March Madness of Medicare!

What does "March 31st" mean to Medicare world?

March 31st is the last day of the period called "Open Enrollment Period" in which you can change from one Medicare Advantage Plan to another "like- to-like" plan. Or you can go back to the original Medicare by enrolling "stand-alone" Part D Drug Plan. After that, you will be stuck in "Log-In period" until the next "Annual Election Period" which begins November 15th and ends December 31st of every year.

REMINDER: If you jointed a MA (Medicare Advantage) Plan or MAPD (MA Plan with Prescription Drug) within last 12 months, and DO NOT like it, or you feel it does not meet your NEEDs, you can get OFF those plans by going back to the Original Medicare and /or enroll a Medicare Supplement (Medigap) plan. If you wait too long, you may not be able to get on it because of the underwriting or health questions.

REMINDER: If you are NEW TO MEDICARE and you joined a MA/MAPD plan and don't like it, you are still within your Open Enrollement Period and WILL NOT be turned down because of health issues. You can get back on OriginalMedicare which pay 80% of all doctor and hospital costs and take out a Medicare Supplement that pays the other 20%. With Medicare supplement your only expense is your monthly premium. There are NO Co-Pay, No Networks of doctors you must use. You can go to any doctor and/or hospital of your choice anywhere in US! We can help you to pick out the best plan fit your needs.

REMINDER: If you are losing your Retirement Group Plan Coverage and need to join a Medicare Supplement plan, we can provide you a comparison of their premiums. The Benefits from all the Medicare Supplement plans are the same, no matter what insurance company you buy it from. The ONLY difference is the quality of their service ans the price they will charge you.

For more details between these plans (MAPD, MED SUPP, PART D), please call us at 714-873-2688 or email: dqmagency@gmail.com for a private and confidential advice for your Needs.

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2010 Medigap Plan Changes

Effective June 1, 2010 there are planned changes to the current standardized Medigap policy offerings. These changes will impact all companies offering Medicare Supplement insurance.

History:
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) included language to encourage the National Association of Insurance Commissioners (NAIC) to modernize the Medigap market. The NAIC decided to review the Medigap plans to determine if there were changes that could be made to the benefit packages in response to changes in the marketplace since the standardization of the product in 1990.

Summary of 2010 Changes:

Eliminates 4 Medigap Plans:

• Plan E, H, I, and J are eliminated

Modernizes Benefits:

• Eliminates the At-Home Recovery Benefit (Affects Plan D, G, I and J)
• Eliminates Preventive Care Benefit (Affects Plans E and J)
• Replaces the 80% Part B Excess Charges Benefit with a 100% benefit (Affects Plan G)
• Creates a new Hospice Benefit as part of Basic (Core) benefits (Affects all plans, starting 6/1/2010) :

1. Medicare offers a hospice benefit with a drug co-pay and inpatient respite care coinsurance. The 2010 modernized plans will now cover the expenses below as a core benefit
2. * $5 co-pay for outpatient prescription drugs for pain and symptom management* 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver so the usual caregiver can rest). Does not include room and board

Creates New Plan Options:

• Plan M - with increased cost-sharing (including 50% coverage of Part A Deductible)
• Plan N - with new co-pay structure (will offer similar benefits to Plan F, but there will be a $20 co-payment for doctor visits and a $50 co-pay for emergency room visits - waived upon admission to the hospital).
• Both Plans M &N have all the core benefits plus the foreign Travel Emergency Benefit. And the cost of these plans will be approximately 75% of the cost of Plan F.

Summary:

• * Overall = Reduces number of plans from 14 to 11.
• * Plans E, H, I, and J are no longer offered due to duplicity as a result of benefit changes
• * Eliminates outdated and underutilized benefits
• * Adds new plans that feature higher cost sharing and lower anticipated premiums for policyholders.

Medicare Coverage: Medicare Advantage Vs. Medicare Supplement (Medigap)

• Medicare Advantage plans offer coverage with little or no monthly premiums. In some instances, you (the beneficiary) can actually receive money back every month!


• When enrolling in a Medicare Advantage plan, you are still part of the medicare Program and retain all of their medicare rights and protections.


• When joining a Medicare Advantage plan, you will continue to receive all of your regular Medicare-covered services. With medicare Advantage, you will also have access to additional services that neither Medicare Supplements nor Original Medicare can provide.


• Medicare Advantage plans can offer prescription drug coverage whereas Medicare Supplements do not.


• Medical providers may or may not accept some Medicare Advantage plans. Ask your Agent to help checking with your doctors prior to purchase a Private-Fee-for-Service (PFFS) plan. Some Medicare Advantage plans may have a published network of providers. Whereas most medicare Supplements are universally accepted.


• Agents who help you to enroll Medicare Advantage plans are required annual certification and strongly enforced marketing practices.


• With a Medicare Supplement, you must pay a premium whether you use it or not! With a medicare Advantage you only makes a small co-pay when you use the services.


