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Posts Tagged ‘texas medicare advantage plans’

AEP May be Over But Some Can Still Get Medicare Advantage Plans Year Around

Thursday, December 20th, 2012

Angry old woman with a rolling pinYes, the normal yearly annual enrollment(AEP) period is over but some Medicare recipients are still in the drivers seat when it come to securing a Medicare Advantage Plan(MAPD). How so? Well its simple, there are several special enrollment periods(SEP) that are allocated to you to secure new coverage and believe it or not you rarely hear about them.

First off the normal time period for folks to blow out of an advantage plan is October 15th to December 7th every year. Beneficiaries that want a new MAPD plan or folks that want out and go back to original Medicare and secure a supplement do it at this time of year. Its a crazy and chaotic time period that has most agents and brokers working on little to no sleep but it has to be done. After this time most agents just roll up their tent and call it a day but in my view the work doesn’t stop there, there are many more chances for seniors and disabled on Medicare to hit the MAPD jackpot.

Lets look at a few and discuss but keep in mind this discussion is only related to those that are already on Medicare and does not apply to those turning 65 or new to Medicare.

Change in residency: Lets say you lived in Houston and moved to Dallas Texas, well chances are your advantage plan will terminate due to being outside the service area. In this case you are free to select another MAPD or even a Medicare Supplement plan without the need to qualify medically.

Non-renewals: I rarely get this request but it simply means the plan you are currently on has made the decision to stop offering that plan therefore creating a SEP to enroll in another Medicare private insurance plan. This period runs from December 8th until the end of February.

Dual-Eligible Individuals: Simply put if you are on both Medicare and receive any type of assistance from the Medicaid program you can change almost anytime to a new and different Medicare Advantage plan.

Loss of Dual-Eligible Status: Just to tie onto the one above, if you loose Medicaid eligibility you can then seek and secure a new advantage plan.

Trial Right:You are allowed to leave a MAPD within the first 12 months(trial right) and go back to a Medicare Supplement plan anytime within that 12 month trial period.

SPAP, State Pharmaceutical Assistance Program: If you are enrolled in a state pharmaceutical assistance program you can also exercise a SEP almost at anytime. It also works in the reverse if you loose your SPAP eligibility you are provided one Special Election Period.

LIS, Low Income Subsidy beneficiaries: If someone is receiving a low income subsidy they also have a SEP and can select a new or different advantage plan outside the annual enrollment period.

SNP Special Needs Plans: Ok, my favorite. These Medicare Advantage Plans are designed for those folks with special needs like diabetes, chronic heart failure and cardiovascular disease. These Medicare Advantage Special Needs Plans offer a different benefit configuration more focused toward the particular health condition. Also, the health plan must be designated as Special Needs Plan, just any old advantage plan wont work.

As you can see from above there are several different situations that seniors or those with disabilities and on Medicare can make plan changes or secure an advantage plan outside the normal annual enrollment period. If you find yourself in one of these situations and need our assistance we do work year-round, unlike some of the normal advantage agents who just show up during the AEP period.

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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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Do all Texas Medicare Supplement Plans Have Rate Increases?

Friday, July 13th, 2012

The sort answer to the question ‘Do all Texas Medicare Supplement Plans have rate increases?’ is yes.  Medicare Supplement plans are insurance policies that provide for the gaps in coverage that occur in Medicare Part A and Part B.  However, Medicare Supplement plans, also called Medigap policies, are not a product provided by the government.  Private insurance companies become approved to offer Medicare Supplement Plans.  The content of the plan offered has to fall under one of ten categories that Medicare mandates.  These plan types are labeled with letters, namely A, B, C, D, F, G, K, L, M, and N.  For that reason, all Medigap Plan A policies, no matter what insurance company offers it, have the same benefits (hospital coinsurance, 365 extra days of hospital coverage, blood, and hospice coinsurance). 

 

The Texas Department of Insurance regulates the offering of Medicare Supplement Plans in the state of Texas.  However, the insurance company offering the Medigap product can set the premiums to whatever they wish.  In addition, the quality and reliability of insurance company varies.  Also, the level of customer service and ease of getting claims paid will be different according to what company is offering the Medigap plan.  But back to the question of increasing rates.

