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Medicare Advantage Plans

What Really Is a “Medigap” Plan?

Many people confuse the term “Medicare Supplement Plans” with “Medigap Plans”. It should be noted that Medicare supplement plans fill in some gaps in coverage in original Medicare which is known as “Medigap”.

There are 10 standardized Medigap plans available for senior citizens, each marked with the letters A to N.  And these plans are only available through private insurance companies, and it is not necessary for the insurance companies to sell all the 10 Medicare supplement plans. Every insurance company selling Medicare Supplement policy have to offer at least Plan A and if they offer any other policy than they must also offer either Plan C or Plan F.

Please note that Medicare Supplement plans can be used only to pay Original Medicare expenses. These plans can be used to cover expenses that you may have in Part C Medicare. If you enroll in Medicare Advantage plan, you can keep your Medigap plan as long as you keep paying the monthly fee, but you will not be allowed to enjoy Medigap plans on the cost of Medicare advantage plans. There are few things that you need to keep in mind before going for Medigap plans.

First and foremost, the beneficiaries must be enrolled in Medicare Plan A and Plan B. Secondly, if the beneficiary has a Medicare advantage plan than they can apply for Medicare policy and you will have to leave Medicare Advantage plan before you can enroll in Medigap. These Medigap policies are only able to cover one person. If anyone from your family want to avail then they will have to enroll themselves.

Monthly premiums will have to be paid to private insurance companies in addition to monthly Plan B premium. You are not bound by any insurance company, you can select any insurance company you like that is licensed in your state. Each standardized Medigap policy is guaranteed renewable, even when suffering from health problems. This means that the company cannot cancel Medicare Supplement insurance contracts as long as you pay the premiums. Medicare supplement plans allow you to use any provider that can accept Medicare. Among all the states of America, Arizona is considered as one of the best places to live after retirement. Arizona provides the best Medicare and Medigap help to senior citizens.

There are two specific Medigap plans (Plan k and Plan L) which are capable of covering out of pocket limits, because once your basic health care costs reaches the limit, your Medigap plan will cover 100% of all the expenses for the rest of your year. It is worth mentioning that original Medicare don’t have the ability to include a yearly out of pocket limit. Remember, Medicare supplement plan is meant to work side by side with your original Medicare coverage. You only need to remain enrolled in original Medicare to take the benefits of Medigap.

Although private insurers are required to offer the same benefits for each Medicare plan, these companies can change the costs of premiums they charge for this coverage. So if you are looking for Medigap coverage, you must contact different insurance companies to find a Medicare Supplement plan that is appropriate for your medical and financial needs. Remember that insurance companies use different methods to price their Medigap plans. Pricing method that company uses may affect the amount of premium you pay when you first enroll in a Medicare Supplement plan, as well as your long-term costs.

Medigap can be used only by people enrolled in traditional Medicare only. It is not a Government-run program but you can buy private insurance to cover some or most of your expenses in traditional Medicare. Medicare advantage plans consist of variety of private health plans for every type of needs. HMOs and PPOs are the most commonly used among the beneficiaries. Most of the plans include drug prescription coverage at no extra cost. Some plans are capable of covering routine hearing and vision services but not all. By law, all plans have annual limits for out-of-pocket costs.

Another difference from the traditional program is that most plans require you to go to the doctors and hospitals within their network and if you want to go out of the network, you will have to pay extra.

If you enroll in Medicare Advantage health plan, you can’t use a Medigap policy to cover your expenses, and it is illegal to sell insurance Medigap policy if you are enrolled in a Medicare Advantage plan. If you want to stay in traditional Medicare, you will need a separate Part D plan to get prescription drug coverage and pay an extra premium for it. A Medigap does not cover drugs outputs of- pocket.

Some states even offer Medigap plans for beneficiaries under 65 years of age who are eligible for Medicare because of disability or under certain conditions. Federal law doesn’t allow states to sell Medicare Supplement insurance for under 65 years, but depending on where you live, some states offer Medigap coverage for beneficiaries under 65 years of age. Every state can have its own eligibility criteria and terms. If you are a Medicare beneficiary under 65 years of age and interested in purchasing a Medicare Supplement insurance, contact your state insurance department to find out if you qualify for Medigap coverage in your state or not.

Select the Best Medicare Supplement Plan for Yourself

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.
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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.

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.

Shedding Light On Arizona’s Medigap Policies

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.
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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. 

