caregivers and the impact on society in general. And let’s not forget to mention the fact that sooner or later we will all fall into the senior citizen category.

What we mean by old age

The western world generally accepts the chronological age of 60+ years to define the term ‘elderly person’. The age of 65 is generally agreed to be the age at which people can get their retirement benefits and for a lack of better option – the default definition of old age in most countries.

The issue of age is complex and it is not easy to determine at which age the person actually becomes old. For example, people in their 30s engaging in health damaging activities such as excessive drinking, smoking or eating junk food can have the health status (in terms of organ function and physiology) of a 50-year-old person – and vice versa.

This is due to the discrepancy between their age as a number on their birth certificate (chronological age) and the actual condition of their body (biological age).

Senior healthcare Arizona – Social and functional aspects of aging

The natural process of aging may give rise to chronic conditions resulting in a variety of functional problems or disabilities. With advancing age, most people will experience a gradual decline in the levels of their functional capacity, self-sufficiency and the ability to live independently.

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Although initially elderly people are capable of handling their chronic health problems and limitations on their own, as years pass, most of them will need help from family members in their routine daily activities. In time, many of them will need some form of external care (personal support workers).

Eventually, meeting their medical and personal needs through family members or support workers will no longer be possible. This is when families often decide in favor of nursing homes, as these facilities provide both skilled nursing and personal care.

Age-related specifics and expected changes in the body

The aging process is a biological inevitability, accompanied by anatomical and physiological changes which should not be confused with pathological processes.

Changes affect all major organ systems:

Alzheimer’s disease and vascular dementia are the most common forms of cognitive dysfunction in the elderly. Although memory problems and confusion are more common, elderly people should be reassured that sporadic instances of forgetfulness are not a sign of Alzheimer’s.

Older people have a reduced ability to cough out mucus and foreign matters from their respiratory system, leading to increased risk of infection and bronchospasm.

Muscle mass and strength decline with age. Bones and joints succumb to the wear and tear over time. Ligament and tendon strength also decreases.

The risk of osteoporosis (porous bones) increases with age, as bones begin to weaken after the fourth decade of life, most often in women.

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Osteoarthritis is also common and occurs when the protective cartilage at the ends of bones wears down.

Seniors should be educated that osteoporosis can be prevented by adequate intake of calcium and vitamin D, physical exercise and smoking cessation. Regular bone density scans are recommended.

As people age, they experience increased susceptibility to infectious agents. Vaccines become less effective.

With advancing age, some tissues become less sensitive to the hormones that regulate their function. Blood levels of hormones also change – some rise, while others fall. Reduced estrogen synthesis in menopausal women increases the risk of osteoporosis and vaginal dryness. Reduced male sex hormones lead to erectile dysfunction.

The thyroid gland may become nodular (lumpy) and the overall metabolism slows down. Problems with fat and cholesterol become more common.

The eyesight starts to weaken around the age of 40. Presbyopia (the inability to see close objects) is a normal consequence of aging. Around 60, cataracts (cloudy areas in the eye’s lens) and macular degeneration may develop, as can glaucoma. Hearing also declines with age.

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Prevalence of gastrointestinal conditions, including gastroesophageal reflux disease and heartburn, increases with age.

Decreased sensation of thirst and malabsorption of carbohydrates, vitamins B12 and D, folic acid and calcium also becomes common. This can lead to fluid and electrolyte imbalance and malnutrition.

A large number of older adults have pre-diabetes. Without intervention, this condition is likely to progress to overt type 2 diabetes, carrying with it the risk of heart disease and stroke. It is very important to point out that lifestyle changes such as weight loss, proper diet and exercise dramatically reduce the risk of diabetes in people over 60.

Urinary incontinence (loss of bladder control) is very common in older people, but can also be caused by infections, constipation and certain drugs. The condition can be managed and controlled.

Prostate enlargement (benign prostatic hypertrophy) can cause urination problems as the enlarged prostate presses on the urethra. Prostate malignancies are the second most common type of cancer and regular checkups are essential.

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Older people produce less saliva, which is needed to clean the teeth. Gums recede with age, making the tooth more vulnerable to decay or infection. Bad breath and loss of teeth is also more common.

