Why Are Medicare Advantage Plans Popular?

Medicare Advantage plans seem to be popular. But why? What is the appeal? What is so attractive about these managed care plans? Are they really free? GA Medicare expert Bob Vineyard explains.

medicare advantage popular
Why are Medicare Advantage plans popular?

Why are GA Medicare Advantage Plans Popular

Are you turning 65 and confused about the Medicare process? Why is it so difficult? Why do my friends, and many agents as well, want to push me in the direction of an Advantage plan? Low premiums are attractive. So is “free”. Is there really such a thing as a free lunch?

Medicare Advantage plans are like the Hotel California. You can check in but you may never leave.

Some people turn to Advantage plans when they first go on Medicare at age 65. Low premiums, many are $0. Extra benefits like dental, vision and some have gym memberships. Drug plans are often included in the plan. “One stop shopping”.

What’s not to love?

Why do sick people leave Medicare Advantage plans?

Georgia Advantage Plan Traps

Have you ever bought something and later realized you had no idea how it works? Maybe the sales person forgot to mention key details that might have changed your decision.

If something is too good to be true it probably is.

There is nothing inherently wrong with GA Medicare Advantage plans. You just need to understand what you have signed on for. Here are a few questions you need to ask.

Preferably BEFORE you enroll.

  • Is the plan a PPO or HMO?
  • Do I need a referral to see a specialist?
  • Will my doctor take my Medicare Advantage plan?
  • Are there any out of network penalties?
  • Can I change plans at any time?
  • Can I return to original Medicare and a supplement plan if I want?
  • Does the out of pocket limit include prescription medication?
  • What will my health care really cost if I use an out-of-network doctor?
  • Will my claims be paid if I use a non-par provider?

If you ask the right questions and are satisfied with the responses, the Medicare Advantage plan could be just what you need.

When you enroll in a managed care Advantage plan, the insurance carrier, not Medicare, provides your benefits then reviews, adjudicates and pays your claims.

“No premium” plans are not free. You still have to pay for health care and prescription drugs.

There is no free lunch.

Health care is not free. SOMEBODY pays the bill. Either you or the insurance carrier.

But you knew that all along, didn’t you?

This Doesn’t Look Like Kansas Anymore

Managed care plans often have small provider networks. Fewer doctors. Fewer hospitals. The question is, how much smaller?

A Kaiser Foundation survey found that on average “Medicare Advantage plan networks included 46% of all physicians in a county.” Some plans had fewer than 5 thoracic surgeons, fewer than 5 neurosurgeons and fewer than 5 radiation oncologists.

This isn’t JUST about dollars. It is also about access to health CARE.

Each calendar year brings a new list of approved providers. Will your doctors be included or will they disappear into a dark hole?

Are you willing to change doctors to save money or pay more to keep your doctor?

Are claims submitted by non-par providers covered by your plan?

A recent government report says seniors are more likely to LEAVE managed care plans when they get sicker.

Managed care is great when you enjoy good health. But how much will your plan cost when your health changes dramatically? Can you really afford to be sick?

Medicare Advantage Final Exam

Many who enroll in a managed care plan never really understood how the plans work . . . until they had large claims. Don’t be one of them!

Do you like your current doctor(s)? Would you like to keep him or her?

Can my doctor refuse to treat me if I have a Medicare Advantage plan?

Do you want to direct your own health care, pick your own doctors and hospitals, or would you rather let an insurance carrier do that for you?

Is it easier for you to budget $120 per month to cover almost all of your health care costs or are you OK paying for your health care only as needed?

Could you budget $6,000 per year or more for your health care (not including drugs) if you had to?

How long could you afford to pay that much? One year? Two years? Longer?

Would you trade places with Marsha’s husband?

You can change your Advantage plan every year. Same is true for your drug plan. You can also enroll in original Medicare any time you want without answering health questions.

But if you want to change to a Medicare supplement plan you may need to prove you are healthy. Your best shot at getting a Medicare supplement plan is when you first enroll in Medicare Part B. If you wait until you NEED a Medigap plan you may not be able to get one. That is Catch-22.

Many will only have one chance to enroll in a Medigap plan. Will you be one of them?

Shop GA Medicare rates.

Medicare.

You have questions.

We have answers.

$GAMedicareExpert #MedicareAdvantagePlans #FreeMedicarePlans  #MedicareHMO  #MedicarePPO

Do You Want Fries With That?

Would you like fries with your Medicare plan? What do you know about those who offer advice about Medicare?

