Medicare Advantage Plans, with or without Prescription Drugs Coverage
These policies are evolved by insurance carriers and approved by Centers for Medicare and Medicaid Services. All insurance carriers generally add additional benefits within the policy to make the policy wholesome and easy for you, and ideally include Prescription Drugs coverage making it a one-stop shop. Insurance carriers have the power and advantage of creating networks of service areas of different plans, providers, hospitals, pharmacies, and integration with similar out-of-area networks in 50 states. The coordinated healthcare by networks of providers generates higher volume of business and drives down healthcare cost for you. Not everyone can be happy, but the goals and objectives are noble. When you want to sign up for a Medicare Advantage plan with Prescription Drugs Plan, you must be enrolled in Part A, Part B and Part D with the Medicare.
You may sign up with an insurance carrier for the plan you want to enter into during defined periods of enrollment. Medicare pays premiums on your behalf to the insurance carrier. In addition, you may have to pay additional premium to the insurance carrier you sign up with depending upon the plan you wish to buy. Typically, a Medicare Advantage Plan with Prescription Drugs Plan has following coverage of financial risks:
- The policies have full coverage of defined Medicare Part A, Part B, and Part D.
- Each plan has its defined cost sharing of deductible, copayment, coinsurance, maximum ‘Out-of-Pocket’ expense on annual basis [typically $6,700], and the insurer’s service area where it is available. This combination varies over large spectrum of choices by insurance carriers, and so do the insurance premiums for large variety of plans and their availability in area where you live.
- The Part D coverage is defined for deductible and coinsurance. The levels of expense have its own account depending upon the plan.
- There are ‘add-on’ benefits like basic dental and vision and sometimes-freemembership of fitness clubs and gyms to encourage you to stay healthy.
- The preventive services are free.
- Sharing for drugs’ coverage that is built into the plan generally works similar to cost sharing in stand-alone Medicare Part D plans.
- You cannot combine stand-alone prescription drugs plan with coordinated care Medicare Advantage plan. You can however combine stand-alone prescription drugs plan with a Private Fee for Service [PFFS] or a Medical Savings Account [MSA] plan mentioned below.
Management of Medicare Advantage Plans
All Medicare Advantage plans encourage you to visit the healthcare providers to get services you need to stay healthy. The design of a coordinated care insurance plan derives its name designation from the functional structure of the healthcare providers who accept the insurance health plan structure and contract with the insurance company. The types of plans are listed below:
- Health Maintenance Organization (HMO) plans: In most HMOs, you can only go to doctors, other care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need referral from your primary care physician to see other doctors or specialist.
- HMO Point of Service plans [HMO POS]: This is modification of basic HMO plan that allows limited ‘out-of-network’ care for higher copayment insurance.
- Preferred Provider Organization (PPO) plans: In a PPO, you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. You can go ‘out-of-network’ and pay a little more for the services.
- Private Fee-for-Service (PFFS): PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, and hospital as long as they accept the plan’s payment terms (including your obligation), and above all, accept to treat you except for emergencies. You may buy stand-alone Part D prescription drugs plan if PFFS plan does not include it.
- Special Needs Plans (SNPs): These plans are of special types that are designed for people with special needs who need considerable and well-coordinated medical care. Special Needs Plans serve following groups:
People who are institutionalized in nursing homes or other long-term care facility.
People who are eligible for both Medicare and the Medicaid assistance program [dual eligible].
People with certain chronic diseases, such as heart disease, or diabetes, etc.
If you are eligible and qualified for such plan, you can join any time of the year.
- Medical Savings Account (MSA) Plans: Medicare MSA Plans are Medicare Advantage Plans [Medicare Part C]. These plans are sponsored by private companies and contracted with Medicare [CMS]. An MSA plan comprise of two parts: 1) It is High-Deductible Medicare Advantage Health Plan; 2) It has Medical Savings Account, which is a special type of savings account that you maintain in the selected bank of your choice, and you report its usage to the IRS with your annual personal tax return. Some features of an MSA plan are as follows:
- The Medicare MSA Plan [issuer of policy] deposits some money in your account for your healthcare costs.
- You may use money out of this account for your healthcare costs, including costs that are not covered by Medicare.
- When you use this money to pay for your healthcare costs during the year, it counts towards plan’s deductible for the year.
- If money in this account is exhausted, you pick up costs until you meet the deductible for the year.
- During the time you pay for your ‘out-of-pocket’ for services before deductible is met, you will only pay Medicare-approved charges.
- Money left in account at the end of the year stays in the account, and may be used for future years.
- The money in this account is not subject to taxes.
- MSA Plans do not cover Part D prescription drugs.
- To check on disqualifying eligibility restrictions on such plan before you consider shopping for this plan, call 1-800-MEDICARE (1-800-633-4227). Check if such plan is available at all in the area of your interest.
Medicare – Medicaid Plans: Medicaid is state sponsored health insurance program for low-income people. It has different levels of Medicaid assistance related to your income level. The centralized administration of state Medicaid programs is coordinated by Department of HHS / Centers for Medicare and Medicaid Services [CMS https://www.cms.gov ]. When you are eligible for Medicaid and you become eligible for Medicare, you become dual eligible.
How to Purchase Medicare Advantage Plan
We represent Unitedhealthcare in Florida for its AARP Medicare Advantage plans. If you reside in Florida, please contact us for consultation and quote.