According to the latest statistics, a huge amount amount of retired people find Arizona the best place to live because of the warm climate and medical facilities. Millions of residents are depending upon the Medicare for health and life insurances. Since basic Medicare plan doesn’t cover everything, people may want Medigap or Medicare advantage plans.
Arizona is only state which has the most amount of Medicare recipients. Phoenix, Tucson and Mesa are the largest cities of Arizona and there are about 15% Arizonians who are 65 years and up receiving Medicare and about 14% Arizonians receiving Medicare. Almost all seniors are dependent on Medicare benefits for health insurance. Among all the senior citizens, approximately 30% will choose the Arizona Medicare Advantage plans. The other 25% will choose Medigap plan instead. The remainder may have a different public or private coverage, but most do not just rely on Part A and Part B Medicare, because they want to ensure that health care costs remain affordable.
Anyone choosing Medicare insurance or any other type of health insurance needs to strike a balance between premiums and benefits. Medicare Advantage plans for Arizona are attractive because many still have a very low or even $ 0 premium surcharge. Medicare Advantage plans also include Part D drug coverage at no additional cost.
On the other hand, these cheaper plans have many co-pays and deductibles. Also many recipients operate on a tight budget during retirement. Everyone has their own plans for retirement, for some people it makes more sense to pay a hefty amount for the Medigap insurances that covers all the health expenses that are not originally covered in Medicare.
Interestingly, Medicare supplement insurance plans C and F are usually the most expensive but they are also the most popular among the people who purchase supplements.
As a beneficiary, you are free to enroll in any Medicare Advantage plans you like. All the plans offer health benefits under Part A and Part B both. Many Medicare Advantage plans also cover prescription drug coverage (Part D). Additional benefits can also be utilized by paying an extra cost on your Medicare advantage plan. You may qualify for these plans if you are entitled to Medicare Part A and enrolled in Medicare Part B.
There are many private companies who offer Medigap plans for senior citizens. People can easily sign up for one of several Medicare advantage plans if they want to receive the most of their medical insurance coverage company. Keep in mind that if you are going for Medicare advantage plan, you must be enrolled in Medicare Part A and B.
Secondly, you must be living in the area where they have Medicare network providing advantage plans. Most Medicare Advantage plans have prescription drug coverage built into the plan. This is not always the case, because it may be what is called stand-alone Part D plan.
Many people join the Medicare advantage plan as soon they turn 65. This process is called open enrollment period when you have only six months to enroll in the plan. After registration, if you want to change your plan, you’ll have to wait until the annual election period, which occurs every year from October 15 to December 7th. During this time, you can switch plans or return to original Medicare options, for this year you will not be able to move out of your plan, or join a new Medicare Advantage plans for 2016 outside of that enrollment period.
Type of Medicare Advantage Plans:
Below listed are some of the main advantage plans available across the United States:
Health Maintenance Organization (HMO):
Health Maintenance Organization plan only allows you to select certain doctors and hospitals within the network. Unless it’s an emergency, only then can you go to those approved locations. If you plan to visit someone outside your network, it will not be covered under your plan and it will be charged separately.
Preferred Provider Organization (PPO):
Preferred Provider Organization plan allows you to save your money by selecting the specified doctor and healthcare provider or hospital. You will be required to pay a bit more if you wish to go to those that are not on the list of approved providers.
Private Fee for Service (PPFS):
Private Fee for Service a plan which does not require you to go to an approved list of providers. Instead, you will have the choice to select any provider you want. The only drawback is that there are very few people who accepts the PPFS plan.
Special Needs Plans (SNPs):
Special Needs Plans are basically designed for the people who have some specific and severe disabilities and diseases. The list of accepted providers is made on the needs of the subscriber and who will be able to fulfill their needs.
Every Medicare advantage plan is created to operate on a network. It means that all health care providers will be located within a specific area. You are required to live in the local area if you want to get covered by a certain plan. If you move to a new area, you may change your provider or insurance plan, depending on where you moved and what type of network is used.
- July 27, 2016
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Diseases don’t only take their toll on your physical and mental wellbeing – they can also deplete your life savings. Most US citizens over the age of 65 rely on Medicare to cover their healthcare expenses, at least to a certain degree, as its coverage is not comprehensive. As a way to avoid excessive medical costs, Medicare beneficiaries can extend the scope of their health insurance coverage by purchasing one of the supplemental Medigap plans. Read on to find out what really matters when you are considering a Medigap policy for your healthcare needs.
Basic facts about Medicare
Medicare is the national health insurance program, addressing the needs of people aged 65 or above and other people with certain qualifying conditions.