Medicare Supplement Plans are all guaranteed renewable by directive from Medicare.  However, the insurance company offering the plan is allowed to change the rates (and by change, I mean increase) generally once a year.  They can change the rates for several reasons, including patient class change or increase in age.  As an agent who seeks the best for his client, I will shop around each year, to make sure you have the best price for your chosen plan.  This can help offset the rate hikes imposed by insurance companies dealing in Texas Medicare Supplement insurance policies. 

I am fully versed in the laws governing switching Medicare Supplement insurance.  Changes must be made within the proper enrollment periods or according to guaranteed issue right guidelines.  Also, you can switch from one company to another at any time, providing you qualify medically but as a rule Medigap plans have very liberal underwriting guidelines. As your agent, I can help guide you through the process and red tape involved with Medicare transactions.  My goal is to make is as easy and painless as possible for you to get the medical care you need at a price you can afford. 

Do all Texas Medicare Supplement Plans have rate increases?  Yes, but that does not mean that you are trapped in a rapidly increasing premium situation.  However, there are issues to think about when you change your Medicare Supplement Insurance policy.  Changing Medigap insurance policies needs to be done with consideration for the coverage, premium price, dependability of the company, and customer service levels.  I take all of these areas into account when researching your options as a Medicare recipient.  I can also help you understand alternatives to Medicare Supplement Insurance, such as Medicare Advantage Plans and more. 

When you want direct, honest guidance through Medicare Supplement Insurance, I can give you the pros and cons about signing up for policies or changing in understandable terms.  Cutting out the confusion over Medicare policies allows you to make educated decisions that will help give you peace of mind, knowing the gaps in your traditional Medicare coverage are being provided for.  You don’t have to let rate increases keep stressing your finances and keeping you from enjoying the benefits of Medicare health coverage.

Do all Texas Medicare Supplement Plans have rate increases?  Yes.  Do you have to pay higher prices every year?  No.  As an industry veteran possessing almost 20 years in the industry, I search high and low for the policies that will provide my clients with the coverage they need at the lowest prices.  We focus on helping Texans on Medicare save money and receive the medical coverage they need.   

For more information on changing your Texas Medigap Plan or to obtain an instant quote visit www.MedicareInsuranceTexas.com right now!

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Do Medicare Advantage Plans in Texas Offer Better Coverage Than Medigap Plans?

Thursday, October 27th, 2011

As a federal health insurance program available to Texans, Medicare is helpful for covering a large portion of medical expenses. However, it wasn’t designed to pay for all of your health care costs.  As a result, many Texans are finding that they need to purchase additional insurance to supplement Medicare. There are two types of plans available that provide additional benefits to Original Medicare- a Medicare Advantage plan and a Medigap plan. Learning the difference between the two can help you decide which type of plan will provide you with the most appropriate health care coverage. 

Medicare Advantage

A Medicare Advantage plan, also known as Part C of Medicare, is offered through private insurance companies. Basically, you receive Part A, Part B and Part D (Prescription Drug Coverage). Therefore, you must be enrolled in both Medicare parts A and B and live in an area where there is a plan available to enroll in Medicare Advantage.  While every company offering a Medicare Advantage plan must follow specific rules set by Medicare, there are different out-of-pocket costs and different rules as to how you receive services. Medicare Advantage plans are available as Preferred Provider Organization (PPO) plans, Health Maintenance Organization (HMO) plans, Medical Savings Account (MSA) plans and even Special Needs Plans (SNP).

Coverage

A Medicare Advantage plan provides all of the services that Original Medicare must offer except hospice care and always includes emergency and urgent care. You receive your Medicare benefits directly through your Medicare Advantage plan, including all of Part A, Part B, Part D (Prescription Drug Coverage) and sometimes additional benefits not covered by Original Medicare like vision or dental. With every Medicare Advantage plan, you pay one monthly premium for all of your services. Out-of-pocket expenses are different from plan to plan and based on a variety of things including if your Part B premium is paid, whether you have a deductible, how much your copayments or coinsurance is etc.

Things to Consider

You should know that you can only join a Medicare Advantage plan at certain times throughout the year and generally, you are enrolled in a plan for a year. In addition, you must follow the plan’s rules. For example, some plans require that you have a referral to see a specialist, others do not. Many Medicare Advantage plans require that you use certain networks of doctors. Unfortunately, choice is sometimes limited. In fact, Tyler, Wichita Falls or Athens may have fewer choices if any at all when selecting doctors. Be cautious.  In many cases, if you use a doctor who is not part of the plan, you’re services may not be covered.

