medicare supplements in phoenix az
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.
- July 30, 2016
- azmedicare, centers for medicare and medicaid services, health insurance, Medicare Advantage Plans, Medicare coverage, Medicare Part A, Medicare Part B, Medicare Part D plans, medicare supplement plans, Medicare Supplemental Insurance, medicare supplements in 2015, medicare supplements in phoenix az, prescription drug plans, private insurance plan
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Many of us spend a lot of time trying to understanding the difference between Medicare and Medigap plans. Today, you will clearly get to know the difference between these two. This article will also help you to wisely select your plan.
Basically, Medicare supplement plans are also known as Medigap plans or policies and they can cover some of the costs that original Medicare coverage doesn’t include. Originally, the government provides Part A and Part B of Medicare coverage to all the eligible individuals. However, this Medicare coverage might not fulfill your demands at later stage so you will need to decide at some point whether the traditional coverage is enough for you which is provided by the government or you need some other Medicare supplement plans.
Medicare and Medigap plans are federal healthcare programs which is designed to fulfill the needs and to help senior citizens during their golden years. According to the law, any senior citizen who is 65+ and currently enrolled in Medicare can apply for a Medigap plan. There are about 10 Medigap plans available to choose from. According to the Centers for Medicare and Medicaid Services (CMS), all the Medigap plans have to offer the same coverage plans, regardless of the company which is selling it or where they are located. It means that Plan A and Plan B is exactly the same in all 50 states of America.
In recent years, private Medicare plans have become more popular than the traditional plans. It has been observed that more than 10 million senior citizens has enrolled in the Medicare advantage plans. These plans actually help to combine the physician and hospital services into one package. Before selecting the perfect plan for yourself or your loved one, you need to keep in mind few things.
First of all, if there are no Medicare advantage or supplement plans are available in your region than you will be in traditional Medicare, which is administered by federal government. You can select any doctor who accepts Medicare in the traditional Medicare and you will have to pay deductibles of the cost of care. If you had a Medigap policy, those expenses would have been covered by your Medigap plan. So, a Medigap plan covers a vast variety of treatments which Medicare wouldn’t cover. There are multiple types of Medicare supplement plans.
Most plans such as health maintenance organizations and preferred provider organizations, manage to control costs. Other like HMOs and PPO, which is based on a network of doctors, so you want to make sure that your doctor and the hospital of your choice are involved in the network. You can also ask about the policy for referrals, In case of a PPO, you may want to know how much you have to pay to see doctors who are not on the network. Private plans fee-for-service provides more choice because they are not allowed to have a network of doctors and hospitals.
Sometimes, Medicare supplement plans have extra benefits like eye exams, dental care and hearing coverage. For many people, this coverage doesn’t seem to be enough, and this is where private insurance, such as Medicare Supplement plans come in. These plans may offer coverage of health services not covered for Part A and Part B. To participate in a Medicare Supplement plan a beneficiary must be enrolled in Part A and Part B, live in the state where it is offered, and generally be over 65 years. But you must make sure you understand each and every point of the Medicare advantage plan you will be selecting.
One benefit of Medigap plans is that Medigap policies are renewable, as long as you pay your monthly fees and your insurance company doesn’t go bankrupt, you cannot be dropped from your plan. Medicare has a small network of doctors, but Medigap provides access to an extensive network of doctors. In short, Medicare is designed for those on a tight budget and if your pocket allows you then you have to go Medigap.
According to the latest research, Medigap plans are usually more expensive than Medicare Advantage plans. Medigap offers a variety of supplemental insurance to Medicare, while Medicare coverage and Medicare Advantage are almost identical. Furthermore, you also need to keep in mind that if you travel a lot or migrate yearly as per job requirements or you live in an area where there are lack of medical facilities, then you must go for a Medigap policy. No doubt, there are other ways to supplement your Medicare coverage but Medigap offers the best flexibility.
With Medigap, you are free to receive care from any hospital and any doctor which accepts Medicare. If you have a need for vision or dental benefits, then you will also have to buy Medicare supplement plans for that which will be covered by your Medigap policies. Now that Medicare Part D is also here, so all Medigap plans which used to offer prescription drugs are being phased out.