Picking a Medicare Plan is as Easy as Ordering Lunch

Picking a Medicare plan while blindfolded is what happens too often. Almost no one understands Advantage plans. Medicare drug plan deductibles? Who can explain that? Much easier to pick a plan without a deductible. You can’t go wrong there.

Medicare supplement plans are easy. All plans with the same letter are identical. Just go with the plan with the lowest premium. Right?

Maybe you will appreciate my Shop Like a Boss video, explaining how to search for Medicare information.

No need to ask an insurance agent. They cost too much.

Questions You Really Should Ask

How long has the agent or carrier rep worked the Medicare market? Maybe feel more comfortable talking with someone at Medicare.gov or a volunteer and a not-for-profit organization.

Surely they will be impartial?

Or will they?

Turning 65 Medicare Options

How does Medicare work?

Bob Vineyard explains in this Georgia Medicare Minute video

If you are turning 65 and enrolling in Medicare, this may be your only chance to purchase a Medigap plan. Here is your guide to understanding GA Medicare.

You don’t have to receive Social Security to enroll in Medicare insurance. CMS is the agency that oversees Medicare.

Senior healthcare insurance is commonly used to describe Medicare.

How to enroll in Medicare? You may sign up for Medicare 3 months before your 65th birthday, the month you turn 65, and 3 months following your 65th birthday. You may enroll online (highly recommended), by mail or by visiting a Social Security office.

Original Medicare has 4 parts.

Medicare Part A covers hospital inpatient charges and has a per admission deductible

Medicare Part B is for outpatient health care treatment. Doctor visits, labs, X-rays, MRI, CT scan (CAT scan), ambulance, ER, outpatient clinics, etc. Essentially any Medicare approved health care received outside the hospital setting. Treatment considered medically necessary under Medicare guidelines. Medicare Part B has a calendar year deductible. Once satisfied, Medicare pays 80% of the approved charge, you are responsible for the remaining 20%.

Most seniors worry about hospital stays, but your major expenses will more than likely fall under Medicare Part B outpatient expenses. Original Medicare stand alone has no cap on your out of pocket expenses.

You pay until you run out of money, get well or die.

Medicare Part C is now referred to as Medicare Advantage. More on that later.

Medicare Part D covers outpatient prescription drugs. Some Advantage plans have drug coverage built into the plan.

Medicare Supplement or Medicare Advantage?

Medigap and Advantage plans cover the same things, but what you pay out of pocket for your care, and where you receive your care, is very different.

Original Medicare does not have networks. You can use any doctor or hospital anywhere in the US. Another plus is the ABN form which is only used with Original Medicare.

Advantage plans are managed care plans. Some are PPO, some are HMO. In 2018 about half the plans are HMO with the balance being PPO.

If you receive non-emergency out of network care under a PPO you may have higher copay’s and deductibles. Your max OOP may also be higher. Some plans do not cap out of network charges.

Non-emergency out of network care charges may be denied if you have an HMO.

Medicare Questions – FAQ

How Much Does Medicare Cost?

In 2018 most Advantage plans issued in Georgia limit your out of pocket for approved in network health care expenses to $6700.

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.

Some cancer centers, such as Mayo Clinic, Sloan Kettering and MD Anderson may not participate in certain Medicare Advantage plans.

Medicare and Cancer

Not all cancer responds to chemotherapy, but 80% of cancers are treated with chemo. Those treatments occur in an outpatient setting and are covered under Medicare Part B.

Chemotherapy drugs administered in a doctor’s office or clinic normally fall under Part B. Medication from a retail pharmacy or by mail fall under your PDP.

This is why most of us chose a Medicare supplement plan in 2018. Bob Vineyard, independent Medicare insurance broker in Georgia, can explain your Georgia Medicare insurance options and will allow you to decide.

We represent several carriers including Aetna, Anthem Blue Cross, Humana and more.

According to the Mayo clinic, “new cancer treatments are routinely priced at over $100,000 per year of treatment.”

A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was “provider access problems”. Number 4 on the list was “cost sharing too high”.

Who is giving you Medicare advice? An experienced agent who is enrolled in Medicare or someone that works in a fast food restaurant?

#GeorgiaMedicarePlans #GAMedigapQuotes #Turning65 https://youtu.be/uMROeyRxqEI

Rich Man, Poor Man – a Tale of Two Scanners

It was the best of times. It was the worst of times.

Does where you receive medical treatment make a difference? If two different facilities use the same CT scanner shouldn’t the pricing be about the same?

Ben Hayden had a pain in his abdomen . . . so he went to see his doctor. To rule out anything serious, Ben’s doctor sent him to a free standing imaging center for a CT scan.