• With a Medicare Advantage plan, you only have to answer ONE health question: Do you have End-Stage Renal Disease - ESRD (kidney failure)? Medicare Supplements may have multiple health questions.

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Medicare Coverage (continued Part 2)

Medicare gap (also called Medicare Supplement Insurance)

"Visit any doctor, any hospital, anytime, and anywhere without getting permission from the insurance company"

Consider these facts in deciding if Medicare Supplement insurance for hospital and medical coverage is right for you:

• Medicare does not cover all health care bills.


• Medicare has deductibles, co-payments, and co-insurance for some services.


• The insured is responsible for paying the costs of services not covered by Medicare.

You can buy a Medigap plan from a private insurance companies that's designed to help pay your out-of-pocket costs (the gaps in Part A & B coverage). Each medigap policy only covers one person, so if you and your spouse both want coverage, you each must buy separate policy.

Each standardized medigap policy, however, must offer the same basic benefits, no matter which insurance company sells it. Premiums will vary depending on the plan you choose and the comapny you buy it from, but usually the only difference among Medigap policies sold by different insurance companies is the cost.

The best time to buy a medigap policy is during your "Medigap open-enrollment period" In all states, there is an open enrollement period that lasts for six (06) months and it begins on the first day of the month in which you are both age 65 or older and enrolled in Part B (some states have additional open enrollement periods). For more information about buying a Medigap policy, call your State Health Insurance Assistance Program.

All Medigap policies must follow federal and state laws that are designed to protect consumers and every Medigap policy must be clearly identified as "Medicare Supplement Insurance". Furthermore, Medigap Insurance companies can only sell you a "standardized" Medigap policy. There are 12 such policies identified by letters (A to L).

Note that there are numerous changes for the policies sold in 2010. For the first time, Standardized plans have beeen revamped in most 20 years. Please check back to this blog for the updated information anf free quotes for the plan fits you best.

Medicare Coverage (continued)

Medicare Part C: Medicare Advantage Plans

Formerly known as Medicare+Choice, Medicare Advantage plans are alternatives to the original Medicare plan and are notthe same as "suplemental insurance". Sometimes called Part C or "MA plans", these plans are run by private companies and are part of the medicare program. For many people, Medicare Advantage plans are a good value because they can offer health benefits at low or no additional monthly plan premium beyond the Medicare Part B.

Basically, Medicare pays an amount of money for your health care into these private medicare Advantage plans every month. In return, these plans must provide all of your Part A and Part B benefits, and they must cover at least all of the medically necessary services that the original Medicare plan provides.

MA plans can change different co-payments, co-insurance and deductibles for their services and generally have set provider networks. This means you will likely be limited to seeing those doctors (Primary Care Physician - PCP) who belong to the plan, going to certain hospitals for covered services and getting referrals to see Specialists. If you use providers who aren't in the netwaork, you may have to pay the entire cost of the services rendered. However, MA plans can offer extra benefits, such as vision, hearing, dental, and health and wellness programs. Most include medicare Part D, prescription drug coverage (usually for an extra cost).

Mmedicare Advantage plans come in several forms: HMOs, PPOs and SNP - are often referred to as " coodinated care" plans.These plans are build on the ideas of doctors and hospitals working together to coordinate and faclitate your care. Each plan create its own network.

1. HMO (Health Maintenance Organizations) plans - Your PCP may oversee your care and, in some cases, refer you to specialists as necessary.
2. PPO (Preferred Provider Organizations) plans - generally provide more flexibility to let you choose your doctors and hospitals. These plans typically don't require you to have a referral to se specialist, and you can see doctors outside the network without having to pay the entire cost yourself. If you do visit a doctor or hospital outside the network, though, you'll usually pay a larger share of the cost of your care.
3. SNP (Special Needs Plans) offer individual attention for people with complex health needs. These plans are designed to serve people with special needs like those living in nursing homes, those with chronic conditions such as Diabetes, COPD, CVD , Arthritis, Dementia - those who qualify for both Medicare and Medicaid.
4. PFFS( Private Fee-For-Services) Plans - will allow you go to any doctor if the doctor agrees to accept the plan's term of payment before treating you. It's important to confirm the doctor's agreement. Otherwise, you may have to pay up the full amount of the cost of your care.

It's very important to call any plan before joining to find out what your services will cost and to make sure that a plan will meet your needs. To enroll in medicare Advantage plan, send to me your contact info, I will send to you the application or simply get you enrolled by telephone or online. Be aware that there are limitations as to when you can join, switch or drop a MA plan.

Remember, when you join a Medicare, you will have to provide your medicare Number from your Medicare card and the date your Part A and Part B coverage started. You will also generally still pay the monthly Part B premium along with MA plan's premium (if any). That include coverage for Part A and Part B benefits, prescription drug coverage (Part D, if offered) and any other extra benefits.

Remember