Last but not the least, if you have signed up for a Medigap plan but you later realized that it wasn’t right for you, there’s no need to worry because as long as you make that discovery within a month of coverage, you can cancel the coverage for a full refund.
For Arizona residents who are confused about which plan to choose, visit www.azmedicare.info for all the details and help on Arizona Medicare Supplement plans.
- July 30, 2016
- Arizona Medicare Advantage plans, azmedicare, health insurance, medicare, Medicare Advantage Plans, Medicare Part A, Medicare Supplemental Insurance, medicare supplements in 2015, medicare supplements in phoenix az, prescription drug plans
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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.
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.
- July 30, 2016
- AARP, az medicare, azmedicare, centers for medicare and medicaid services, gap, Kaiser Family Foundation, Medicare Advantage Plans, Medicare Part C, Medicare Part D plans, Medicare Supplemental Insurance, medicare supplements in 2015, medicare supplements in phoenix az
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In Arizona, medical beneficiaries who are in need of help for paying Medicare expenses must consider enrolling in a Medicare Supplement Plan known as Medigap Plan. It must be noted that Medigap plans are available through private insurance companies, not only in Arizona but in every state across U.S.
Medigap plans generally help with the expenses which are incurred under original Medicare plans which are Plan A and Plan B. Medigap plans are now almost same across all of the United States in terms of both policies and cost. For those of you who are not sure about the number of Medigap plans, just know that there are 10 standardized Medigap plans available in all of the states. The plans are labelled from A to N where Plan A and Plan B are the most basic plans which every state offers under the rule of federal administration.
If you are already enrolled original Medicare Plan A and B, then you are eligible to sign up for Medigap Plans. Not many people know but the best time to buy a Medicare Supplement plan is during the Medigap Open Enrollment Period. This period starts as soon as you reach the age of 65 and is also enrolled in Medicare Plan B. Individuals can sign up for any Medigap plans during this time according to the plans available in their state. The important thing to keep in mind is that there are no additional enrollment periods besides each of theirs Medigap Open Enrollment Period.
In Arizona and across all of the United States, Medigap plans doesn’t include prescription drug coverage, so you have to enroll in a Part D plan for prescription for separate Medicare to cover the cost of medicines or drugs. Prescription drug plans for Medicare Part D in Arizona are available through private insurance companies.
It has been observed through the survey that Arizona is the most famous destination to retire. Surprisingly, above a million residents of Arizona are dependent on the Medicare for their main source of health insurance.While no revolutionary changes in Medicare supplement insurance is scheduled for 2016, there are some things to keep in mind which may affect the safety and availability of certain plans.
Here is the possible increase in premiums and Part B deductible. For example, Plan C, Plan F, and high deductible Plan F covers Part B deductible, so if the increased rates for these popular supplements may also increase. In Arizona, all the Medicare Supplement Plans must conform to the standards set by the Medicare Organization. Supplement standards include names from A to N. Each supplement offers basic benefits like coinsurance and blood donations. The only thing to remember is that every supplement is identical from one or another insurance company. In order to determine rates, you must compare different insurers providing Medigap plans however there should not be a big difference because of the Arizona Medigap Policy. It is important that you familiarize yourself before with the Medigap plan as well as each and every plan before you make any purchase.
Supplement Plan F is the most comprehensive among the 10 other plans, covering almost 100 % of Medicare related costs. But even for Medicare Supplement Plan F recipients in Arizona can still incur some out – of -pocket expenses such as Medicare Part B premium.
As soon as you reach the age of 65, you need only a phone call to buy Medigap policy and get excellent coverage without question. And if you buy a policy in the first six months of enrolling in Medicare, you do not have to answer questions about your health. Do not worry if your doctors are not in the network, because you will be covered if you see any doctor who accepts Medicare.