The radiologist didn’t see anything wrong on the images, and Ardesia didn’t recommend any treatment.

A few weeks later, Hynden, who has a high-deductible health insurance policy with Cigna, got a bill for $268. He paid it and moved on. – KHN

Then 3 months later the pain returned. Ben’s regular doctor was not available so he saw a nurse practitioner. Thinking Ben might have appendicitis, he was told to go to the hospital ER for a scan. Tale of Two Scanners

The results of the scan ruled out appendicitis but this time he had a different problem.

 

Two Scanners – Two Prices

A word of advice.

If you have a choice between going to the hospital ER for a CT scan, and a free-standing imaging center, choose the center.

“It was the exact same machine. It was the exact same test,” Hayden said.

The results were also the same as the October scan: Hayden was sent home without a definitive diagnosis.

And then the bill came.

Patient: Benjamin Hayden, 29, a adviser in Fort Myers, Fla.

Total Bill: $10,174.75, including $8,897 for a CT scan of the abdomen

Service Provider: Gulf Coast Medical Center, owned by Lee Health, the dominant health care system in southwest Florida

Quite a shock.

This time instead of owing $368 Ben’s share was $3,656, roughly 10x his share for the same scan 3 months earlier.

Click here for the rest of the story . . .

 

High Deductibles, Networks and More

Ben was only 29 years old and not on Medicare. But the outcome could have been the same under a managed care Medicare plan.

Over half the Advantage plans offered in Georgia are HMO’s. As long as you use a network provider your claims should be paid. But step outside the network and you could owe the entire bill. What happens if the provider who does your scan is not in network?

An exception could be made in the case of a life-threatening emergency.

But who decides if your case is a true emergency?

If the carrier decides against you, the claim is denied. Do you really want to take that chance?

 

 

 

 

Original Medicare and a Supplement Plan

Original Medicare does not have networks. You can use any doctor, any hospital, anywhere in the country. Never any penalties for using the wrong provider.

Even better, your out of pocket for a scan is limited to 20% of the Medicare approved amount. With a Medicare supplement plan (Medigap) your out of pocket cost could be less than $200.

Which makes more sense to you?

It was the age of wisdom. It was the age of foolishness.

HMO Advantage Plan

Medicare Advantage HMO plans have strict rules for Medicare beneficiaries. You must play by their rules or else your claim is not covered. This is a summary of the HMO rulebook.

  • You can only obtain care from an HMO approved doctor, hospital, lab or other participating medical provider
  • Your Advantage HMO will only pay for a specialist if you have a referral from your HMO PCP (primary care provider)
  • Some medical procedures require prior written approval from the HMO before they will be covered
  • You have limited rights of appeal if your HMO claim is denied

Bob Vineyard and Georgia Medicare Plans does not recommend Advantage HMO plans to our clients. We believe the choice and value from GA Medigap plans is superior to those offered by HMO plans.

Piedmont Wellstar Medicare Advantage 2016

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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.

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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

Medicare Advertising – What is Legal?

Medicare advertising kicks into high gear in the fall because of the annual open enrollment period. This year you open enrollment begins on October 15 and runs through December 7. You can expect your mailbox to be stuffed with all kinds of medicare mailmansolicitations and advertisements. Your email volume may pick up as well with promises of better coverage for less money.

How much is real? What is a come-on? Are some of them scams? Are insurance companies legally allowed to offer Medicare advertising for enrollment purposes?

Most of the people we talk to, that already have Medicare, are in the wrong plan, paying too much, or both. It doesn’t matter if you are turning 65 and going on Medicare the first time, or have been covered by Medicare and just got bad advise. We can help.

We offer instant online Medigap quotes. No tricks. Compare plans and rates side by side. Your information is never sold.

Medicare shop and compare

We have rates on more than 170 different Medicare supplement plans and will always give you the lowest rate by phone.

 

 

Medicare Advertising

I have been in the insurance business for 40 years and am always interested in staying on top of what is going on around me in
“my world”. I read news articles daily, subscribe to information on Medicare and Social Security, and continuously scour the web for anything that might be of interest to my clients.

have I got a deal for youJust today I received the following in a newsletter published by an “independent” Medicare adviser. Normally their information is spot on but this was just wrong on so many levels.

Dear Marci,

Last year around this time I started receiving a lot of notices in the mail advertising different health insurance plans for my Medicare coverage. I was overwhelmed by the amount of information I received, and I don’t want to experience that again. How can I sort through these notices and make sure that I am not being taken advantage of? How are insurance companies allowed to market their plans?

– Naomi (Pittsfield, MA)

Marci’s response follows in part.