Skin naturally changes as we age. Elderly people tend to produce less sweat and oil, the skin becomes drier, thinner and loses fat, causing it to appear less plump. Smoking greatly accentuates age-related skin changes.

Sunlight is greatly related to the skin changes we associate with aging – wrinkles, dry skin or age spots. For better skin health and prevention of skin cancer (most notably melanoma), the importance of staying out of the sun and using protection can’t be stressed enough.

With age, hair becomes progressively thinner and nails become more brittle. Nail fungal infections become more common.

Older people are more prone to falls due to weakened perception acuity, lower muscle strength, loss of coordination and slower reflexes. Certain drugs like blood pressure meds or sedatives can also cause dizziness. As osteoporosis is common in the elderly, these falls often result in fractures that are slow to heal.

In conclusion, although the aging process can’t be reversed, a healthy lifestyle and overall good care of one’s health can delay age-related changes, making old age healthier, happier and more productive.

The costs of medicare supplements in Phoenix AZ

Health services in Arizona and the rest of the U.S. are expensive and most people cannot afford to pay the full costs out-of-pocket. Health insurance allows people to receive medical care without incurring huge expenses. Medicare is the federal health insurance program which primarily serves the needs of elderly and disabled people, as well as adults with certain medical conditions. The program has limited coverage, so make sure to check out the medicare supplements in phoenix az before deciding how to cover healthcare costs outside the Medicare coverage scope.

How are medicare supplements in Phoenix AZ structured?

The Medicare program has 4 parts (A to D), each providing different benefits. Parts A (hospital insurance) and B (medical insurance) are also known as Original Medicare (check out this 2015 guide before choosing the right plan).

Part C (Medicare Advantage) is an enhanced alternative to Original Medicare supplied by private insurance companies. Part D (prescription drug insurance) covers prescription drug costs through private insurance companies contracted by the government.

On average, Original Medicare covers about half of your healthcare costs. The rest is covered by supplemental insurance or other forms of personal (out of pocket) payment.

What is Medicare Part A?

Medicare Part A is automatically available (premium-free) to people aged 65 and over who have been employed for at least 10 years and have paid social security taxes during that period. Adults aged 18 to 65 with work-preventing disabilities, dialysis and kidney transplant patients, people with an end-stage renal disease or amyotrophic lateral sclerosis are also eligible for Medicare.

Senior couple choosing Medicare

Individuals who aren’t eligible for premium-free Medicare Part A can still enroll by paying a certain premium. Beneficiaries who postpone enrollment beyond the eligibility window may be subject to a late enrollment penalty after sign-up.

What does Medicare Part A cover?

  • Hospital services – covers inpatient care (semi-private accommodation, meals, intensive and coronary care, nursing services, medications and supplies) in hospitals, rehabilitation facilities, long-term care and mental care facilities. The first 60 days of your hospital stay are fully covered, after which you are charged a considerable copayment, unless you have supplemental insurance.
  • Home healthcare – Medicare covers skilled healthcare services, such as occasional nursing care, physiotherapy, and occupational or speech-language therapy, when provided by a Medicare-certified agency. If your needs include durable medical equipment, you have to pay 20% of the Medicare-approved amount.
  • Skilled nursing facility – covers inpatient care in a Medicare-certified facility for a minimum of 3-day inpatient stay. Medicare Part A covers up to 100 days of your inpatient stay. Days 1-20 are covered 100%. For days 21-100, you will be charged a daily copayment of $157, unless you have a supplemental insurance plan.
  • Hospice care – includes palliative care and pain relief for terminally ill patients with life expectancy of six months or less, delivered at home or in a hospice facility. To qualify for hospice care, patients must waive curative treatment, but they reserve the right to terminate hospice care and resume curative treatment.

What Is Medicare Part B?

Medicare Part B is available to Medicare Part A policyholders, at a monthly premium. Higher-income seniors may be required to pay more. If you delay enrollment in Part B for 12 months, you are required to pay a 10-percent premium penalty.

Once you turn 65 and join Medicare Part B, you have a six-month window (open enrollment period) during which insurance companies are obligated to sell you any Medicare Supplement Plan that you choose (Medigap), irrespective of your current health condition or past issues. These companies are not allowed to charge you anything extra. Keep in mind that this is a one-time opportunity.