Many people don’t realize the fact that how much they will be spending if they will be selecting the plan which covers the entire Medigap plans. There are total of 10 Medigap plans and each one has its own benefit. The four most comprehensive plans are C, D, F and G which account for more than 60% of all the Medigap sales according to Kaiser Family Foundation research. Plan F, the most expensive among all of them and covers every Medicare gap represents 40% of all policies sold. If your health is good than you must consider a plan which is not much comprehensive for e.g. Plan N and L are good choices because they will save you around $200 to $400 a year.
Medicare and Medigap benefits are identical in all 50 states, however policies and pricing rules may differ (Massachusetts, Minnesota and Wisconsin have their own standardized plans). If you know the rules in your state, this may save you money. You can choose when to upgrade an existing plan to switch to another insurer or drop your current Medicare plan during the annual open enrollment to change Medigap policies.
Most of the people become eligible for Medicare when they turn 65, although some beneficiaries can get Medicare even before if they have some kind of disability. You will automatically get Medicare as soon as you turn 65 if you are already receiving Social Security benefits. Otherwise, you will have to enroll in Medicare during the enrollment period.
There are also many private Medicare options available if you are a Medicare beneficiary in Arizona. Medicare coverage like drug prescription and supplemental coverage are only available through private insurance companies. Your private Medicare options will depend on where you live and the plans available in your area. We hope you found this article helpful as we shed light on Arizona’s Medigap policies. If you are an Arizona resident, feel free to contact www.azmedicare.info for further details.
- July 27, 2016
- Arizona Medicare Advantage plans, centers for medicare and medicaid services, MA PLANS, medicare, Medicare Advantage, Medicare Advantage Plans, medicare az, Medicare beneficiaries, medicare supplements in phoenix az, Medigap plans, Part D plans, prescription drug plans
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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.
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.
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
- AARP, health care, health insurance, Kaiser Family Foundation, Medicare Advantage Plans, Medicare Supplemental Insurance, medicare supplements in 2015, medicare supplements in phoenix az, Part D plans, PDP, prescription drug plans, prescription drugs
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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.
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.
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.
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:
- 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.
- 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.
- 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.
- 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.
- 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.
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.
There are situations and unfortunate circumstances in life when the choice of hospital is beyond our control. This primarily refers to the (hopefully unlikely) event of a health emergency. However, if you are planning elective surgery or arranging treatment for a specific health condition, it is well worth the effort to ‘shop around’ for a hospital that best addresses your particular needs. If you are using or considering one of the various Medicare supplements in Phoenix AZ, you should also take this factor into account during your search for a good hospital.
Types of hospitals
There are many different types of hospitals, based on funding, size, range of services, patient age etc. In the broadest sense, hospitals can be divided into two main categories – public and private hospitals.
As the name implies, public hospitals are funded by state and federal funds. They are obligated to treat everyone, regardless of their financial status. Public hospitals have long waiting times and offer less personalized care, mainly due to the large patient load.
On the positive side, public hospitals are usually bigger and more affordable. Furthermore, since they have to accept all patients, their medical staff has the opportunity to treat a great variety of conditions (regardless of the symptoms), which significantly adds to their expertise and experience, and hence the ability to handle even the most serious of cases.
Private hospitals are nicer looking and better equipped. The waiting times are much shorter and the staff is usually more attentive. However, these hospitals are more expensive than their public counterparts and often accept only certain types of medical insurance. Although private hospitals reserve the right to refuse treatment on financial grounds, they are still obligated to accept emergency cases.
Non-profit hospitals are founded or operate (or both) under the patronage of charitable, usually religious organizations. In contrast, for-profit hospitals are commercial entities, owned by corporations or individuals.
Safety-net hospitals provide a significant level of charity care to low-income, uninsured and vulnerable populations. These hospitals receive supplemental funding from governmental agencies to offset the under-reimbursed care.
General hospitals treat a broad range of common medical conditions. Specialized hospitals are dedicated to treating specific conditions (cardiovascular, oncological, psychiatric) or specific age groups, such as pediatric hospitals focusing on children care or geriatric hospitals which address the medical needs of the elderly.
Teaching hospitals are best equipped to treat a full range of complex conditions, in terms of staff, technology and subspecialty services. Due to their affiliation with medical schools, patients can benefit from cutting-edge treatments, provided by distinguished, highly-skilled medical experts.