Dear Naomi,

You are not alone—this is a common concern among beneficiaries. October 15 marks the beginning of Fall Open Enrollment, which is the time during the year when Medicare beneficiaries can make changes to their health care coverage. Starting October 1, Medicare Advantage Plans will start advertising their offerings for next year. While most plans abide by the marketing rules set forth by Medicare, not all plans do.

Some of Medicare’s marketing rules for plans are:

  • Unless you are already a member of a plan or have given permission, plans are not allowed to contact you in any way other than through the mail.
  • Plan names cannot suggest that the plan is preferred or endorsed by Medicare.
  • Plan representatives cannot approach you in public places, such as parking lots of malls. In health care settings, plans can only advertise in common areas such as cafeterias. They may not advertise in waiting rooms.
  • If you schedule a time to speak with an insurance broker about Medicare Advantage options, they cannot try to sell you products other than a Medicare Advantage Plan, such as a life insurance policy.
  • Plans cannot offer gifts worth more than $15. Further, they must provide the gift even if you do not sign up for the plan.

In addition to being aware of these rules, you should consider these tips to help avoid becoming the victim of marketing fraud:

  • Always verify all information you receive from an insurance plan representative. If a representative says that a particular doctor is in network, you should call the practice to confirm with the doctor.

  • Be aware of your right to choose how you receive Medicare coverage. Medicare Advantage Plan representatives should not tell you that Medicare Advantage is your only option.

  • If you are feeling pressured, you can tell the plan representative that you will follow up at a later date. This will give you time to make your decisions.

  • Use government websites and official sources of information.

All of the above is good and helpful information, except it is not 100% correct.

The marketing rules above apply only to Medicare Advantage and Medicare drug plans.

Medicare advertising for supplement plans (Medigap) or about Medicare in general are not subject to the same rules and guidelines.

That being said, just because governance over Medigap advertising is somewhat relaxed does not mean carriers and marketers are free to say anything they wish.

 

Medicare Open Enrollment

Does the Medicare open enrollment affect you?

In some cases, yes.

If you have a Medicare Advantage plan or Part D prescription drug plan, welcome to open enrollment. In most cases you can change your Advantage plan without medical underwriting. There is never any underwriting for Part D.

Medicare supplement plans can be changed ANY time, not just during open enrollment. Unless you are a new enrollee, you will probably have to pass medical underwriting before you can make a change.

Just about everything you need to know about open enrollment can be found in our featured post, Medicare Open Enrollment 2015.

I suggest you click the link and take notes.

 

Are You Being Scammed?

Is the Medicare advertising misleading? Maybe, maybe not. Use common sense.

While perfectly legal, the Medicare Advantage literature quite often makes a big deal about $0 premium but (in my opinion) falls short in explaining the true cost of MA plans.car salesman scam

Advantage plans are great until you use them, then they can get quite expensive. That is usually when I get calls from people who say they can’t afford their $0 premium plan any more.

What they are really saying is they can’t afford to pay their medical bills. Unfortunately when it gets to that point they probably can’t qualify for a Medigap plan.

Here are a few things to watch out for if you are enrolling in Medicare for the first time or considering making a change.

Medicare Advantage –

  • Look for your doctors and hospitals in their provider directory
  • Find out if you need a referral to see a specialist
  • What is the penalty for using out of network (non-par) providers?
  • What is your in-network maximum out of pocket?
  • What is your out of network out of pocket maximum?
  • Do your drug copay’s change?
  • Are all your drugs on the formulary?

Medicare Part D –

  • Do your drug copay’s and deductibles change?
  • Are all of your drugs on the formulary?

Medicare supplement –

  • Don’t buy plan F
  • Don’t cancel any existing coverage until you know you have been approved by your new carrier
  • Don’t buy a Medigap plan based on price alone
  • All plans with the same letter pay claims and pay them on time
  • The only difference is the premium you pay
  • Never buy direct from the carrier
  • Use a local Georgia agent that knows the market

When shopping online bear in mind that most of the sites you go to are marketing sites. They gather your information and sell it to multiple agents.

When you get a quote from Georgia Medicare Plans your information is never sold. You get instant, online Medigap quotes. You will also get one phone call from me, usually within 48 hours.

I only call once. I will answer your questions, give you the best rates on plans in your area and give them over the phone.

No pressure. No tricks. Shop and compare now.

Medicare shop and compare

 

 

#MedicareOpenEnrollment #MedicareAdvertising #MedicareAdvantage #MedicareSupplementInsurance

 

Medicare and Diabetes

Does Medicare pay for diabetes treatment? How about diabetic supplies? Will my Medicare plan pay for insulin? How can I save money on my diabetic prescription drugs?

