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Texas Medicare insurance should be easy. Get the help and benefits you deserve today.

Archive for November, 2012

Disabled on Medicare Have Fewer Options

Thursday, November 29th, 2012

When you hear the term Medicare most Americans think of seniors, older folks or anyone over 65 but did you know that a large percentage of people on the government Medicare rolls are made up of those Americans that are under the age of 65? These younger folks are on the government insurance rolls due to an illness or accident and have been declared disabled by social security.

Well if you are one of these underage recipients of the Medicare what are you to do for extra coverage? You could go without any form of additional coverage although that’s probably not very wise, you could select a traditional Medigap supplement plan but Texas law only requires Plan A to be offered and lastly you could select a Medicare Advantage plan.

Medigap Supplements
Since we have discussed doing nothing was not such a wise decision lets discuss the two options that provide some additional coverage and benefits. First the Medigap policy, also referred to as a Medicare Supplement Plan are offered in 10 different “flavors” or plan types labeled Plan A thru N. Well, Texas law only requires Plan A to be offered to those on early age Medicare disability and this plan is what we consider the bottom of the supplement food chain, this plan does not provide benefits for either Part A or B deductibles and the monthly premium runs around $250 a month or more and will be subject to steady rate increases. Selecting this option will also mean you will need to secure a Part D prescription drug plan with more additional cost.

On the positive side it does give you the freedom to go to any doctor of hospital that takes Medicare but that freedom will cost you an arm and a leg. Most people on disability and early age social security just don’t have that kind of cash lying around to pay this heavy insurance nut. But hope is out there in another option.

Medicare Advantage Plans
Medicare Advantage plans
are also an option for these early age disability beneficiaries. With most plans offering low to zero plan premiums in addition to your Part B medical insurance premium. This number is obviously more affordable than the typical supplemental plan and some of these advantage plans also provide Part D prescription drug coverage, kind of an all in one plan with little or no monthly plan premium.

The advantage plans have copays for most medical treatment instead of deductible and you may find you pick up other added benefits like vision, dental and hearing benefits. Some MAPD plans offer free membership in your local gyms and fitness centers thru the SilverSneaker program. All in all you get both Medicare A and B coverage and other value added benefits. All advantage plans have a set maximum out of pocket the member would incur so there will be limits on how much you will spend on copays and such yearly.

Now the drawbacks on these plans, some imaginary due to politics and some legitimate are simple in our mind, its called networks. Medicare advantage HMO plans do require you to receive regular treatment from inside the provider network and most require the selection of a primary doctor that gives referrals to specialist. Emergency care is a different story regarding where you can seek treatment but normal routine care must be delivered from network providers. You can also entertain going the PPO route which have far less restrictions related to who you can and can’t see for medical treatment but you may find your out of pocket maximums increase over their HMO counterparts.

Overall we feel the Medicare Advantage route may be your best option if you are what we call early age Medicare due to a disability. For more information on these plans just call and ask for additional information on Medicare Advantage plans today.

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2013 Medicare Changes Come as a Shock to Many Seniors

Thursday, November 22nd, 2012

Well, well… Election time is over and conveniently the federal government released the Medicare plan changes for the 2013 year. I think some were good and others not so much. We will take a look at the new changes below.

Part B Premium Increased
Let’s start with the most asked about first: the Part B premium. As a refresher the Part B premium is the amount for your medical insurance portion of Medicare mostly for outpatient things like doctor visits, lab work and testing. The premium increased to $104.90 a month up from $99.90 last year. Now you rich folks will always pay more for your part B and this year some of the upper income earners got creamed fairly hard but for most seniors your premium went up 5 dollars a month, not all that bad but any increase is still hard to work around on a fixed income.

Part B Deductible
The Part B deductible, or the amount a Medicare recipient pays for outpatient services also increased this year but the amount was nothing to be alarmed about. It went up $7 a year to $147. This increase was well below what some were expecting and still very manageable considering just a few years ago it stood at $162 a year. Also, if a senior is on a Medicare Advantage plan or Plan F if they have a Texas Medigap policy they never see the Part B deductible anyway so overall this is no big deal.