Medicare enrolment application form

If you have employment-based coverage, you can delay Part B enrollment. In this case, you can sign up later, during a special enrollment period, without paying a late enrollment penalty.

To receive Part B benefits, you must first pay the Part B annual deductible ($147). When you receive healthcare services, Medicare covers 80% of the approved amount and you pay the remaining 20%.

Part B covers outpatient care, preventive services (flu and Hepatitis B shots, cardiovascular, cancer and diabetes screenings), ambulance services, durable medical equipment, as well as occasional home-based health and rehab services that are deemed necessary by your doctor.

Medicare at the doctor’s office

Don’t forget to use the services of healthcare providers that always accept assignment (the Medicare-approved amount). These providers are referred to as participating providers and their contract with Medicare obligates them to accept the amount paid by Medicare for healthcare services as “full payment”. In this case, you only pay the deductible and the coinsurance amount. The doctor directly submits the claim (request for payment) to Medicare without charging you in the process.

Providers that haven’t signed a contract to accept assignment (non-participating providers) are not obligated to see you, but can choose to do so. In this case, you pay the entire cost of the service immediately and get reimbursed by Medicare later. These doctors cannot charge you more than 15% above the Medicare-approved amount (limiting charge). The limiting charge doesn’t apply to durable medical equipment and medical supplies.

Visiting a doctor

Some providers choose to opt out of Medicare and not accept any Medicare payments. Consequently, they are free to charge you whatever they want, they don’t submit a claim to Medicare and you pay the entire cost of the service out-of-pocket. As an exception, Medicare will cover treatment expenses if you have been admitted as an emergency patient.

What is not covered by Original Medicare?

Original Medicare doesn’t cover prescription drugs (except immunosuppressive drugs and oral anticancer drugs), cosmetic surgery (except for reconstructive purposes), routine checkups, most immunizations, healthcare outside of the United States, hearing aids and exams, eyeglasses and contacts, dental care and dentures, etc. Some of these services are covered by supplemental insurance plans, such as Medicare Advantage and Medigap.

Remember

It is up to you to do your research, and decide which supplement suits your needs best. The main thing to remember here (again) is that your “optimal plan” will change with time. As you get older, you might have to change to a more expensive supplement, in order to (ironically enough) save money.

Medicare Supplements in Phoenix AZ – Is Your Current Medicare Plan Right For You?

Whether you are one of the few people who are satisfied with their current Medicare plan, or are looking for something better, it is always a good idea to review other options. If you are trying to improve your health care coverage, you should research Medicare supplements in Phoenix AZ and get informed about your options.

Health care is one of the most crucial aspects of your life, so you need to be fully satisfied with your Medicare coverage. The idea that there may exist a better option than your current Medicare plan, opens up a new perspective – an opportunity to learn if something better might be available and more appropriate for you.

Regardless of your current Medicare coverage, you should search for and evaluate all available Medicare plans, including Medicare supplements in Phoenix AZ. You should consider the prescription drug benefit that each plan is offering and see which plan offers you the most suitable coverage.

The Medicare plan that worked for you in 2014 may just not be the best option in 2015. Reviewing Medicare supplements in Phoenix AZ and planning in advance could help you save a large amount of money on your medical bills. This money saving opportunity is welcome, especially if you foresee a surgery or any special testing and examinations.

What is a Medicare Supplement plan?

If Medicare beneficiaries wish to make changes in their Medicare coverage plan, they can certainly do so by choosing Medicare supplements in Phoenix AZ. A medicare supplement plan is referred to as Medigap, since this plan would fill out gaps and complete your original Medicare coverage.

Beneficiaries are offered to choose from a variety of Medicare supplements in Phoenix AZ. These medical supplements are classified by letters. Regardless of the insurance company that offers the plan, same lettered Medicare plans offer the same benefits for the beneficiaries.

Even though same-lettered Medicare plans offer the same benefits, they differ by cost. Every company has its own pricing policy when offering Medicare benefits to its users. In general, coverage doesn’t include vision or hearing care, although some additional benefits may be covered (medical coverage while traveling outside the country).

How to evaluate your current Medicare Plan?

