PFFS Advantage Plan

PFFS Medicare plans allow you to see any willing provider but ONLY IF that medical provider accepts the terms and pricing structure offered by your PFFS Medicare Advantage plan.

  • For each medical service (including lab, X-ray, etc.) the provider must accept whatever limits your PFFS carrier places on the treatment plan
  • If the doctor or medical provider does not agree to the terms your medical procedure is not a covered expense and you must pay out of pocket
  • To avoid any penalty, you need to check with each provider BEFORE services are rendered, to see if they still agree to the terms and payment limits of your  Advantage plan
  • You cannot assume that a doctor or service that was covered in the past will be covered the next time
  • Some Advantage plans require you to pay a copay every time you see a doctor or receive a medical service
  • Some PFFS plans have a network just like PPO plans. If you use a non-par provider you pay a penalty.

Bob Vineyard, President of Georgia Medicare Plans, has decided to specialize in GA Medigap plans. We believe the flexibility and overall VALUE of original Medicare and a Medicare supplement plan are superior to the Advantage plans currently on the market. We invite you to compare GA Medigap quotes using our instant online quote engine or ask for a free, no obligation consult.

PPO Advantage Plan

PPO Medicare plans come in two varieties. There are regional PPO Medicare Advantage plans and local PPO Advantage plans.

  • PPO plans have a list of network (PPO) approved doctors and other providers you may use
  • You may use a provider that is not on the list but you will have more out ot pocket (penalty)
  • You do not need a referral to see a specialist, but if you use a non-par specialist your costs will be higher
  • Medicare Part A and Part B services are provided by your PPO plan but you will generally pay more for these services than you would with original Medicare and a Medigap plan
  • Many Medicare Advantage plans charge a premium IN ADDITION TO your regular Medicare Part B premium
  • Advantage plans can charge deductibles and coinsurance that is higher than original Medicare

 

Bob Vineyard, President of Georgia Medicare Plans, has decided to specialize in GA Medigap plans. We believe the flexibility and overall VALUE of original Medicare and a Medicare supplement plan are superior to the Advantage plans currently on the market. We invite you to compare GA Medigap quotes using our instant online quote engine or ask for a free, no obligation consult.

SNP Medicare Advantage Plan

SNP Medicare plans are Special Needs Plans for a certain class of Medicare beneficiary. Many who qualify for SNP’s are considered dual eligible (qualify for Medicare and Medicaid).

Special Needs Patients usually meet the following criteria.

  • Qualify for both Medicare and Medicaid (dual eligibility)
  • Have a specific qualifying debilitating illness such as chronic diabetes or COPD
  • Live in a nursing home or require at home nursing care

Special Needs Plans provide “focused care” for those with specific health needs. Their care is more tailored to the condition than is possible with traditional Medicare. Some SNP’s have benefits not included in original Medicare. These benefits may include prescription drugs, hearing and vision benefits and more.

Special Needs Plans allow you to enroll or disenroll at any time during the year.

SNP’s are great options for those who qualify. We are not approved by CMS to offer Special Needs Plans but will refer you to someone who can assist.

 

#SNPMedicareAdvantage

Piedmont Wellstar Medicare Advantage 2016

shopCompareBig_new2

The popular Piedmont Wellstar Medicare Advantage HMO plan will not be available in 2016. Existing members have received their non-renewal notice and now begins the task of finding new coverage.old lady adjusting glasses computer

Piedmont Wellstar tried to put a smiley face on their announcement ……….

“While PWHP has chosen to exit the Medicare Advantage program, largely because of premium deficiencies, our success … can be measured against the ‘triple aim’ health care goals of improving the patient experience and quality of care, while reducing the trend in health care cost,” the statement read. “To this end, PWHP has been successful as demonstrated by our members’ satisfaction, our quality of care and our ability to keep healthcare cost trends per member flat for the past 18 months.” – Marietta Daily Journal

“Premium deficiencies” is just another way of saying the plans provided way too many benefits which resulted in attracting sicker patients that led to losses.

Premium deficiencies and success do not belong in the same sentence.

Roughly 12,000 existing members will lose their P-W coverage as of 12/31/15.

Post summary

  • Piedmont Wellstar discontinued for 2016
  • Pick a new Advantage plan and you may have to change doctors and hospitals
  • Original Medicare, keep your doctor
  • Original Medicare and a supplement plan
  • Sleep well at night knowing you made the right choice

If you are tired of having coverage dropped and want to pick your own doctors and hospitals, perhaps it is time to return to original Medicare and a supplement plan.

Medicare does not have doctor or hospital networks.

Medicare will never cancel your coverage.

When you select the right Medigap plan you can keep it for life.

Medicare shop and compare

 

Piedmont Wellstar – What Next?