There are 2 ways to get your Medicare coverage: Original Medicare, consisting of Part A (hospital insurance) and Part B (medical insurance) or Medicare Advantage (Part C), which is a standalone plan designed as a substitute for Original Medicare, administered through Medicare-approved private insurance companies.
If needed, users of Original Medicare and Medicare Advantage can add prescription drug coverage by purchasing Medicare Part D. Original Medicare beneficiaries in Arizona can also buy supplemental coverage known as Medicare Supplement Insurance (Medigap), which can only be used in combination with Original Medicare. Medigap and Medicare Advantage are mutually exclusive and you cannot have both.
Medigap – concept and important facts
Medigaps are private health insurance policies designed to supplement Original Medicare and cover some of the costs left out by Original Medicare. These are referred to as coverage gaps, hence the name Medigap. Coverage may include out-of-pocket costs such as deductibles, coinsurance, copayments, as well as hospice or additional hospital coverage.
When you receive healthcare as a Medigap beneficiary, Medicare pays its share of the Medicare-approved amount, after which the Medigap policy pays its share, thus supplementing the costs of your Original Medicare benefits. Medicare doesn’t cover any of the purchase costs for your Medigap policy. One Medigap policy only covers one person.
In Arizona, insurance companies can only sell you “standardized” Medigap policies, labeled by letters (A, B, C, D, F, G, K, L, M, and N). Standardized means that all providers selling a particular Medigap plan must offer the same coverage and benefits.
However, unlike the benefits, the costs of same-lettered plans do differ across providers. This is why, when purchasing a healthcare plan, it is best to choose the plan that fits your needs first and foremost, and then shop for the best price.
Arizona companies are not required to offer Medigap plans to disabled Medicare beneficiaries. Medigap policies are renewable (with the exception of policies purchased before 1992), meaning that your insurance provider cannot cancel your policy, unless you stop paying premiums or the company goes out of business.
Medigap plans offer the following basic benefits:
- Hospitalization – Part A coinsurance plus additional 365-day coverage after Medicare benefits end
- Medical Expenses – Part B coinsurance (usually 20% of Medicare-approved expenses) or copayments for outpatient services
- Three pints of blood each year, if you need transfusion
- Hospice care – Part A coinsurance
Medigap plans – coverage scope and costs
As a rule, Medigap policies sold in Arizona do not include long-term care, vision or dental care, hearing aids, eyeglasses, or private‑duty nursing, but some of them do offer coverage while traveling abroad.
As of 2006, Medicare Supplement plans in Arizona do not include prescription drug coverage. Your Medigap plan comes with a monthly premium, in addition to the monthly Medicare Part B premium. Monthly premiums for Medicare Supplement plans in Arizona range from around $40 to $300, depending on the beneficiary’s age and provider.
How insurance companies set their premiums
The ways in which insurance providers price their Medigap policies are important, as they will affect your present and future expenses. Premium rates can be set as follows:
- community-rated i.e. no-age-rated: premiums are the same, regardless of the beneficiary’s age;
- issue-age i.e. entry-age rated: premiums are based on your age when you first buy the policy. The sooner you enroll, the less you will pay;
- attained-age rated: premiums are based on your current age, and they increase as you grow older.
When to purchase a Medigap policy in Arizona
It is recommended that you join a Medigap plan during the open enrollment period (OEP), when you have a guaranteed issue right to buy a Medigap policy, regardless of your health status (i.e. when the provider is required by law to sell you a Medigap policy).
The 6-month Medigap OEP automatically starts on the first day of the month you turn 65 and are enrolled in Medicare Part B. However, you may have to wait up to six months for coverage of a pre-existing condition.
If you enroll in a Medicare Supplement Plan outside of your OEP, you may be subject to medical underwriting, which can affect the premium rates and whether the provider will sell you a policy or not. This basically means the company can ask you to take a physical, review your health information and then decide whether to offer you coverage, at which price and under which conditions.
Choosing a Medigap policy in Arizona
Arizona residents can choose from 10 standardized Medigaps, offered by around 50 insurance providers. More than half of the beneficiaries statewide use Medigap Plan F, followed by Plan C as the distant second.
Medigap providers don’t have to sell all Medigap plans, but their Medigap offer must include Plan A. If they offer any plan in addition to Plan A, they must offer Plan C or Plan F.
Plan F is also offered as a high-deductible plan. This means that you have to pay for Medicare-covered costs (coinsurance, copays, deductibles) up to the deductible amount of $2,180 before your policy pays anything.
For Plans K and L, after you meet your annual out-of-pocket limit and Part B deductibles ($147 in 2015), the Medigap plan pays 100% of the covered services for the rest of the year.
