All posts by Cody Lane

Different Plans for Medicare Advantage

No plan is suitable for everyone. Many people are very happy with Medicare Advantage PPO or HMO policies because they like network providers and health benefits. Others like the flexibility of a Medigap or Any Doc MA plan. A person’s budget will also affect their Medicare Advantagechoice. Medsupps come with a premium, but some medicare advantage plans do not have an additional price. After months of debate, health reform is finally a reality! What does this mean for insurance companies? This is a good thing? Is it a bad thing? Is it a mixed bag? From my perspective, health reform is a big thing. Health care reform focuses on primary health insurance, not life insurance, voluntary benefits, or Medicare supplements. Voluntary profit sales should continue to expand and not just for small businesses. Employers continue to reduce worker-sponsored insurance coverage at an alarming rate. Many large companies and corporations have experienced a steady increase in insurance premiums over the past ten years as medical costs have risen. As part of health reform, employers with fifty or more workers will be fined by the government when they do not provide their employees with insurance coverage.

According to the Medicare employees, the overall average prices charged for prescription drug plans do not determine what an individual beneficiary will eventually pay. Jon Blum, deputy administrator of Medicare, said a general conclusion cannot be reached because each person’s medication needs are individualized. You must consider the specific plan and medications that the individual takes. The health care review law is helping high-cost drug recipients save money. For those who fall into Medicare’s “overdraft period” coverage gap, beneficiaries can get a 50% discount on branded drugs. Approximately 47 million people with disabilities benefit from Medicare and approximately nine out of 10 beneficiaries have a prescription drug plan. Medicare Part D plans have different coverage levels. The policy which is most common has 5 levels: non-preferred generics, preferred generics, non-preferred brands, preferred brands, and special drugs. An Advantage plan is a contract Medicare has with a private insurance company to manage its benefits. You don’t pay after Medicare, you pay instead of Medicare. Premiums associated with Advantage plans are generally lower than premiums; however, when you go to a doctor or hospital, you get paid. There are different types of Advantage plans. There are PPO, HMO, and PFFS (i.e. private service charge) plans. With HMOs, you are restricted to “networked” doctors and will need “referrals” to consult a specialist.

Extra Help program and Part D Drug Plans

Homes, cars, life insurance cash, and money received from family or others to pay for household expenses do not count as resources. Some people with higher annual incomes may qualify for the Extra Help program. To ask if you qualify, contact the Social Security Administration or visit your local Social Security office. If you are about to turn 65, you have no doubt already signed up for Medicare or at least read the application information. So the first question to ask is whether you should get Medicare supplement plan and prescription drug coverage from Part D or if you should enter a Medicare Advantage plan.

For the purposes of this article, suppose you already have your Medicare plan. So the next question is, what next? Medicare was easy, mainly because there is only one place where you can get it, namely the federal government. However, once you have your Medicare, you only have one third of the way. Medicare covers 80% of your hospital and medical expenses, but there are still two other health insurance plans needed. In addition to the premium and copayment adjustments, we have noticed a significant change in the Part D program. This year, many companies are no longer stopping the mail order for Level 3 drugs.

As many of you know, during the last two years, you can receive medication for three months for a two month co-payment if you do so in the mail. You can still do this for Tier 1 and 2 drugs, but not for Tier 3 in all companies. To make matters worse, Kaiser Family Health reports that drug manufacturers have raised their Medicare part D plans prices in an attempt to collect what Medicare will pay. Consequently, Medicare simply refused to include covered drugs in the first two years. The bottom line is that you don’t change your drug coverage just because someone talks about buying a single cheaper drug.

The Social Security Administration has a program available to qualified people, called Extra Help. Extra Help can save people who qualify for up to $ 3900 a year. Extra Help can help you with premiums, deductibles, and co-payments associated with a Medicare prescription drug plan. To qualify for Extra Aid, a person must be enrolled in a Part D prescription drug plan by 2010; Resources should be limited to $ 12,510 for an individual or $ 25,010 for a couple. Resources would include things like bank accounts, stocks, bonds and mutual funds.