If you have diabetes, you need a good Medicare plan that will cover most of your out of pocket costs for care and allows you the freedom to choose your own doctor. Once you find a doctor that can help you regulate your sugar levels, you don’t need to be forced into changing doctors every few years.

This means finding a good Medicare supplement (Medigap) plan you can keep as long as you live. With over 170 different Medigap plans in Georgia, we can help you find the one that fits your needs and budget.

Instant GA Medigap quotes online. No waiting. We never sell your information.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

Shop and compare now.

 

Medicare and Diabetes

If your diabetes has been under control for most of your life, consider yourself fortunate. I have friends that are diabetic, both type I and type II. Some have lived most of their life without major issues. Others have not.diabetic

Consider this. According to the Diabetes Care Project

  • 26 million people in the US have diabetes
  • 79 million have “pre-diabetes”, 7 million have UNDIAGNOSED diabetes
  • More than 90% of diabetics are type II and obesity contributed to most of those cases
  • The US spends $174 million each year to treat diabetics; $119 million in direct health care costs
  • $1 out of every $3 spent by Medicare is to cover the cost of care for diabetes
  • Diabetics have medical expenditures that are more than 2x that of non-diabetics
  • The average annual cost of care for diabetics is $13,700 with $7,900 of that tied directly to the disease
  • The costs of treating diabetes rose 41% from 2007 to 2012

The longer you have diabetes, the greater chance you have of incurring high medical costs and complications. This is not the time to manage your illness and out of pocket costs with a Medicare Advantage plan.

 

Medicare Coverage forDiabetes Treatment

Original Medicare Part B covers the cost of testing equipment and supplies, insulin pumps and therapeutic shoes.

Part B also covers regular screening, diabetes self management training, nutrition therapy services, A 1c and glaucoma testing and much more. Check out Publication 11022 for more details.

medicare diabetesOral medication and self injecting insulin (not for a pump) are covered by Medicare Part D.

Don’t get sucked into the deals that promise free diabetic supplies. If you get an unsolicited call offering FREE diabetic supplies, hang up. Diabetes Health has this to say.

Scammers often pose as federal employees or workers representing legitimate diabetes associations. They’re looking for Medicare and Social Security numbers, as well as other financial information, that they can use fraudulently on their own behalf or sell to criminal syndicates.

Fraudsters that actually do send diabetes supplies send supplies that are inferior in quality, and then turn around and fraudulently bill Medicare for the order. “Free” supplies offered include glucose meters, diabetic test strips, and lancets, as well as such items as heating pads, lift seats, foot aids, or braces.

If you get such a call, immediately hang up and call the fraud hotline (1-800-HHS- TIPS, 1-800-447-8477)

 

Medicare and Prescription Drugs

The weakest link in the Medicare program is Part D, the prescription drug plan. Nowhere is it more obvious than when it comes to covering the cost of diabetic drugs.

Insulin can be very expensive, especially if you use a pen instead of a needle. The NovoLog patient assistance program can be a financial lifesaver for those who qualify.

Other PAP’s (Patient Assistance Programs) are another option.

We will review PAP’s in more detail in a future post.

 

Don’t Pay Too Much for Your Medicare Supplement Plan

Almost every day we talk to people who have bought the wrong Medicare plan for their needs, are paying too much, or both.

We recently compared plans for a lady who lived in zip code 31630, was turning 65 and going on Medicare. After talking with her friends she had decided to buy plan F from either Blue Cross or United Healthcare (through AARP). She was told that plan F  “pays everything” (which is true) and that she should go with a big carrier that will pay all her claims.woman shaking fist

Of course no one told her that ALL the carriers pay 100% of the contractual claims approved by Medicare. The normal claim process is your doctor files with Medicare, Medicare approves the claim, your supplement plan pays their portion.

A routine claim will take a couple of weeks with Medicare and about another week with the Medigap carrier.

Any doctor that participates in Medicare will also accept ANY Medigap plan, regardless of the issuing carrier.

Blue was going to charge this woman $168 per month. She could save a few dollars with the AARP/UHC plan F for $166.

But she can save even more by using a carrier I represent that will pay her claims in the same manner as Blue and UHC but with a monthly premium of $126 per month. That $40 per month savings adds up quickly!

Maybe she should consider new friends.

Better yet, introduce me to her friends so they can save money too.

Medicare shop and compare

Diabetes can be expensive. Let us show you a number of ways to minimize your out of pocket costs.