Skilled Nursing Care
The copay for skilled nursing care increased by $3.50 a day for more than 20 days in these types of facilities, again nothing that earth shattering. Also, most Medigap plans will handle this increase and you will never see it.

Hospital Inpatient Stays
The hospital inpatient copay also increased for days 61 thru 90 by 7 dollars, up to $296 for the upcoming year. Days 91 and beyond was jacked up by 14 bucks to $592 a day but again if you have a Medicare Supplement plan you should be insulated from this increase.

Part A Deductible
Another important one is the Part A deductible. This benefit increased from $1156 per benefit period to $1184 per period. This one is important because if you didn’t know it the deductible is per benefit period… not calendar year like most of us are used to so in theory a senior could get spanked with more than one deductible a year. Again, Medigap plans F and G will keep you from ever seeing the Part A deductible, Medicare Advantage plans also do the same for their members.

Overall I think it’s about what we expected and now we can move on to 2013 knowing exactly where we stand as it relates to Medicare beneficiaries potential out of pockets and premiums for the upcoming year. If these changes are just to much to handle for the next year and you feel a Medigap plan will keep you away from these increasing cost give us a call to review your current insurance situation. Protecting your nest egg is our only goal.

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Medicare Advantage PPO Plans in Texas

Sunday, November 11th, 2012

Medicare Advantage PPO plans work very much in the same fashion as HMO in that there is a network of providers and doctors and a maximum yearly out of pocket. There are a few differences in PPO plans in that generally the out of pocket is higher as well as co pays are slightly elevated over their HMO counterparts. Also, PPO offerings may have a deductible involved but the advantage is the addition of more doctors and hospitals in the plans network.

These plans may or may not have a plan premium whereas several more of the HMO types hove none other than your normal Part B premium to Medicare. Also there will be both an in network out of pocket and an out of network out of pocket if you choose a provider not in network. The out of network providers must agree to accept the terms and conditions of the plan in order to get covered treatment; generally look for providers that accept Medicare on assignment.

MAPD PPO plans also include your drug prescription coverage better known as Part D coverage, easing the hassle of searching not only for an advantage plans but also a Part D plan.

PPO plans work great in some counties where the HMO network of providers may be “thin” in the sense the network is not strong on doctors and hospitals. They also fit nicely for the Medicare beneficiary that just doesn’t like the structure and potential restrictions of an HMO.

Value added benefits like the Silversneaker gym program, dental, vision and hearing coverage are generally included in these plans just like the HMO offerings so you do pick up lots of nice extras over and above you normal medical care. Also,PPP plans are offered by private insurance companies that have contracts with Medicare and you will still have Parts A & B coverage however you will receive your care through the private insurance company.

Since most PPO Advantage plans have little to no plan premium other than your normal Part B premium they make an excellent choice over traditional Medigap or supplement plans that have not only a monthly premium but you will also have your Part D drug premium.

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Medicare Advantage HMO Plans in Texas

Saturday, November 10th, 2012

Medicare Advantage Plans come in several types, HMO, PPO and PFFS plans are some of the more common availiable but far and away the most common plan here in Texas is the HMO variety. Our state is blessed with several very large population centers likeDallas, Ft.Worth and Houston that these plans can build large doctor and hospital networks therefore providing members and potential members huge provider choices. Some of the best facilities in the nation like Baylor Hospital and Medical City in the DFW metroplex and now in HMO Advantage Plan networks making life easier for those on Medicare.

So, what is an HMO Medicare Advantage plan? Simple, they are plans provided by private insurance companies with a contract from Medicare to provide your health care benefits. The plans must provide at least the same benefits as Part A and B of Medicare and generally offer additional benefits like gym memberships and discounts, dental, vision and hearing benefits not normally offered by traditional Medicare.

Benefits of Lower Plan Premiums VS. Supplements

These plans all have pre set maximum out of pockets and most require co pays for things like doctor visits and hospital stays. Theses co pays make things easier on seniors as small co pays generally add up to a far lower amount as compared to the monthly premiums you would pay for a Medicare Supplement policy. Some Medicare Advantage HMO plans have a zero plan premium; however you will continue to be responsible for your normal Part B premium.