AETNA ADVANTAGE PLANS IN MISSISSIPPI

Medicare Advantage Medicare Advantage plans are extra beneficial plans which are provided by private organisations. These private organisations are certified by the government. The Medicare Advantage plans not only organise your original medicare but also provide benefits like dental services, vision care, chiropractic services, over the counter benefits, meals, acupuncture services, and much more. There are many organisations which compete in this sector, due to which you can avail Medicare Advantage plans at a monthly premium as low as $0. Aetna Medicare Advantage plans are offered all over the United States. The plans, however, differ from region to region. Aetna Medicare Advantage plans offered in Mississippi are discussed below.

 

  1. Aetna Choice R0110-001 (Regional PPO)

With an overall rating of 3.5, Aetna choice plan is a regional preferred provider organisation plan. This plan has a monthly premium of $0. It has an annual deductible of $1000 and provides an out-of-pocket maximum of $6700 for in-network services. You also have to pay a $0 copay for visiting an in-network general doctor, and a $35 copay for a specialist. The plan covers both in-hospital acute as well as psychiatric stay, with a $0 copay after the fifth day. It provides hearing services, vision care, dental care, and fitness programs as well. It also provides preventive services and home health care services as well, at a copay of $0.

 

  1. Aetna Honor (PPO)

With an overall rating of 4, the Aetna honor plan has a monthly premium of $0. It is a preferred provider organisation plan, which lets you choose a healthcare provider of your choice. In this plan, you don’t even have to get a referral to see any special doctor. The plan has an annual deductible of $1000, and an out of pocket maximum of $6700. Under this plan, you have to pay a $0 copay for visiting your primary doctor, and a copay of $35 for specialist. Aetna Honor plan provides added services like dental coverage, oral exams, vision care, hearing services, and chiropractic services. You are also entitled to fitness, and over the counter benefits. However, the plan does not cover prescription drug services and you have to enrol in a Part D plan separately.

 

  1. Aetna Choice H5216-159 (PPO)

With an overall rating of 4, this plan is offered by Aetna at a monthly premium of $0.The annual deductible for the plan is charged as per medicare defined part B amount, with an out of pocket maximum of $6700. While visiting a primary doctor or a specialist in this preferred provider organisation plan you need to pay a 20% coinsurance. Prescription drugs are also covered in these plans, and you have to pay a deductible of $340, which is applicable to preferred generic, generic, preferred brand, non-preferred drug, and specialty tier. Along with providing various fitness program benefits, the plan also entitles you to the entry into the SilverSneakers program. With this, you have the benefit of working out at more than 14000 fitness centres all around the nation. The dental, and vision care services are also a part of the package. Outpatient rehabilitation services are provided at a 20% coinsurance. The plan also covers the Skilled Nursing Facility at $0 copay for the first twenty days.

 

  1. Aetna Value Plus H5216-160 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $25.10. The annual deductible for the plan is charged as per medicare defined part B amount, with an out of pocket maximum of $6700. While visiting your primary doctor or a specialist you would have to pay a 20% coinsurance. The plan covers prescription drug services as well, with a deductible of $435. The deductible is applicable to generic, preferred brand, non-preferred drug, and specialty tier. For generic as well as brand name drugs you have to pay a 25% coinsurance. For the urgently needed services, you have to pay a maximum copay of $65. The plan also covers outpatient mental health, at 20% coinsurance.

 

  1. Aetna Choice H5216-136 (PPO)

With an overall rating of 4, the plan is available at a monthly premium of $43. This preferred provider organisation plan has an annual deduction of $1000 and an out of pocket maximum of $6700.  While visiting your primary doctor you have to pay a copay of $10 and for a specialist, a copay of $45 has to be paid. The plan covers inpatient hospital services, providing services for both acute diseases as well as psychiatric care. The plan covers your prescription drugs as well, with a deductible of $400. The deductible is applicable to non-preferred drug and specialty tier. The plan provides dental care, vision services, hearing services, over the counter benefits, fitness benefits as well as enrollment into the SilverSneakers program as well.