 

#MedicareDiabetes #Insulin  #DiabeticSupplies  #MedicareSupplement #MedicareAdvantage

Georgia Medicare Supplement Rates Increase

Georgia Medicare Supplement rates increase less than 10%, but not by much. Most Medigap plans have limited premium increases to less than 10% for the last few years. Two of our preferred carriers raised rates by 4% (Equitable) and 3% (New Era). BCBSGA increased some rates in January while lowering the other rates. Continental Life (Aetna subsidiary) is withdrawing from the Georgia Medicare supplement market and simultaneously increasing rates for new and existing policyholders by up to 9.5%. medicare supplement rate increases

Double digit renewals have declined medicare supplement rate increases since 2010. Rate changes on new business have also declined to the 5% range. Prior to 2012 Medigap rate adjustments of 10% to 15% or more were common, especially for the “big name” carriers.

Is now the time to change and lock in low rates?

 

Georgia Medicare Supplement Rates

Females generally pay lower rates than males. If you live in a rural area your rates will typically be less than the same plan in Atlanta, Macon, Savannah or Augusta. Tobacco users pay more than those who do not use tobacco. georgia medicare disenrollment

Medigap plan F still remains the most popular plan but it is also overpriced compared to plan G or N in most situations. Even if you find a “bargain” on Medicare supplement plan F the pricing advantage will most likely be lost on renewal.

There are a few exceptions.

We have carriers with very competitive rates for plan F in the following areas:

Zip 302 – Fayetteville, Jonesboro, Griffin, Hampton, Jackson, Jonesboro, Lagrange, McDonough, Morrow, Newnan, Peachtree City, Sharpsburg, Stockbridge, Thomaston, Conley

Zip 304 – Swainsboro, Claxton, Lyons, Metter, Millen, Pulaski, Statesboro, Vidalia

Zip 305 – Gainesville, Alto, Baldwin, Blairsville, Blue Ridge, Buford, Clayton, Commerce, Dahlonega, Dawsonville, Ellijay, Helen, Hiawassee, Hoschton, Martin, Mineral Bluff, Toccoa,

Zip 306 – Athens, Bethlehem, Bogart, Bowman, Hartwell, Hull, Monroe, Tignall,

Zip 307 – Calhoun, Chickamauga, Dalton, Flintstone, Resaca, Ringgold, Rising Fawn, Rossville, Ft Oglethorpe, Tennga,

Zip 310 – Bolingbroke, Bonaire, Vienna, Cordele, Cochran, Dublin, Eastman, Fort Valley, Kite, Knoxville, Lizella, Milledgeville, Monticello, Oglethorpe, Warner Robins

Zip 315 – Waycross, Baxley, Brunswick, Douglas , Folkston, Jesup, Kingsland, Nahunta,

Zip 316 – Valdosta, Adel, Boston,

Zip 317 – Albany, Americus, Camilla, Fitzgerald, Leesburg, Moultrie, Thomasville,

Zip 318 – Pine Mountain, Warm Springs, West Point

Zip 319 – Columbus

Zip 398 – Bainbridge, Blakely, Cairo,

If you live in the zips listed above and have a Medigap plan F we can probably save you a lot of money.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices

We have access to over 170 different Medicare supplement rates in Georgia. You will almost certainly save money when you allow us to help you shop the market.

 

Medicare Advantage surprise

Valerie bought a Medicare Advantage plan from a nice lady that came to her house and explained the benefits of having your medical and drug plan under one policy. Your new policy allows you to use a number of doctors and hospitals in their PPO network and you don’t have to worry about finding a Medicare drug plan.

confused senior medicareThe glossy brochure with smiling faces was reassuring to Valerie but she was concerned about the copay’s.

Don’t worry, she was told. Your copay’s are only $15 – $45 and most people don’t go to the doctor that much.

(Apparently the agent failed to notice Valerie was sitting in a wheel chair).

But what about my hospital stay’s? I was admitted twice last year.

No problem. You only owe for the first 7 days then nothing.

Valerie wanted to know if her medications were covered.

The agent looked over the list. “All but two are generic and will be covered. Your insulin is covered too but it isn’t generic”.

Valerie still felt a bit uneasy but enrolled any way.

The first time she filled her medications she was shocked to discover her medications (all 23 of them) were going to cost over $700 for a 30 day supply. Further, she found out that 3 of her med’s were not on the plan formulary.

She had no choice but to hand over her credit card. She needed the medications to live.

Fortunately she was in the Medicare Advantage disenrollment window when we talked. I suggested replacing her Medicare Advantage plan with original Medicare, Medigap plan F and a separate drug plan.

Valerie’s Advantage premium was $52 per month + copay’s.