The 2016 Medicare open enrollment kicks off October 15 and ends on December 7. Current members can pick from any of the following.

  • Enroll in another Medicare Advantage plan
  • Return to original Medicare
  • Return to original Medicare and enroll in a Medicare supplement plan

The first two options are straight forward. Keep in mind that changing to a new Advantage plan means checking to make sure your doctors and hospitals are in the new network and cross-referencing your medications with the drug formulary.

It also means being prepared to repeat this process every 1 – 3 years in the future. grandma shaking head

One couple losing Piedmont Wellstar coverage had 13 doctors between them and numerous medications. After spending more than an hour researching options they still did not have a workable solution.

Who wants to go through that again?

Medicare Advantage plans are great when you are healthy but the numbers change when your health goes south.

 

Return to Original Medicare

Some Piedmont Wellstar orphans will simply go with original Medicare, maybe a drug plan, and take their chances.

While that approach does guarantee access to any doctor or hospital it may not be the best financial option. Medicare alone is an open ended plan that pays 80% of covered Part B charges while you pay the remaining 20%.

Open ended means you pay the 20% portion until you are well again, dead, or run out of money.

Two of those three options are not good.

 

Medicare Plus Supplement

All of my clients want the freedom to pick their own doctors, find a drug plan that fits their needs and don’t want the hassle of trying to change plans every year.

With original Medicare and a supplement you can sleep well at night.sleep well at night

Almost every conversation I have with prospective clients begins with them saying “I don’t want to change my doctor”. I can certainly understand that position. When you have health issues you want a doctor you know and one that knows you. Conditions that require frequent checkups to make sure that mole on your skin is not changing or making sure your medications are controlling your sugar levels give you comfort when dealing with someone you like and trust.

If you are in good health you can purchase any Medigap plan you want from any carrier. This opens up a wide range of plan choices and premium savings that are not otherwise available.

But if you are in poor health you are not frozen out of the Medicare supplement market. Instead your choices will be limited to a handful of plans and high prices. The most common “guaranteed issue” option is Medigap plan F.

It is also the most expensive.

A female, age 67, non-tobacco user in zip code 30060 will see plan F premiums from popular carriers at $154 (Aetna), $159 (Omaha), $180 (AARP) and $183 (BCBSGA).

That same female that can qualify medically will have the ability to enroll in a Medigap plan N without the network hassle. Plan N premiums for this lady start at $89 and the out of pocket maximum is normally less than $500 vs the cap on the Piedmont Wellstar plan at $4000.

Plan N is very similar to Medicare Advantage plans except without

  • provider networks
  • annual notice of change
  • pronounced increase in your out of pocket cost sharing
  • threat of cancellation (when you pick the right carrier)
  • insurance carrier bureaucracy

Georgia Medicare Plans has rates for over 170 different Medigap plans available throughout the state. You can also review instant online quotes, comparing multiple plans side by side. The image below links to our quote engine. This is a secure, private site. Your information is never sold.

shopCompareBig_new2

This might be the right time to replace your cancelled Piedmont Wellstar plan and return to the security of original Medicare and a quality Medicare supplement plan.

 

 

#PiedmontWellstar #MedicareAdvantage #MedicareSupplement #GeorgiaMedicarePlans

How to Find the Right Medicare Plan

shopCompareBig_new2

Scroll down for UPDATE

 

Do you want to know the secret of how to find the right Medicare plan when you turn 65? Medicare supplement plan F or a $0 premium Medicare Advantage plan? What’s the big deal if you can change plans every year? How can the insurance company offer a free Medicare plan? What’s the catch? Is there something the insurance agent isn’t telling me? Why not cut out the middle man (the agent) and just buy direct?which-medigap-is-best2

If you are turning 65 and aging in to Medicare you have more questions than answers. And there are probably questions you never thought to ask ………. until it is too late.

If you already decided on a Medigap plan you might want to check the rate. There are more than 170 Medicare supplement different plans in Georgia but most don’t illustrate their premiums online.

Shop and compare GA Medigap quotes.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

 

Find the RIGHT Medicare Plan

Georgia has more than 170 different Medicare supplement insurance plans, more than 45 drug plans and about 25 different Medicare Advantage plans. How can you possibly find what you need to know and make the right decision the first time?

Compared to Medicare Part D, and Advantage plans, picking a Medigap plan is a piece of cake. That doesn’t mean it is easy, just easier.

If you have the right information.

The information a consumer really needs is not available to the public.

You won’t find it on Medicare.gov.

You won’t find it on the Georgia Dept of Insurance site.

You won’t find it on public forums.

You won’t find it on sites with “instant Medigap quotes” ……………. including mine.