Plan N pays 100% of the Part B coinsurance (except up to $20 copay for some doctor visits and up to $50 copay for ER treatments that don’t require inpatient admission).
When choosing a Medigap policy, check if the company offers discounts, such as discounts for women, non-smokers, or married people, yearly payment discounts, multiple policy discounts etc.
Generally, your choice of health insurance policy should match your medical needs but also your financial abilities. When choosing a plan, always consider your current needs and try to foresee future concerns.
Medicare is the principal state-administered health insurance program in Arizona and the rest of the US. It aims to address the needs of seniors (65 and older), as well as younger adults with qualifying disabilities and diseases. Since it’s not all encompassing in terms of coverage, many people purchase additional coverage, such as one of the Medicare supplements in Phoenix AZ, commonly referred to as Medigap plans.
Meanwhile, financially vulnerable populations can use the benefits of the joint federal and state program called Medicaid, designed to help with their medical costs. Here are some Medicaid basics explained to help you get more acquainted with this health insurance program.
What is Medicaid?
Medicaid is a health insurance program providing assistance to families with low income and limited resources that cannot afford healthcare coverage. The program provides full coverage for its low-income beneficiaries, whereas moderate-income beneficiaries receive substantial coverage.
Medicaid is jointly funded by the federal and state governments and managed by the states. Each state has the freedom to set its own eligibility criteria. Common criteria for all states include US citizenship and permanent residency status. Low-income families, people with certain disabilities and pregnant women can also qualify for Medicaid.
Poverty is a criterion, but it does not make a person automatically eligible for Medicaid. Financial eligibility is defined in terms of income and resources. Thanks to the Patient Protection and Affordable Care Act, the eligibility and funding for Medicaid have increased significantly.
What does Medicaid cover?
Medicaid coverage varies between states and people are advised to contact their state’s Medicaid office in order to fully understand the coverage options. Under federal law, each state must provide a minimum benefit package, including:
- hospital inpatient and outpatient services
- doctor services
- skilled nursing
- home care
- lab and x-ray tests
- health screening follow-up services for children under 21
- nurse-midwife services
- family planning services
- rural health clinic services
- transportation services
Although Medicaid doesn’t cover prescription drugs, the program can pay the premium for Medicare prescription drug coverage (Medicare Part D). In addition to Medicaid, each state also runs a Children’s Health Insurance Program (CHIP), designed to cover children from families whose income is modest, but still too high to qualify for Medicaid. In some states, CHIP also assists parents and pregnant women.
The Children’s Health Insurance Program covers dental care, eye exams and eyeglasses, regular checkups, prescription drugs and vaccines, specialty services and mental healthcare, hospital care, medical supplies, x-rays, lab tests and treatment of pre-existing conditions. In each state, Medicaid and CHIP work closely together to address the needs of their target populations. They are evolving and improving from the aspect of eligibility, enrollment and renewal, thanks mainly to the flexibility enabled by the Affordable Care Act.
Medicare supplements in Phoenix AZ and Medicaid – are they related?
Many people confuse Medicare and Medicaid, despite their apparent differences. In a nutshell, these are the main differences between the two programs:
- Medicare is a federal program addressing the needs of people aged 65 and older, as well as people with certain diseases and disabilities. Medicare is available to people of all income levels and the coverage is the same in all states.
- Medicaid is a joint federal & state program providing healthcare benefits to people of all ages, available to those of low income and resources. Medicare programs are different in each state.
Sometimes, Medicaid can work together with Medicare to cover healthcare costs. In other words, Medicaid can help Medicare policyholders with the payment of excessive medical bills that Medicare doesn’t cover. In this case, for services covered by both Medicare and Medicaid (doctor visits, hospital care, home care and skilled nursing facility care), Medicare is the primary payer, whereas Medicaid covers the remaining costs, such as coinsurances and copays.
Who is eligible for Medicaid?
Each state has its own eligibility and application rules within the federal standards, and the state Medicaid offices are best suited to answer all your questions. Medicaid and CHIP provide assistance to around 60 million Americans, including children, pregnant women, parents, elderly and disabled people. Federal law requires all states to include certain population groups in their Medicaid coverage (mandatory eligibility groups).
Each state has the freedom to cover additional groups (optional eligibility groups) and many states have decided to expand the scope of coverage, especially for children, beyond the required federal minimum. Since each state individually decides how to design its Medicaid program, a person’s ability to qualify can depend on whether their state of residence has decided to expand its Medicaid coverage to include more people.
Generally, the eligibility assessment for Medicaid and CHIP coverage is based on income, household size, disability, family status and some additional factors. Certain states have expanded Medicaid coverage to all low-income adults. In this case, people can qualify for Medicaid based solely on income and family size.