Factors that influence your hospital choice
Your choice of hospital will depend on your healthcare needs, your budget and your healthcare insurance plan. Talking to your doctor about your options is a good place to start. Doctors are uniquely positioned to suggest the best hospitals and specialists for your condition and advise you on the type of hospital you should choose – a specialized hospital, a community hospital, or perhaps an academic medical center involved in research or clinical trials related to your condition.
Keep in mind that your choice of hospital can depend on where your preferred doctor has admitting privileges. Don’t forget to ask your doctor if you will require post-discharge care and where this care can be provided. Also, check the hospital reputation, as it is a good indicator of the quality of staff and services. It’s helpful to know the number of nursing staff in the hospital to make sure you’ll be well taken care of.
Ways to obtain information on hospital quality
In an effort to empower patients and assist them with their healthcare decisions, the Centers for Medicare & Medicaid Services (CMS) periodically release data on the quality of care provided by hospitals, physicians and other healthcare professionals, including patient well-being and updates on the management of specific conditions, such as diabetes and cardiovascular care.
The data also includes updates on HACs (reasonably preventable Hospital-Acquired Conditions, including central line-associated infections, catheter-associated urinary tract infections and pressure ulcers) in the scope of the HAC Reduction Program. In an effort to encourage hospitals to reduce HACs, their performance is rated (1 to 10). The higher the score, the worse the performance.
You can use the browsing tools available on the Medicare website (Medicare.gov) to search and compare hospitals, physicians and other healthcare professionals. Using the hospital compare tool, you can browse over 4000 Medicare-certified hospitals by name, city, state and zip code. You can review information on the quality of care or check the results of patient surveys to see how people rate the services of certain hospitals.
Similarly, you can use the physician compare tool to browse physicians and other healthcare professionals enrolled in Medicare, as well as their primary and secondary specialties.
Medicare supplements in Phoenix AZ and your hospital stay
When planning a hospital stay, it’s essential to know what your insurance covers, so you can avoid unpleasant surprises when the hospital bills come. Here’s what you should check with your provider:
a) if the hospital of your choice is included in your plan’s network,
b) if you need their authorization before you’re admitted and
c) if you are required to choose from a list of approved hospitals or doctors.
One thing to remember is that even if the hospital is in the network, the doctors practicing there may not be part of it.
Beneficiaries of Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are entitled to the full range of Medicare-covered hospital services. Medicare covers expenses such as semi-private accommodation, meals, nurse services, medications and other essential hospital services and supplies during your inpatient stay.
If you are using Medicare supplemental insurance (Medigap) or Medicare Advantage (an alternative to the traditional Medicare), it will protect you against excessive costs, such as deductibles and copays in cases of accidents or serious illnesses.
Keep in mind that Medigap and Medicare Advantage are mutually exclusive, meaning that you cannot use both, and it is illegal for insurance companies to provide you with both options.
As you get older, health insurance becomes an undeniable necessity, regardless of current health status. Medicare, the national health coverage system managed by the US federal government primarily addresses the insurance needs of senior citizens and the disabled. Its coverage however is limited, hence many Medicare beneficiaries opt for some form of additional health insurance. If you are looking for a plan that addresses your health insurance needs more comprehensively, consider the different Medicare supplements in Phoenix AZ.
What is Medicare?
Medicare is a nationwide health coverage program available to US citizens 65 and older, people receiving disability insurance and people suffering from specific conditions (end-stage kidney disease and Lou Gehrig’s disease).
Medicare is a four-part program. Parts A and B are referred to as Original Medicare. Part A covers costs of inpatient care in hospitals, skilled nursing or rehab facilities, whereas Part B covers outpatient and preventive care, doctor visits, ambulance services etc.
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare. To join, you must have Medicare A and B. Medicare Part D is available as a standalone plan and covers prescription drug costs. Parts C and D are optional and are offered by private companies.
What is not covered by Original Medicare?