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.

Arizona Medicare Advantage Plans

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.
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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.

Medicare Advantage Premiums To Decrease For 2011

In something of a surprise announcement, Donald Berwick, Director of the Centers for Medicare and Medicaid Services, says that premiums for Medicare Advantage plans will decrease slightly in 2011. Berwick says that the monthly costs for MA plans for more than 11 million enrollees will drop by about 1%. In addition, enrollees should see some relief from the cost of prescription drugs and the continuation of certain no-cost preventative health care services.

In 2009, premiums for Medicare Advantage plans increased by an average of 15%. Berwick and other Medicare officials say that the health care reform act has provided the Medicare and Medicaid Service with additional negotiating power. Initially, officials used their newfound clout to drop about 300 previously approved Medicare insurance plans offered by private providers. According to Medicare officials, the rejected plans increased out-of-pocket costs without increasing benefits or covered services.

Most of the insurers then modified the plans to provide additional services at reduced costs. Upon reconsideration of the new offers, Medicare approved most of the 300 rejected plans. Fewer than ten of the original 300 rejected plans did not modify their initial proposed coverage, improve their benefits or reduce beneficiaries’ proposed out-of-pocket expenses. Upon review, these plans were rejected a second time and will not be offered in 2011.

Some analysts say that insurance providers are more willing to negotiate with Medicare because they are more dependent now upon Medicare premiums than they had been in the past; a large number of new enrollees are expected in the next decade; and the new health care legislation will open new opportunities for providers in the coming years.

Seniors who have elected Medicare Part D (prescription drug coverage) can also expect to see some decreases in their out-of-pocket expenses if they have significant prescription costs in 2011. The relief comes as part of the Obama Administration’s effort to eliminate the “donut hole” gap in Medicare prescription drug coverage. Reduced out-of-pocket expenses for Part D benefits will not translate into lower Part D premiums, however. Part D premiums are expected to rise in 2011 for most prescription drug plans.

How Good Is Your Medicare Health Insurance Coverage?

Medicare health insurance is generally designed to offer some coverage for hospitalization and routine health care, but it does not offer complete coverage for most services. In some cases, health care services you may need or want might not be covered at all, or may be covered only in limited circumstances.

Another consideration for Medicare beneficiaries is that not every health care provider accepts Medicare insurance. There is no requirement that doctors or hospitals accept Medicare. Many do, however based on recent and proposed changes in Medicare payment to providers, some doctors and hospitals are limiting the number of Medicare patients they’re accepting, and some providers have said that they will no longer accept Medicare.

When you enroll in Medicare, it’s important to decide how much you want to stay with your current doctor(s), hospital and/or pharmacy. Don’t make assumptions about your health care providers. You may need to ask each provider you see whether or not s/he accepts Medicare. If your provider does not accept Medicare, you may need to ask for a referral to another provider who does accept Medicare, or cover your health care costs from that provider out-of-pocket.

If you’re enrolled in traditional Medicare Part A and Part B, you can choose your health provider. Assuming your provider accepts Medicare, you can see the doctor(s) you want to see and receive services at your choice of hospitals that participate in the Medicare insurance program.

If you’re enrolled in a Medicare Advantage plan, you may have to choose your doctor(s), hospital(s) and pharmacies based on a list of participating providers who have been approved by your Medicare Advantage plan provider. In this way, Medicare Advantage plans are much like a health maintenance organization (HMO). If you choose to go out of your Medicare Advantage provider network, you could end up paying most or all of the costs associated with your care by yourself.

In short, not all health care providers accept Medicare, and not all services are covered. With traditional Medicare Part A and Part B coverage, you can purchase additional Medicare Supplemental Insurance to fill in some of the coverage gaps. With Medicare Advantage plans, some of these gaps are already filled in, but you may pay extra premiums with these plans, or you may find a limited network of health care providers whose services are covered by your Medicare Advantage plan.

Medicare Advantage Plan v. Medicare Supplement: Which One Is Right?

Medicare InsuranceIf you are new to Medicare, or will be joining the ranks of the Medicare-eligible in 2011, you may not know much about Medicare, Medicare Advantage Plans and Medicare Supplemental Insurance, also known as Medigap.  In addition, you’ll probably want to take a crash course in Medicare Part D plans, just to be on the safe side.

