Health Maintenance Organizations (HMO): Provide access to a range of doctors and hospital insurance through a flat monthly rate with no deductibles. HMO plans have the strictest network guidelines, meaning all visits and prescriptions are subject to the plan’s approval. Going outside the established network of doctors, labs, hospitals, and pharmacies will result in a higher cost to the beneficiary. When enrolling in an HMO, the beneficiary must select a primary care physician who must approve all referrals to specialists.
Video: Medicare Advantage Enrollment Period Opportunities
Medicare Advantage Plan Enrollment Periods « Insurance News from Crowe & Associates
There are only certain times when you can enroll/dis enroll or change a Medicare Advantage plan. Note that Medicare Advantage plans are sometimes called Medicare Part C or an MAPD plan. There is a general period when someone turns 65 in which they can enroll. This time frame is 3 months before the month they turn 65, the month they turn 65 and three months after they turn 65. There is also the AEP period during which current members can make any type of plan change. This period runs from October 15th to December 7th every year. During this time, an application can be put in to make a change for a January 1 effective date. The last type of period is the SEP period (Special Election Period) in which a change can be made at any time during the year. Click on the link below for access to a grid showing all elections.
Health Insurers Launch TV Campaign Opposing Medicare Advantage Cuts
The Medicare NewsGroup: Medicare’s Middlemen Await Word From CMS To Put In Play Sequesration Cuts Medicare’s middlemen, the companies that will carry out the administrative work of the automatic budget cuts set to hit Medicare providers on April 1, are waiting for directions from the Centers for Medicare & Medicaid Services (CMS) to put in play provider payment reductions. The updates to the payment systems will ultimately lead to $11 billion in reduced payments to hospitals, doctors and other health care providers for the remainder of fiscal year 2013. These middlemen are Medicare Administrative Contractors (MACs), the private companies that handle the bulk of the entitlement program’s administrative claims processes. They will implement the 2 percent across-the-board payment reductions, mandated by sequestration, which is the result of the federal government’s inability to reach a deficit-reduction deal totaling $1.2 trillion. This means a .02 cent cut for every $1 paid to health care services providers, such as doctors, hospitals, skilled nursing facilities, insurers, medical device suppliers and home health companies (Sjoerdsma, 3/6).
Medicare Advantage Enrollment Periods
The Initial Enrollment Period lasts 7 months. It would be to your advantage to submit an application prior to the month that your Medicare will be effective so your Medicare Advantage plan can be in place at that time.
GAO Report Finds Excess Spending in Medicare
According to a recent U.S. Government Accountability Office (GAO) report, private insurers offering Medicare Advantage plans receive inflated payments because insurers tend to use relatively high risk rates when calculating what Medicare should pay insurers per enrollee. The Centers for Medicare and Medicaid Services (CMS) offsets these higher rates by decreasing payments using a risk score adjustment, but the GAO reports that the CMS has not adequately adjusted these payments. The GAO estimates that this has resulted in “substantial excess payments” to Medicare Advantage plans—totaling in the range of $3.2 to $5.1 billion between 2010 and 2012.
How Medicare Supplement Plans & Medicare Advantage Plans Work
When beneficiaries turn 65 and first become enrolled in both parts of Original Medicare, they fall into their six-month Medigap Open Enrollment Period (OEP), which starts the first day of the month they are both age 65 or older and enrolled in Part B. This may be the best time to buy a Medigap policy because if a beneficiary decides to enroll after this time, their options may be limited and they may have to pay more for coverage. At the same time, beneficiaries also fall into their Initial Enrollment Period (IEP), which runs for seven months starting three months before they turn age 65 and lasts until three months afterwards. During this time, beneficiaries can sign up for any MA or Part D plan that contracts in the county and state in which they reside.
Medicare open enrollment: Will Obamacare end Medicare Advantage?
Should you be worried that Medicare Advantage plans will economize by reducing your benefits? “The plans are required to provide all Medicare benefits, so there’s no way they can cut them,” Gold explains. That includes the free preventive services added to Medicare by the Affordable Care Act. And Advantage plans that include a drug benefit are closing the doughnut hole just the same as stand-alone Part D drug plans. The only area where plans can even consider cutting back are for optional services such as dental and vision benefits, but the plan finder on Medicare.gov still features plenty of plans that have these bonus features.
Population Health Management In Medicare Advantage
Wellnesss promotion. A key component of PHM is the ability to promote health and wellness among all individuals, and MAOs reported extensive activities directly for members, including smoking cessation, wellness discounts, and the promotion of healthy lifestyles (exercise and nutrition). In addition to promoting wellness, PHM requires monitoring of population risk and designing and implementing programs that manage sub-populations based on their risk. Health risk assessments used universally by MAOs serve to segment populations at risk for disease. For patients identified as being at risk for chronic conditions, common interventions include targeted health education or outreach to engage members in activities intended to reduce risk factors, enrollment in care management programs, and working with nurses in health education.