Original Medicare doesn’t cover cosmetic surgery, health care outside the US, hearing aids, long-term care, most types of eye and dental care, non-emergency transportation and prescription drugs (with the exception of immunosuppressants and oral anticancer drugs). Also, policyholders need to pay the deductibles, copays and coinsurance required by Medicare.
To cover medical expenses not included in Medicare, a majority of Medicare users have some kind of supplemental health insurance, including employer or military-based coverage, Medicaid (government insurance for low-income families) or some of the different private options – Supplemental Insurance for Original Medicare (known as Medigap) and Medicare Advantage.
Choosing Medicare supplements in Phoenix AZ
When it comes to supplemental health coverage, people tend to confuse Medigap and Medicare Advantage, despite their significant differences. Medicare Advantage (Medicare Part C) replaces your Original Medicare. It is supplied by private insurance companies, which provide the full range of Part A and B benefits, under contract with Medicare.
To join Medicare Advantage, you must have Medicare Part A and be eligible for Medicare Part B. Medicare Advantage comprises several plans with different benefits. Most of them cover prescription drug expenses.
How does Medigap work?
Unlike Medicare Advantage, Medigap complements Original Medicare. As the name suggests, Medigap is designed to fill in the coverage gaps in Original Medicare. This includes copays, coinsurance, deductibles, health care abroad and hospice expenses (palliative care for the seriously ill).
To buy Medigap, you must have Medicare Parts A and B. You can’t buy Medigap if you already have Medicare Advantage, but you can drop the latter and apply for a Medigap plan before your Medicare Advantage coverage expires. Medigap plans don’t cover long-term care, eye or dental care, hearing aids, eyeglasses, or private nursing care.
When to buy a plan
The best time to buy a plan is during the open enrollment period. This term describes a six-month period that starts the first day of the month you turn 65, during which insurance companies are obligated to sell you any of the 10 Medigap plans, irrespective of your current health status or past medical history.
If you miss this opportunity, you may still buy a Medigap plan, but the insurance company has the discretion to reject you on health grounds through a so-called medical underwriting process. This is a process where the insurance company uses your health information to decide whether or not to sell you a policy.
You can cancel your Medigap by asking your provider to terminate your plan and send you a confirmation. However, your provider cannot cancel your policy as long as you pay your premiums on time, regardless of changes to your health. This is known as guaranteed insurability.
As of January 1, 2006, Medigap policies do not offer prescription drug coverage. For this purpose, you can buy Medicare Part D (Prescription Drug Plan) available through private insurers.
Medigap plans at a glance
Medigap comprises 10 standardized plans, offering different levels of coverage. Standardized means that regardless of the insurance provider or the location, the benefits offered by the 10 plans will be the same. In accordance with federal law, all Medigap plans have to be labeled “Medicare Supplement Insurance”. Each of the 10 standardized plans is designated by a letter (A, B, C, D, F, G, K, L, M, and N).
However, although the plans offered by different providers are standardized, the costs are not. This means that different insurance companies charge different premiums for the same policy, so make sure you do some research before making a decision. In Arizona, people can choose from all 10 Medigap plans. More than half of policyholders opt for Plan F, followed (albeit not closely) by Plans C, B and D.
Despite coming at the highest cost, Medicare Supplement Plan F is the most popular choice, due to its comprehensive coverage. Plan F covers 15% in excess of the Medicare-approved costs, leaving the policyholder with zero additional costs after Medicare has paid its share.
Plan C is the second most comprehensive plan. This plan doesn’t cover Medicare Part B excess costs. Both F and C don’t cover post-discharge expenses i.e. home recovery costs (drugs, rehab, medical supplies etc.).
No matter which option you choose, supplemental health coverage will significantly lower your medical expenses not covered by the traditional Medicare policy. Just keep in mind that after you choose your plan, you will also need to carefully choose the insurance company, since providers differ in the packages, premiums and coverage they offer.
Also, remember that the least expensive policy is not necessarily the best choice. Your health can change considerably in the future, actually making your currently affordable policy the most expensive one tomorrow. In any case, both Medigap and Medicare Advantage have annual memberships, which gives you the opportunity to change your mind and your plan once a year.