Some people are eligible for both Medicare and Medicaid. This is called dual eligibility. If a person has Medicare and full Medicaid, most of their healthcare costs are likely to be covered. In all states, people can apply for Medicaid in one of two ways – either directly through the state’s Medicaid agency or by filling out a Marketplace application. The applications for Medicaid and CHIP can be submitted any day of the year (not only during Marketplace Open Enrollment).
What is Medicaid spend-down?
Spend-down is an option within Medicaid designed to help people pay huge medical bills, which are beyond their payment abilities. People whose income exceeds the Medicaid eligibility levels are referred to as having excess income.
They can nonetheless become eligible under the spend-down program (as persons that are medically needy), if this excess income is spent on medical bills. With the spend -down option, the person pays the bills up to the excess amount and Medicaid pays the rest.
To become eligible as medically needy, a person’s resources must be under the resource amount allowed in the particular state. The spend-down option is available to children under 21 years of age, adults over 65 years of age, the disabled and the blind, as well as families where one or both parents are absent, diseased, disabled or out of work.
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.
- February 7, 2011
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According to an annual analysis conducted for the trustees of the Social Security Trust Fund, changes to the delivery of health care in the United States are expected to extend the solvency of the Medicare program until at least 2029, an eleven-year extension from 2009’s prediction of insolvency in 2017. The future of Social Security is somewhat less clear, however.
While Medicare – which had largely been considered the more vulnerable of the two entitlement programs – is seemingly on a more stable path, the outlook for Social Security has not brightened much, if at all. The trustees for the Social Security Trust Fund once again predicted insolvency in 2037 just as they did in 2009. In this case, insolvency assumes that no changes are made to shore up the trust fund, delay benefits or reduce program expenses.
The trustees predict that unabated rising health care costs will place the Medicare program under extreme financial pressure and will likely force cuts in services as the program tries to balance the cost of care with the available resources. Without Congressional intervention this year, Medicare providers are looking at a potential cut of 30% in reimbursements beginning in December 2010. Providers say that reimbursements already fail to keep up with the rising cost of providing services, and a 30% cut, if enacted, will force many Medicare providers out of the Medicare program altogether.
For Social Security recipients, the trustees say that a cost-of-living increase for 2011 is unlikely, largely due to low inflation. Recipients did not see an increase in their benefits for 2010, for the same reason.
While the Medicare program is a winner under new health care reform, the Social Security program doesn’t go away empty-handed. Beginning in 2019, the law requires an additional tax to be levied on so-called “Cadillac” health care plans. At that time, employers are expected to begin reducing health care coverage to avoid triggering the tax. At the same time, compensation for certain employees will rise to offset the loss in benefits. Cash compensation is taxable to a point, and the Social Security administration is likely to see at least some additional revenue from increased wage-based compensation levels.
A bi-partisan committee is examining the Social Security program and is expected to make recommendations to the President no later than December 1. Recommended changes to the Social Security and Medicare programs could include delaying access to full benefits, increasing in tax revenues, and decreasing benefits to eligible recipients.
Medicare says it will now extend smoking cessation counseling to its recipients citing the cost of providing health care to smokers as one reason for adopting the benefit. A study commissioned by Medicare found that the agency will spend about $800 billion on smoking-related health care over the 20-year period between 1995 and 2015.
Effective immediately, Medicare will pay for up to eight counseling sessions per year for smokers who want to kick the habit. In 2011, the counseling sessions will be offered under Medicare Part A and Medicare Part B at no cost to interested seniors. Medicare already pays for pharmaceutical interventions and counseling for those who have developed smoking-related illnesses, but did not pay for smoking cessation counseling for seniors who simply want to attempt to quit. Studies show that senior smokers are less likely to try to give up smoking, but those who do try are more successful at quitting than younger smokers.
Research has also shown that counseling is highly effective in helping seniors give up a tobacco habit – even a long-term one. Seniors who undergo smoking cessation counseling are more likely to quit successfully and are more likely to live longer, even after having acquired smoking related illnesses like heart disease.
Only about 10% of seniors are regular tobacco users, compared with 20% of the general population. Despite this, tobacco-related illnesses remain the number one preventable cause of disease and death among Americans. Because many more smokers are not yet Medicare-eligible, the agency expects to see a larger number of smokers and smoking-related illnesses among newly eligible recipients.
Right now, Medicare estimates that about 4.5 million senior Medicare recipients smoke along with another one million disabled Americans younger than age 65 who receive Medicare coverage. The new coverage is part of the Affordable Health Care Act and is extended to all Medicare recipients, regardless of their age.
- December 17, 2010
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