The Medigap was going to run $120 per month but no copay’s. The drug plan added another $52 to her monthly premium but cut her drug costs by $500 per month!

Don’t get trapped in a plan you cannot afford.

 

Medicare Advantage disenrollment period

From now through February 14th you may elect to disenroll from your Medicare Advantage plan. If you are disappointed in medicare disenrollment periodyour current Medicare Advantage plan for any reason you may disenroll from that plan and enroll in original Medicare. You may also qualify to enroll in a stand alone Medicare Part D drug plan.

In some situations you may qualify for a Medicare supplement plan without medical underwriting.

 

 

#MedicareAdvantageDisenrollmentPeriod    #MedicareSupplementRateIncreases

How Obamacare Impacts Medicare Advantage Plans

Obamacare affected under age 65 health insurance but left Medicare alone. That popular belief is incorrect. Obamacare (ACA) which-medigap-is-best2reduces funding for Medicare plans and cut’s reimbursement to carriers. Taxpayer subsidies to “poor” people (those earning less than $95,400 for a family of 4) are funded in part by cut’s to the Medicare program. These funding cuts amount to $700 billion from 2013 through 2022.

Depending on which side of the aisle you are on determines whether you refer to these cuts as lower funding or savings.

No matter what you call it, the federal government will spend less on Medicare each year in order to fund Obamacare for the “working poor”.

 

Obamacare impacts how Medicare Advantage carriers are paid

According to Benefits Pro as of January 2015 20% of the Medicare cuts have been implemented and retirees are paying more for their Medicare Advantage plans. These higher costs come as

  • higher premiums
  • higher copay’s
  • higher deductibles
  • higher out of pocket
  • smaller networks
  • more HMO’s
  • fewer plan choices

senior-scratching-headMost Medicare plans began receiving less pay in 2012 but the cuts are to be phased in from 2012–2017, so we have a ways to go yet.

Under PPACA, plans also can qualify for a bonus payment for providing better care. Plans have to report data detailing how many of their members are routinely getting preventive care under the plan, as well as how many get additional support in managing chronic conditions such as diabetes. Plans receiving higher star ratings get higher bonuses, with the desired result being that the bonus program will encourage plans to focus on delivering a higher quality of care, thus increasing the value of the health care dollars spent by consumers.

There is only one 5 star plan in Georgia. Most are 3 to 3.5 stars and several do not qualify for a star rating.

 

Benefit changes because of Obamacare

Original Medicare as well as Medicare Advantage plan have certain benefits that must be included in all plans. “No charge” annual preventive exams are now the norm as are “lifestyle” counseling and information pamphlets. medicare-age-65-enrollment2

But Medicare Advantage plans have had a more drastic makeover than original Medicare and Medigap plans.

PPACA also introduced a new mandatory cap for all Medicare Advantage plans designed to cut member costs. The cap limits the total out-of-pocket costs a member can incur for Medicare covered services each year. The limit is set to $6,700 in-network right now, which is substantially lower than limits many plans had before the law and thus results in higher spending by the plan.

Most plans now have out of pocket maximums of $6700 for charges by par providers. These charges can run significantly higher when you use non-par providers. This is considerably higher than the average max OOP of less than $4,000 from just a few years ago.

Compare that with less than $150 OOP for our most popular Medicare supplement plan AND no networks. Our second most popular plan has less than $500 OOP (and often less than $300) and features premiums that are about 20% lower.

 

Georgia retirees in rural counties hit the hardest

The number of Medicare Advantage plans available to those living  in outlying counties shrinks every year. In the last few years at least 7 rural hospitals have closed, at least in part because of Obamacare.

  • Folkston – Charlton Memorial Hospital
  • Richland – Stewart-Webster Hospital
  • Hartwell – Hart County Hospital
  • Glenwood – Lower Oconee Community Hospital
  • McRae – Telfair Regional Hospital
  • Arlington – Calhoun Memorial Hospital
  • Eastman – Dodge County Hospital

stewart webster hospital smallOther hospitals like Ty Cobb in Lavonia may be shuttered before too long. CMS rules for Medicare Advantage plans require them to have a specific number of doctors and hospitals under contract in a given area before they are allowed to offer a plan. As regional hospitals close your choice of Advantage plans also dwindles.

Retirees in rural areas face higher premiums and PPO plans are being replaced with more restrictive HMO offerings. In some areas Advantage premiums of $50 – $70 per month (or more) are becoming quite common.

For a few dollars more you can have a Medigap plan, not have to worry about networks and have considerably less out of pocket.

