| Medicare Advantage Or Original Medicare--Shill I Shall I? |
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| Written by Max Logan |
| Wednesday, 01 September 2010 13:00 |
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If you are in Medicare this year, in 2010, you may be trying to decide if you will join a Medicare Advantage plan or remain with Original Medicare. The choice is between private management of your Medicare benefits and Federal management. Which is best for you? Many of the Medicare insurance companies are re-evaluating their 2010 Advantage program in light of the health insurance reform passed into law by President Obama. The new law will mean significant financial change as subsidies for the plans will be reduced. Although this will not affect the benefits offered to members, it may affect their experience in the plans.
If you are in Medicare this year, in 2010, you may be trying to decide if you will join a Medicare Advantage plan or remain with Original Medicare. The choice is between private management of your Medicare benefits and Federal management. Which is best for you? Many of the Medicare insurance companies are re-evaluating their 2010 Advantage program in light of the health insurance reform passed into law by President Obama. The new law will mean significant financial change as subsidies for the plans will be reduced. Although this will not affect the benefits offered to members, it may affect their experience in the plans. Medicare Advantage plans in 2010 How Medicare Advantage plans work in 2010 is pretty much the same as they did in 2009. This is true regardless of whether we are talking about Advantage PPO plans, HMO, or any other sort, such private fee for service plans. One major difference, however, is that premium and out-of-pocket costs have generally gone up from 2009. We also find that there are far fewer Advantage plans with zero monthly premiums. Also, in past years there were more plans whose cost sharing was less expensive than Original Medicare. In 2010, we find more Advantage plans whose out-of-pocket costs are nearly the same or greater than those of Original Medicare. What are you getting when you join a 2010 Medicare Advantage plan? The Medicare program requires that the Advantage plans offer you the same core services that you receive in Original Medicare. However, the Advantage plans deliver your benefits according to their own policies and procedures. When you join an Advantage plan, that plan takes over management of all of your Medicare health benefits and become the only and single payer on your medical expenses. You are still in the Medicare program, but instead of the Federal government managing your benefits, the private, Advantage insurance takes over. The Advantage plans are not supplemental insurance and will never pay after Medicare. They pay instead of Medicare, and Original Medicare will never pay on charges while you are enrolled in a private plan. Medicare Advantage PPO Plans and HMOs Two of the most common sort of Advantage plans are the Medicare Advantage PPO and HMO. These sorts of plans suit people who expect to receive most of their care in the same, general area as where they live. Both the PPO and HMO have networks of health care providers their members can use, but in an HMO, members must use the provider network in order for claims to be paid. In a PPO, members can go out-of-network without a referral to any doctor they choose as long as the provider agrees to submit claims and accept payment from the insurance company. In both kinds of plan, as with any Advantage plan, you can expect to pay all costs yourself if you receive care outside of the plan service area. The only exception to that is receiving emergency and urgent care. In those situations, the Advantage plans must accept the claims. Most Advantage plans, whether they are a PPO or HMO include coverage for medication. The drug coverage benefit is often referred to as Part D, and in 2010 the rules are practically the same as in 2009. One important change is that in 2010, if you enter the coverage gap, also known as the "donut hole," you will receive a $250 rebate. If you plan on joining an Advantage plan and want drug coverage, you must join a plan that bundles Part D into its package of benefits. In other words, if you join a PPO or HMO, you will not be allowed to join a separate, stand-alone prescription plan. So, how do you choose? How do you decide which is the best decision? These are not easy questions, and ultimately how you choose will depend on your research and what makes you feel most confident. It is important to keep in mind that the core benefits of both programs should be the same as Medicare law requires that all beneficiaries have equal access to the same set of benefits. It is also important to carefully weigh your health care needs against the relative costs of private care versus Original Medicare. And finally, when considering the Advantage plan program, be sure to talk not only with plan representatives but to the Original Medicare customer service staff, as well. DISCLAIMER: This article is provided as information only and is not to be taken as financial advice. Learn more about cheap Medicare PPO insurance and get free tips on cheap health insurance for your family. |