Where will you find the information you need to make an informed decision and choose the right Medicare plan for your needs and budget.

Pick up the phone and call. I will answer all your questions and give you rates by phone and email a comparison.

Call 404 907 0925.

 

You can also start the discussion by email or securing a Medigap quote through my site.

 

 

Susan is turning 65 and wants a Medicare supplement plan

A short time ago, Susan visited my site.

Twice.

Medicare changesThe first time she entered her information for a quote she was a non-smoker. The second time she was a smoker.

Both times she listed a valid email address.

Both times she gave a bogus phone number.

I know because I called and the number was disconnected.

No problem. I know some people don’t like to talk on the phone.

Since I didn’t have a valid phone number I sent an email asking if she used tobacco or not. Rates are higher for tobacco users with most carriers, so I wanted to give her accurate rates.

I also have access to over 170 different plans and rates. Most of them are not shown online anywhere.

They are not on Medicare.gov

They are not illustrated on carrier sites.

They do not appear on agent sites, including mine.

This isn’t a plot. Some carriers don’t want their rates made public.

Susan responded to my email. Here is what she had to say.

The first entry was a mistake.  I didn’t realize that non-tobacco was checked.  I am still a tobacco (cigarette) user but I have cut my smoking down to about 5 cigarettes or less a day, using e-cigarettes. (Comment: for rating purposes she will be considered a smoker with MOST carriers)

I don’t really have any questions.  I won’t be 65 until November so I have plenty of time to search online for the best rates. (Comment: Yes, she does have time. Will she find the best rates online? No).

I’ll probably go with Plan G if the difference in a year’s premiums between it and Plan F is more than $147, and I’m sure it will be. (Comment: Plan N might be an even better choice)

The last thing I want is a long, drawn out conversation on the phone with someone attempting to explain things I always know. (Comment: That’s the last thing I want too).

I’m just simply looking for the best rates for Plan G or Plan F.  I’m familiar with Medicare and how it works.  My husband is already on Medicare.  I much prefer to search online and actually read article than have someone attempt to explain anything to me.  I will let you know if I do have further questions.

My response was simply to provide the best rates based on her data and wish her well.

I don’t know if she believes she can game the system and get a non-tobacco rate or not. That is not my concern since I closed her file.

I did quote non-tobacco rates, using a carrier that does not assess tobacco loads if you buy when you first turn 65 and go on Part B. The rates are accurate and lower than anything Susan can find online.

Based on her age, tobacco use and zip code she will probably pay at least $150 more per year than she needs to and that is just the first year. The carrier with the next best tobacco rate has a history of dealing higher than normal rate increases.

Medicare.gov is a great place to go if you want information on ALL the Advantage plans in your area, and ALL the Part D drug plans. In fact, I tell prospective clients to buy Advantage plans or drug plans by calling 1-800-MEDICARE.

But if they want accurate information on all the available Medigap plans in Georgia, they should talk to me. I have more information on Medicare supplement insurance carriers than Medicare does. And if you ever have a question AFTER you buy, give me a call.

You will get me or my voice mail.

You will never hear “Press 1 for English”.

 

UPDATE

A few weeks later I got another email from Susan, our online shopper that didn’t want to talk to anyone. She told me the best rates she could find for plan G were $115 from Aetna and $118 through Omaha. She wanted to know if these rates were good.

She completely ignored my email from a week earlier giving her a rate of $106 for plan G.

My response, “The rates are good. Pick the one you want”.

 

 

Medicare supplement or Medicare Advantage?

Which is the right Medicare plan for you?

That is something you need to decide once you have the facts and understand your options. My job is to educate you so that you have enough information to make the right choice based on your needs and budget.

I won’t tell you what to buy.

You will never be pressured into buying anything at any time.find medicare information

There is no charge for my advice. The carriers pay me when I assist you in finding the right plan based on your needs and budget.

Give me 5 minutes on the phone and decide if I can be helpful or not. That’s all I ask of anyone.

If you like what you hear, great. If not, no problem. Move on and I will close your file.

The rates and plans I show you are identical in every way to those you can get direct from carriers.

The difference is, you get the benefit of my 40 years in the health insurance business at no additional charge.

Call the carrier or 1-800-INSURANCE and you never know who will answer the phone or how much they know about Medicare.

Before you go any further, I suggest the following links.

The Secret Life of Medicare Advantage Plans

Don’t Buy a Medicare Drug Plan

Those two posts should answer many of your questions and put you on the track to finding the RIGHT Medicare plan.

You might also want to shop and compare GA Medigap quotes. Click the image below for an instant quote. No gimmicks.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

 

 

#Turning65Medicare #ChoosingTheRightMedicarePlan  #MedicareSupplementInsurance