Georgia Medicare Plans specializes in low cost Medicare supplement plans and tailoring a drug plan to fit your needs. Our average client saves over $1,000 per year in out of pocket drug costs. We showed one client how to save over $6,500 per year in premiums and OOP costs.

Don’t get tripped up by Obamacare changes to Medicare Advantage plans. Let us help.

Georgia Medicare supplement rates

 

#Obamacare  #MedicareAdvantage  #Medigap

 

Do I Need a Medicare Supplement Plan and Medicare Advantage?

Medicare supplement and Medicare Advantage. What’s the difference? Do I need both? What is the difference in Medigap and Medicare supplement? Do AP20C7Advantage plans have more advantages? Can I change plans every year during open enrollment?

Which plan is better? Should I have an Advantage plan or Medigap?

That is a question only YOU can answer.  Consider the differences and then decide which plan fits your needs and budget.

Are you turning 65? Do you need help navigating the Medicare maze?

Call us. We can help.

 

Medicare supplement and Medicare Advantage

What is the difference?

A lot.

Do I need both a Medicare supplement plan and an Advantage plan?

Nope. Even if you wanted both, Medicare says you can’t have both.

So pick one or the other.

 

Medicare supplement plan F rates

What is the difference in Medicare supplement and Medicare Advantage?

Medicare supplement plans work with original Medicare.

  • No networks
  • Use any doctor, lab or hospital anywhere in the U.S.
  • Referrals not necessary to see a specialist
  • Keep your current doctor(s)
  • Your doctor cannot be dropped from the plan mid year
  • You can keep your plan every year.
  • Annual review not needed (for your supplement plan)
  • Out of pocket is clearly outlined and can be budgeted
  • Pick a drug plan that covers the drugs you need

 

Is Medicare Advantage Better?

The advantages of a Medicare Advantage plan are, the monthly premium is lower.
The disadvantages are:
  • you are limited in most cases to docs and hospitals in the network
  • the Rx is often paired with the plan and may not include the meds you need
  • your doctor can be drop out of the plan at any time
  • you may have to change your plan every year
  • you have to review the plan every year (participating network providers, meds, cost of health care, etc)
  • your out of pocket for in network only claims is almost always higher than Medigap
  • your out of pocket cap averages $6,700 (most 2018 plans) + out of network claims + Rx copay’s
  • you can find yourself out of network and incur penalties any time, anywhere
But other than that, the Advantage plans are great until you use them.

Can I change plans every year during open enrollment?

Medicare supplement plans do not have annual enrollment periods. When you first turn 65 you can purchase any Medigap plan with any carrier, no questions asked.
Medicare Advantage plan and Part D drug plans can be changed every year, but only during open enrollment. Most retirees will change their Advantage and Medigap changedrug plan every year or so, whether they want to or not. Each year the plans change and you MUST review to make sure you are not going to pay more for your health care than you expected.
Never ever take the “automatic” renewal option. Always ask your agent to shop and compare plans for you every year.
One of my Part D clients was prepared to take the automatic renewal from Cigna. Their new rate was dropping a few dollars and other than the addition of a deductible, the plan seemed like a good buy.
What they did not know (until I reviewed it for them) was this.
The renewal plan did not include all of her medications.
The renewal offer was $7 less than the Cigna plan I suggested but the difference in her out of pocket costs was significant.
Her expected annual prescription drug cost for the renewal offer was $2880.
The projected drug premium for the plan that was $7 higher but her annual prescription cost was only $1530. That additional $7 monthly premium saved her more than $1300 in out of pocket drug costs.
Had she accepted the automatic renewal she would have saved $84 in premiums but would have paid out more than $1300 for her medications.

Comparing Medigap plans is easy

Kind of.
Benefits are standardized and assigned a letter of the alphabet from A through N.
But Medicare only uses 9 of the letters
Medicare supplement plan F is the most popular. Also the most expensive and most oversold.
Plans G and N offer exceptional value.
Some carriers don’t offer all the plans.
AARP/United Healthcare does not off plan G. Neither does Blue Cross of Georgia (BCBSGA). Nor does Humana.
Mutual of Omaha (Omaha Insurance Company in Georgia) does not offer plan N. They did at one time, but not any more. Makes you wonder why, doesn’t it?
We never recommend a plan that does not have at least a 5 year renewal rate history.  That is to protect you.
Manhattan Life and Omaha Insurance Company have only been offering Medigap for a little over a year. Same for Companion Life.
There are over 250 different Medigap plans in Georgia. We have Medigap rates you won’t see anywhere else, but you can start your online shopping experience by clicking this button.

Georgia Medigap plans & Prices

Georgia Medigap plans & Prices