In order to determine if your current Medicare plan is the right one for you, there are few crucial things to consider. The first thing is to decide if your current coverage plan meets your needs at the moment, based on your current health condition. The next thing is to determine if there are any changes in the way you can benefit when using your Medicare services.

If you are diagnosed with a health condition that requires a specialized test and your plan doesn’t cover such expenses, you should change it. Start comparing Medicare supplement plans to find which ones offer you the best possible coverage for your current health and needs.

evaluate-your-medicare-plan

If your doctor retires, and you have a new doctor that doesn’t accept your current Medicare plan, you should choose another option. If your Medicare plan doesn’t provide you with the right Medicare services, you should find the one that offers the best for your health care.

Considering the costs for your current Medicare plan, you should determine a few crucial things. If you are paying more out-of-pocket than expected, or can’t afford to pay for your medications, consider changing your Medicare plan.

In addition, if you spend a lot of money on your prescription drugs, search for a Medicare plan which offers the lowest medication costs. If you pay high prices for specialist services, choose the plan which offers the lowest copayments for specialist visits and services.

If you spend a lot of money on monthly premiums and you are in a good health condition, it is wise to consider the Medicare plan with the lowest premium. However, you should keep in mind that lower premium costs may mean a higher deductible.

Choosing from the available Medicare supplements in Phoenix AZ

Although your current Medicare plan coverage may be similar to the Medicare Supplements of the same type, you should perform a careful selection. You should first select the Medicare plan that meets your needs in terms of coverage. Then, you can choose plans within that single plan type, based on your needs and their cost.

medicare-supplements

If you have Original Medicare, you already know that it is the default category which is managed by the Federal Government. An Original Medicare coverage policy is accepted anywhere Medicare is accepted. This coverage consists of hospital insurance referred to as Part A and medical insurance known as Part B.

When referring to the Original Medicare, it is essential to understand that it doesn’t cover all of your medical costs. Therefore, you should consider a Medicare supplement policy which will cover expenses such as dental care, hearing aids, prescription drugs etc. Medigap helps you out with expenses such as deductibles and coinsurance.

If you prefer having a single plan which includes dental coverage, prescription drug or vision coverage benefits, you should consider Medicare Advantage. This plan includes Part A and Part B and is known as Part C Medicare coverage.

Unlike Original Medicare, the Medicare Advantage coverage plan is managed by private insurance companies. These Advantage plans correspond with other private insurance plans and differ in costs and coverage options. If you choose the Advantage plan, you will have a monthly premium to pay and become a beneficiary to deductibles and coinsurance.

If your Medicare plan no longer meets your budget or health needs, change it for a better Medicare supplement plan. The best Medicare supplements in Phoenix AZ are: Aetna Medicare Supplement, Blue Cross Blue Shield Arizona, Mutual of Omaha Medicare and United Healthcare Supplement.

medicare-supplements-in-phoenix-az

The Aetna Medicare Supplement Plan is an addition to Medicare Part A and Part B. It offers assistance in paying for the additional healthcare costs (copayments and deductibles). This Medicare plan is available in fifteen states across the country. It allows you to choose the doctors and hospitals you want to be checked-into.

Blue Cross Blue Shield Arizona covers the expenses that Medicare and Medicare Advantage plans do not cover. These plans do not work with Medicare Part C and other insurance plans you may have as part of your retirement benefits.

Mutual of Omaha offers Medigap insurance plans that reduce co-pays, deductibles, and premiums for Medicare Part A and Medicare Part B plans. Although these Medigap policies are offered by various private insurance companies, they are all standardized and offer the same coverage.

United Healthcare Supplement Plans offer coverage that is not included in Medicare Parts A and B. They cover expenses such as coinsurance, deductibles and copayments. These Medicare supplement plans may help you cover your annual out-of-pocket expenses.

Health Care Services Through AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS) provides certain income-eligible Arizona residents with coordinated health care services. This agency contracts for health care services for eligible residents through a list of authorized providers.  Health care plans are specifically tailored to meet the needs of Arizona residents, including American Indians, who may choose to receive services through the Indian Health Service, a tribal health facility or an urban tribal clinic.  In these cases, enrollment in the American Indian Health Program (AIHP) is also required.