Medicare Supplement Insurance

Medicare Supplement insurance, also called “Medigap” insurance, is health insurance sold through a private insurance company to supplement Original Medicare. In other words, a Medigap plan does not provide your Medicare benefits, but provides additional coverage.  You still receive Part A and Part B through Medicare and pay your Part B premium. Medigap insurance is designed to help you with the “gaps” in coverage that Original Medicare doesn’t pay for like deductibles, copays and coinsurance. Typically, monthly premiums are higher for Medigap plans than for Medicare Advantage, but with some plans no out-of-pocket expenses, this may be a better option in the long run.

Coverage

In Texas, there are 10 Medigap plans available for purchase, each with different combinations of coverage. Some plans cover a portion of your out-of pocket expenses, like your Part B deductible and nothing else.  Some cover all of your out-of-pocket expenses, like Plan F, which is the most popular Medigap plan in Texas. Plan F completely eliminates your deductible, copays and coinsurance. However, Medigap plans do not include prescription drug coverage and you will have to consider a Medicare Part D Prescription Drug Plan separately. Remember, unlike a Medicare Advantage plan, with Medigap insurance, you can see any doctor you choose and there is never a referral needed to see a specialist. Also, any treatment approved by Medicare would be covered on a Medigap plan. There is no need to worry if the plan will approve the treatment.

Deciding between a Medigap plan and a Medicare Advantage plan can be a bit confusing. While Medicare advantage typically offers lower premiums than Medigap insurance and sometimes includes prescription drug coverage, you are generally limited to using doctors within a network and still have to pay out-of-pocket expenses. With a Medigap Plan F, all of your out-of pocket expenses are completely eliminated, but you will need to add prescription drug coverage separately.

Choose wisely when selecting your health insurance. Remember, price is not the only difference between private insurers. Choose only reliable, dependable companies like Blue Cross Blue Shield of Texas or United of Omaha and get not only reliable health care coverage you can depend on, but also, the peace of mind that comes from knowing you are insured by a company that has earned the trust and respect of Texans.

Now the picture is a little clearer why not take a look at the available Texas Medigap Plans or take a look at quotes at our Texas Medicare Supplement Insurance website.

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Texas Medicare Supplement – When Medicare Isn’t Enough

Thursday, June 9th, 2011

A Texas Medicare supplement is a policy that is sold through a private insurance provider in the state to help supplement the original Medicare coverage that you have. The government created Medicare to offer a solution for insurance to older adults, but they never intended for it to cover everything that people needed. Therefore, supplement plans were created in a set of 11 modernized plans that are sold by a variety of insurance companies. These plans help offset the gaps in your coverage and provide you with more support for your medical needs.

It is important for you to keep in mind that a Texas Medicare supplement is NOT the same as a Texas Medicare Advantage plan. These are actually the two options that you have when you are shopping for additional insurance to add to your Medicare coverage. A supplement is standardized by the government and sold by private companies. An Advantage plan is a private HMO or PPO insurance plan that is an alternative to supplements. This is very important to know and remember in your search for coverage. Considering that there are more than 3 million residents in Texas enrolled in Medicare, you can count on the fact that insurance companies have options for all types of people and needs.

In our opinion Medicare is never going to be enough coverage on its own. Unless you are extremely healthy or extremely wealthy, you cannot afford to go without a Texas Medicare supplement. This will take over where Medicare leaves off, allowing you to have peace of mind and financial protection regardless of what type of situation you are in. You need to shop around and find a reputable company that sells supplement plans so that you can get the coverage that you deserve. While the basic policy is the same everywhere, the features, perks, and service will vary from one insurance provider to the next.

Medicare was never designed to provide you with full coverage. It doesn’t matter if you think you need it or not, a Texas Medicare supplement is always a good idea. Allow yourself the time to explore the options and see just what you have to choose from so that you can get the right supplemental plans for your needs. There are plenty of options and more than 50 insurance providers in Texas to choose from, no matter what type of supplement plan you might be searching for.