Traditional Medicare coverage is designated as Medicare Part A and Medicare Part B.  Part A coverage, which pays for hospitalization, has no additional premium, provided that you are age-eligible for Medicare.  Part B coverage has a premium attached to it. In 2010, the monthly premium was about $111, and is deducted from your monthly Social Security check, Railroad Retirement or Office of Personnel Management payment. If you receive none of these payments, you’ll get a quarterly bill in the mail for your Part B premiums.

You can choose some other Medicare options, including a Medicare Advantage Plan (Medicare Part C), an optional Medicare Part D plan for prescription drug coverage, and a range of Medicare Supplemental Insurance plans, collectively known as Medigap insurance.  Medicare Advantage plans take the place of Medicare Part A and Part B coverage and operate much like an HMO plan does.  Medicare Advantage plans generally offer some additional coverage that traditional Medicare plans do not.

You may also be required to enroll in a Medicare Part D plan if you choose to go with Medicare Advantage coverage.  With Medicare Advantage, you’ll still pay your Medicare Part B and Part D premiums. You may also have to pay additional premiums for a Medicare Advantage plan, depending upon the level of coverage you choose.

You can also choose to enroll in one or more Medicare Supplemental Insurance plans. Medigap plans are designated by letter (e.g., Medigap A, Medigap B, etc.) Each letter plan offers a different level of coverage but all Medigap letter plans are the same, regardless of the insurer that provides them. For example, all Medigap A plans have identical coverage; all Medigap B plans also have identical coverage, etc.) Insurers are not required to offer all Medigap insurance plans, and the premiums among insurers can vary.

Medigap supplemental insurance is designed to provide coverage for certain services that Medicare Part A, Part B and/or Part D don’t pay for, or don’t cover completely.  To take advantage of a Medigap insurance plan, you must be enrolled in both Medicare Part A and Part B. You will pay additional premiums for these services to a private insurance provider, and the additional insurance is strictly optional.  Many Medicare beneficiaries choose not to buy supplemental coverage either because they don’t need it or can’t afford it. Also, each recipient must have his or her own Medigap plan. Your Medigap insurance will not provide benefits to your spouse.

Since each beneficiary’s situation is different, your best strategy is to read all information about Medicare prior to enrolling in a plan. When you become eligible, you will receive a Medicare information booklet in the mail. This document has all of the basic information you’ll need about Medicare. You can also visit the Medicare Web site if you have Internet access to find out more information about Medicare coverage, Medicare Advantage plans and Medicare Supplemental Insurance.

Choose the insurance options that offer the best combination of coverage and cost, based on your income, your current health, and the coverage you’re likely to need in a given year. As you age, you may want to review your coverage and make changes to meet your evolving health needs.

Medicare Proves To Be Driving Issue In Midterm Elections

Planned cuts to Medicare spending are driving senior citizens to rethink their support of some candidates in the November election. Republicans wasted no time in trumpeting the fact that Democrats have “cut $500 billion from Medicare.” In reality, the plan calls for a reduction in the increase on federal Medicare spending. The increase has been trimmed from 6.8% to 5.5% annually.

Does this really translate into cuts for Medicare? Overall Medicare spending is expected to reach nearly $1 trillion by 2020. Currently, the federal government spends about $520 billion on Medicare annually. Over the next decade, the cuts will reduce anticipated Medicare spending from $7.6 trillion to $7.1 trillion, but annual spending on Medicare is still expected to increase.

The annual increases are due in part to the number of newly eligible Medicare beneficiaries. As the number of eligible seniors increases, more money must be made available to cover new participants in the program. Some participants will also be covered by private health plans, so seniors may actually receive better coverage.

Where are the reductions coming from? Right now, seniors are most likely to see reductions in coverage or coverage options if they’re enrolled in a Medicare Advantage program. New rules prevent health care insurance organizations from offering multiple plans that substantially duplicate each other. Instead, the number of Medicare Advantage plans will be reduced, as will some benefits.

This reduction in Medicare Advantage benefits is designed to equalize government spending on persons enrolled in traditional Medicare and those enrolled in Medicare Advantage programs. Seniors enrolled in Medicare Advantage plans may be able to keep some of their benefits (like vision, dental care and some preventative health benefits) by paying higher premiums than they have in the past.

The new regulations on Medicare Advantage plans will take effect January 1, 2011. Seniors who are enrolled in a Medicare Advantage plan that is being withdrawn must choose new Medicare coverage during the Open Enrollment period to maintain Medicare coverage.

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