 

  1. Aetna Choice H5216-093 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $62. The plan has an annual deductible of $750 for both in as well as out of the network, and a maximum out of pocket expense of $6700 for in-network. While visiting your healthcare provider you have to pay a copay of $5 and for a specialist, a copay of $45. The plan also covers your prescription needs and provides a deductible of $150, applicable to preferred brand, non-preferred drug, and specialty tier. For generic and brand name drugs, you have to pay a coinsurance of 25%. The plan also covers outpatient lab services, diagnostics, therapeutic radiology services, occupational therapy services, physical therapy, as well as language and speech therapy. You can also avail home care and preventive care services at a $0 copay. The plan also gives you the flexibility of working out in any of the 14,000+ physical centres available nationwide.

 

  1. Aetna Choice R0110-002 (Regional PPO)

With an overall rating of 3.4, the plan is offered at a monthly premium of $82. With an annual deductible of $1000, the plan has a maximum out of pocket expense of $6700. This regional PPO plan gives you the flexibility of choosing any health care provider of your choice, at a copay of $15, and a specialist at a copay of $50. Along with covering in-hospital stay for an acute disease, the plan also covers psychiatric hospital stay at a $0 copay after the fifth day. The prescription drugs are also covered under this plan, with a deductible of $435. It is applicable to the preferred brand, non-preferred drug, and specialty tier as well. Extra benefits include vision care, hearing services, over the counter benefits, dental care, and fitness benefits as well.

 

  1. Aetna Choice R0110-003 (Regional PPO)

With an overall rating of 3.4, the plan has a monthly premium of $110. It has an annual in-network deductible of $1000 and the plan has an out of pocket maximum of $6700. There is a $15 copay, whenever you would visit your primary doctor, and a $50 copay while visiting a specialist. The plan also covers your prescription needs and provides a deductible of $400, applicable to the non-preferred drug and specialty tier. For generic and brand name drugs, you have to pay a coinsurance of 25%. Emergency ambulance services and air ambulance services are also covered in this plan at a minimal copay and coinsurance. Along with pulmonary rehabilitation services, occupational therapy services, physical therapy, speech and language therapy services are also covered under this plan at $25 copay.

Medicare Advantage Plans May Look Better Than They Really Are

People over 65 and older automatically enroll in most cases under Medicare insurance.  Medicare AdvantageMedicare, a social security program, provides basic health coverage for the elderly; However, Medicare leaves many gaps in what it really covers and pays for. To address additional medical services, such as prescription drugs or home medical services, Medicare supplemental plans may be added to help cover the costs that the original Medicare plan does not cover. Another way seniors can go and what private insurance companies love is to buy a Medicare Advantage plan that in many cases turns out to be a bad idea.

What about other Medicare Advantage plans?

Medicare Preferred Provider Organizations and Medicare Health Maintenance Organizations (HMO) have been in existence for such an extended period. The two kinds of Advantage plans of Medicare utilize physician networks and the other providers of medical care who have an agreement to be involved in the programs. So long as policy members utilize their ID card, they will not have many billing issues. Overall, Medicare PPO and HMO members are expressing great satisfaction with their health plans.

A combination of private competition and federal incentives allows private plans to offer health plans that provide quality medical care and save money for Medicare beneficiaries. Networks, once considered restrictive, actually ensure that doctors understand and accept the system so that it works more smoothly. These plans usually include Medicare’s Part D or prescription drug part!

You only have until December 7 to decide if you want one of the MA plans to offer your Medicare benefits. This year, the open enrollment period is prior to last year. This way, they can ensure that those who sign up have the benefits in effect before January 1st. If you find that your new plan does not work as well as the Medicare coverage you left, you can return to traditional Medicare between January 1 and February 14 next year. You can add an independent prescription drug plan at the same time to get your prescriptions covered.

Health insurance rarely offers trial periods, but that’s exactly what you can do with dozens of different Medicare Advantage plans. Sign up before December 15 and if you change your mind, you can return to Medicare between January 1 and February 14 next year. To ensure you get the medical care you need, check the list of doctors and prescriptions that a plan will pay before you sign up.