For more information or assistance in finding a quality Texas Medicare supplement plan visit www.MedicareInsuranceTexas.com today!

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Texas Medicare Supplements – Review Your Options Carefully

Wednesday, March 30th, 2011

Texas Medicare supplements are available in 10 different modernized plans for residents of the state who have Medicare coverage. Companies like Mutual of Omaha, Blue Cross Blue Shield of Texas and United HealthCare offer plans to name a few. There are also private insurance plans offered by various insurance companies throughout the state to help you make sure that you get the coverage that you need. You will have to take the time to review your options very carefully and make sure that you apply for the right policy to get the most from your insurance coverage. Some people take supplemental insurance shopping like a gamble, just picking whatever policy seems right, but this isn’t the way to do it.

When you are shopping for Texas Medicare supplements, whether you live in Houston, Dallas or the rural areas of West Texas, you need to be very careful in your decision. Supplement plans allow you to have the coverage that you need so that you can visit any doctor or hospital, which is an advantage that you don’t usually get from private insurance plans in many cases. Plus, Texas has patient protection laws in place to make sure that all insured customers are getting the benefits that they deserve and that insurance companies aren’t taking advantage of anyone.

You should know that Texas Medicare supplements and Texas Medicare Advantage plans are different options, as well. This is important because you have either to choose from and one might be better for you than another. If you are confused, get in touch with an insurance agent who understands Medicare and supplemental insurance plans so that you can get the help that you need in choosing the best insurance coverage to add to your existing Medicare coverage. These agents don’t cost you anything and are a great asset to have when you’re shopping for insurance so you should take advantage of them when you need a little assistance.

Texas Medicare supplements are going to offer something for everyone, but you really need to make sure that you’re getting the right thing. Look at what your Medicare covers, where you need additional coverage, and which supplement plans seem to best fit the gaps in your insurance coverage. Then, you will be able to enjoy your retirement and trust that you are protected with the coverage that you deserve, no matter what you might need. In Texas, the state is on your side when it comes to insurance but you still have to be an informed consumer to get the right Medicare supplements.

For additional information on Texas Medicare supplements visit www.MedicareInsuranceTexas.com today!

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Texas Medicare Supplement – Tips and Information

Sunday, March 27th, 2011

Understanding Medicare is difficult enough, but when you are trying to buy supplemental coverage, it can get even more complicated. There are so many different plans to choose from and a variety of ways that you can get more protection than Medicare offers. That can often get confusing for people, which is why you need to know what you are dealing with. A Texas Medicare supplement is similar to any other state’s supplemental coverage, but it has a few more perks and insured people have some better laws on their side to protect them from insurance companies.

If you choose a private Texas Medicare Advantage plan instead of a Texas Medicare supplement plan, having these laws on your side will make a big difference. You can also choose more affordable plan options because Texas has plenty of budget-friendly options in place to make sure that everyone can get health insurance when they need it. Not many states are standing up for their residents like Texas does when it comes to insurance, and it is something that everyone needs to take advantage of when you are shopping for a Medicare supplement plan or any other kind of insurance.

There are 10 standard Medicare supplement plans in Texas to choose from, along with the endless options that you get from private companies through Medicare Advantage plans. By taking the time to review all of these plans, you will have a much better idea of what coverage is going to be best for your needs when there are gaps in your Medicare insurance. You can’t just look at one or two plans and be satisfied that you are getting the right coverage because there are so many different options and you deserve the opportunity to explore each one and see what it has to offer.

Some states have limits or restrictions on Medicare supplements outside of the modernized plans. However, Texas has created provisions that actually work in favor of the insured customer and provides people with many more options for a Texas Medicare supplement in addition to the standard plans that are featured in every state. Because you have so much working in your favor as a resident of Texas, you really need to make sure that you take the time to explore all of your options and get the best insurance. You’re being offered something that most people don’t get—a state that is on their side when it comes to insurance. Use that any way that you can.

Last thing to keep in mind: a Medicare supplement Plan F from Mutual of Omaha for example will be the exact same benefits as a Plan F from say Blue Cross Blue Shield of Texas, all due to federal laws. All Medicare supplements are the exact same as long as the plan type is the same. Now its all about price.

For more information on Texas Medicare supplement plans visit www.MedicareInsuranceTexas.com today!

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  • 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
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