Some HMO Advantage plans also include your Part D Prescription Drug coverage so you can also benefit from not having an additional Part D Plan premium. It is also a good idea to check and see if your drugs fall within the plans formulary listing to enjoy maximum benefit. Once again, no Part D premium equates into potentially lower monthly premium cost.

Draw Backs of Doctor Networks

Now, with the good you have to take into account the bad. Medicare Advantage HMO plans require you to only use doctors and providers in the plan network unless its and emergency and sometimes those networks can get rather restrictive so check to be sure you can live with who is and is not in network. If you are someone that demands to preserve your choice of medical providers this plan probably won’t work for you, stick with a Medigap supplement plan. Another drawback is these plans are specific to certain counties and geographic locations. For example, one plan may operate in the four county DFW metroplex but that same plan wont be available in then very next county unlike supplements that are available everywhere.

Overall we feel that the MAPD concept is solid, provides Medicare users a great potentially lower cost option and provider networks have remained relatively strong for 2013, if you will do a little research on drug formulary list and provider networks you might find this is the plan for you. A fixed income is just that and we want you to keep as much of it as you can, for more information on these or any other Medicare Advantage plans just contact our office today.

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Medicare Advantage Plans Can Lower Overall Expenses

Saturday, November 10th, 2012

Medicare Advantage Plans, also known as Part C coverage, are private insurance plans that are regulated by CMS(Centers for Medicare and Medicaid Services). These plans are approved to take the place of Medicare Part A and B and some plans even include the Part D prescription drug coverage.

There are several types of Medicare Advantage plans but the two most common MAPD plans are HMO and PPO plans. Differences between the two are haw the doctor networks apply. HMO Medicare Advantage plans have a more restrictive provider network but for the most part have lower out of pocket cost and most times lower plan premiums. PPO Medicare Advantage Plans generally have a larger provider network with fewer restrictions and you can receive care out of network in a non emergency provider visit. The PPO plans tend to have higher monthly plan premiums than their HMO counterparts.

Lots of Value Added Extras

Texas Medicare Advantage plans offer many additional benefits that are not included in original Medicare at little or no additional cost or premium. How can they do this? Simple, the federal government compensates the plans for providing the coverage on a per member basis and that equates to them paying a large majority of the premium for the member. This also allows several added benefits that you don’t get with original Medicare like:

  • Set co pay amounts
  • Free Gym Memberships thru the Silversneakers Program
  • Out of  Pocket Maximums
  • Medicare Dental Benefits
  • Vision Benefits
  • Discounts of additional services

These plans can offer more than what your traditional Medicare coverage does. Now keep in mind the above benefits may not be available for all plans and it will depend on what county you live in if a MAPD plan operates there.

Here are some additional important factors to consider before selecting a MAPD. First, again it should be stated that most Medicare Advantage plans have a network of doctors and hospitals and unless you are selecting a PPO plan must use the providers in the network except in cases of emergency treatment. Next, most HMO Advantage plans require your main (primary) doctor to refer you to any other doctor in the network. Again, most require this referral practice but there are a few “Open Access” plans that are still HMO’s however don’t require the selection of a primary care doctor or referrals to seek medical care.

Another point is your doctor may be in the provider network today but 6 months late leave the group forcing you to select other providers in the network. We suggest you always ask your doctor or hospital if they are in network.

Next, once you have selected your plan you’re on it for the entire year or until the next annual enrollment period so make the correct selection so you will be happy. There are some cases where you can exit the plan midyear but for the most part you’re on it for the year.

Due to the above statement we suggest you follow this advice, speak with an insurance broker that specializes in the Medicare insurance market. Reviewing your options and making informed decisions will go a long way in making your healthcare treatment painless and worry free.

For additional information on MAPD plans contact us today!

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Recent Posts
  • AEP May be Over But Some Can Still Get Medicare Advantage Plans Year Around
  • Disabled on Medicare Have Fewer Options
  • 2013 Medicare Changes Come as a Shock to Many Seniors
  • Medicare Advantage PPO Plans in Texas
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