Know The Differences Between Medigap And Medicare Supplement Insurance And How Things Work To Your Advantage
Monthly Premiums. Medicare supplement insurance quote by way of Medigap are actually higher, when contrasted with Medicare Advantage. Medigap asks for monthly premiums, while Medicare Advantage does not always require them, and if it does, at a slightly more affordable price. Medicare Advantage can be cheaper, but Medicare supplement insurance quote from Medigap tend to be more consistent. Medicare Advantage can raise its rates, while Medigap has a more stable premium, especially as policy holders can choose plans that have locked premiums.
Video: Medicare Advantage vs Medicare Supplement
medigap vs. medicare advantage
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Medicare Advantage VS. Medicare Supplement in Texas?
There are other factors to consider. It’s important to compare benefits when comparing premium rates between the two options. For instance, the premium for Medicare Advantage may be lower than for a Medigap plan, but when prescription drug coverage is added, the premium rate may increase considerably. In addition, with Medicare Advantage, it’s likely that your premium will rise over time. Medigap plans have locked premiums, meaning that they will not increase. Finally, because Medigap plans are guaranteed renewable, you don’t have to worry that your plan will be canceled, even if your health deteriorates. The same is not true with a Medicare Advantage plan. In fact, if your plan discontinues, you will be faced with finding a new plan in your coverage area, or going back to Original Medicare.
Medigap Vs. Medicare Advantage? Which to Choose?
Medicare Advantage, also known as Medicare Part C, is an alternative to traditional Medicare and is much like a regular HMO or PPO. Unlike Medicare Part A and Part B, Medicare Advantage is offered by private insurance companies. It covers Parts A and B, but many times provides additional benefits including hearing and vision coverage, as well as health and wellness coverage. Medicare pays a fixed amount monthly to Medicare Part C providers; however, each insurance company can charge additional fees in excess of this amount.
Medigap Supplements Can Be Cheaper Than Medicare Advantage Plans
Significantly, if he relied on Medigap policy G instead of the MA plan as he used more healthcare services, his out-of-pocket would remain at $1,583. Medigap Plan G’s MOOP is effectively the sum of the premium and a once-yearly $155 Medicare Part B deductible. Medigap Plan G specifically avoids co-pays, co-insurance and other deductibles (as does more-expensive zero-deductible Plan F). Other Medigap plans (A, B, C, D, K, K, L and N) vary as to payment for these charges, and are generally less comprehensive than Plans F and G.
Medicare Advantage vs. Medicare Supplement Solutions
Many people in the 65 and older age group, as well as those under 65 who have Medicare coverage due to certain disabilities, may not have any idea of the differences that exist between Medicare Advantage and Medicare Supplement Solutions. If you are unsure about Medicare Advantage vs. Medicare Supplement, you are not alone and we’re here to help. Below is some information on the differences, but if you still have questions about Medicare Supplement, please contact us at 800-308-7156 or fill out our online form to have a licensed representative call you within 24 hours. If on the other hand you still have further questions on Medicare Advantage, we suggest visiting Medicare.gov.
Understanding Medicare and Medigap
The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare, in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more. However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs. Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care. Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans. Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.” There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.” Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans. On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism. In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars. Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees. Others have reported that minority enrollment is not particularly above average. Another study has raised questions about the quality of care received by minorities in MA plans. The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.  Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Medigap vs Medicare Advantage Policies
Switching to a Medicare Advantage policy may mean that you have to switch doctors. You may need to go to a different drug store or hospital also. Your health insurance company will have a network of providers that they want you to use. Except where the information in the contract says otherwise, you will need to go to those providers for your routine care if you want them to pay for the care you receive.
Original Medicare vs. Medicare Advantage Plans
These are private run health insurance plans that have to carry the exact same coverage as Original Medicare’s Part A & Part B, this is possible because Medicare is paying for it. To quote Medicare.gov “Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services”
Medigap vs Medicare Advantage
Medicare Advantage plans are Medicare approved, and participants normally receive all Medicare covered health benefits by using this plan. So, you will receive Part A the hospital insurance portion, and Part B the medical portion in the same plan and in some cases can add Part D the prescription drug coverage. Medicare advantage policies provide many benefits and fit most budgets. Regardless to whether you want a standalone health plan or you want a prescription coverage built-in.
Almost 65 and pondering medicare supplement/advantage policies
Check your own state to be sure, but in WA one can always move from Classic Medicare to a Medicare Advantage Plan, during the open enrollment period which is in late fall. There is no medical qualification for this. Also, you can switch from one Medicare Advantage Plan to another yearly, during the fall open enrollment period. Additionally, the premium for brand new enrollees is the same as it would be for a 90 year old with 14 chronic diseases. The competition to get new-to-Medicare enrollees, without which the plan would quickly be in trouble keeps the premiums reasonable. The reverse movement is not guaranteed. You can drop your MA plan and return to Classic Medicare during a certain period after the beginning of the year, but except under certain limited circumstances you cannot force a Medigap insurer to insure you. For this reason, I choose Classic Medicare and a Medigap Plan F when I turned 65. I was told and read that my premium would always be the same as new plan entrants. However, this has turned out not to be true. Several years ago Medicare reorganized the Medigap plan menu, and many companies somehow were able to use this to hive off their existing members into a separate pool from their new entrants. In 2011, for example, my premium was ca. $80/mo higher than new entrants, and of course it will get higher yet, each and every year, as those in my pool age and are not replenished by new participants. Additionally, the healthiest participants will leave, either to Medicare Advantage or try to qualify medically for a different, new Medigap plan and pool. This business is directly in conflict with what I was told at issuance, both by the company I choose and by the State Insurance Office, and also in conflict with the principle of insurance being non-cancellable once it is in place. I was recently told that the WA Insurance Commissioner ruled against this practice, but later learned that this only applied to policies originally issued during or after 2010. So, as usual, these insurance companies are lying thieves, and our federal government is collaborating with them. In my state, many doctors, clinics, and hospitals are demanding membership in certain MA plans, rather than original Medicare, because these chosen plans pay better, and the billing procedures are more streamlined and payment is faster. I am not sure how I will proceed currently, but I am tempted by the good MA plans, because it appears that worst case, if I got every disease known to man and was in and out of the hospital weekly it would only cost me marginally more than a Plan F Medigap, and if my health continues good I will save money. It is my opinion that federal government wants to hobble Plan F, as it violates the principle in place in almost all employer plans that there must be meaningful co-pays. One note about the star rating. They are not outcomes oriented, they are process oriented. To a large extent they depend on getting lots of paper filled out, which is easy in an HMO as you just require it of the staff, who are in fact your employees. But not so easy with a PPO, the providers of which have power equal to or greater than the insurers’. One large and well regarded HMO in Puget Sound has a 5 star rating which I think is reasonable, from what I know by talking with plan members and a few people I know who work there. My girlfriend has this HMO through her work (an employer plan, not the MA plan) and she seems to get very good and attentive care from them, but her primary care Doc is in charge of who she gets to see, other than few things, like I think dermatology and ob/gyn. I think Medicare people get similar or equal care, and they pay very much less due to the government subsidy. All this may change as the medical system gets tinkered with, and I don