Health care coverage offered by AHCCCS is delivered through a network of pre-approved health care providers. In many ways, AHCCCS is similar to a Health Maintenance Organization (HMO). You can determine your health plan provider based on your ZIP code. You will choose a primary care doctor, who will coordinate all of your health care services, including routine doctor’s visits, diagnostic tests, routine health care, and non-emergent hospital services.  AHCCCS will also provide coverage for emergency health care services and transportation.

Some health care providers that offer services to AHCCCS-eligible persons require co-pays for some services. The co-pay amounts are listed on the AHCCCS Web site, and services that incur copays are identified.

For more information about health care services available to Medicare-eligible persons, please call (480) 706-1702.

Medicare Fraud Scams Net 75 In AZ, FBI Investigations

Two people have been arrested and charged with fraudulently billing insurance companies for more than $600,000 in services that were never provided. Gevorg Melkonyan and Elina Aruryunova are accused of stealing nearly 130 identities from Medicare recipients and 12 doctors to generate phony Medicare reimbursement claims.

The Department of Insurance became involved when one of the physicians whose identity was stolen contacted them to report that patients he had never treated were calling about charges from his office that showed up on their insurance statements. Further investigation led the Department to the fraudulent claimants.

The Obama administration recently awarded $9 million in grants to help more than 50 organizations combat Medicare fraud. Much of the money will be spent on information and education programs designed to teach Medicare recipients how to spot and report potential Medicare fraud. The grants, which fund the Senior Medicare Patrol (SMP) are targeted to assist in areas where Medicare fraud is among the highest. To date, the program has reached more than 3 million Medicare recipients and has produced more than 3,000 reports of Medicare fraud, waste and abuse.

Medicare fraud is a growing problem. The National Health Care Anti-Fraud Association estimates that about 3% of total expenditures on health care are based on fraudulent claims. If the statistic is accurate, that means about $15 billion is wasted each year on fraudulent Medicare claims.

In October, the FBI launched raids that resulted in the arrests of 73 Armenians with ties to organized crime after finding billing for $163 million from nearly 120 non-existent clinics in 25 states. In this particular fraud ring, the organizers used identity information stolen from nearly 3,000 New York Medicare recipients to generate bills for services. About $36 million was paid since the operation began in 2006. Phony invoices for unreasonable tests performed by specialists tipped investigators to the fraudulent scheme.

SCAN Health Plan Hispanic Outreach Program Targets Arizona

SCAN Health Plan Arizona has unveiled an outreach program designed to help Arizona’s aging Hispanic population become more aware of its services for seniors. The program’s organizers say the goal of the effort is to help keep Hispanic Arizonans healthier and more independent for a longer period of time.

The outreach program works with other community organizations to deliver prevention and education programs and Spanish-language advertising materials to the state’s Hispanic media organizations. In addition, SCAN Health Plan Arizona will increase its participation in community health fairs, and will host open houses designed to attract Hispanic senior citizens.

Some Medicare patient advocates believe that new federal health reform legislation will result in reduced care for aging Hispanics. Under current regulations, they charge that a study by the Heritage Foundation shows as many as 41% of Arizona’s Hispanic seniors currently enrolled in a Medicare Advantage plan will lose their coverage by 2017. This is in part due to changes in a beneficiary’s ability to enroll in Medicare Advantage plans when all of the health reform provisions are in effect.

Critics charge that beneficiaries who would have chosen Medicare Advantage plans under the old system will be barred from selecting that option under the new reform rules. The majority of persons affected by the change will be low-income and minority beneficiaries, many of whom are Hispanic. The Heritage Foundation report says that nearly 5 million Americans will either lose Medicare coverage altogether or will have their coverage significantly reduced, while their out-of-pocket expenses significantly increase.

SCAN hopes to reverse this and ensure that Medicare covers all Hispanic seniors in Arizona adequately by providing outreach programs in settings that are culturally sensitive, and in ways that eliminate the language barrier. The organization has already participated in one focus group study with Hispanic seniors and health care providers to better understand the concerns of Hispanic seniors and to make sure these concerns are addressed.

SCAN (Senior Care Action Network) is a non-profit organization dedicated to providing affordable, comprehensive health care and health care advocacy for all seniors. The group is also active in the State of California.

SCAN Health Plan Arizona Expands Medicare Advantage Coverage To Pima County

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.

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