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HMO vs PPO

How do HMO and PPO Plans differ?

There are many choices to make when it comes to your health insurance. You may be familiar with the terms HMO and PPO.  You may not know what the letters stand for or what the differences in the plans are.  Let’s start by telling you what these initials mean.  An HMO is a Health Maintenance Organization.  A PPO is a Preferred Provider Organization.  We will give some information about HMO vs PPO plans in this post. Note: Medicare Advantage plans also have HMO and PPO plans designs.  The information is applicable to Medicare MA and MAPD plans as well.

We have listed some information about each type of plan below:

The decision to choose one health care plan over another depends on many factors.  These factors include your health, your budget and the network of providers available for each plan.

Click here for information about choosing the right Medicare Plan

If you would like more information about choosing a Medicare health plan, please contact us.

You can reach us either by phone (203)796-5403 or by email teal@croweandassociates.com.

Medicare & You eHandbook

If you want the most up-to-date, accurate Medicare information, you need the Medicare & you eHandbook.  Sign up by May 31, 2019 to receive your downloadable copy.  Just click the following link to sign up:

Sign up to get the “Medicare & You” eHandbook.

If you don’t like to have paper clutter all over the house, Medicare will email you this fall as soon as the eHandbook is available. You will also receive an email notification when there are major updates; such as cost changes.  This way you will always have the latest most accurate information.

This a quick and convenient way to find the answers to your Medicare questions.  You will receive important update notifications by email.  You can use the search tool to find what you are looking for easily.  It only takes a few minutes to sign up for this useful tool.

If you need to sign up for Medicare, learn how to do it quickly on line click here.

Need help with Medicare questions?  Please feel free to contact us either by phone at (203)796-5403 or by email at teal@croweandassociates.com.  We are happy to help youfeel confident with your Medicare choices. There is no cost to speak to a licensed agent who can help you navigate Medicare.

If you would like to quote Medicare plans, click here for Advantage, Supplement and Part D plan quotes

Compare Medicare plans

Medicare beneficiaries will feel confident with their choice when they have the option to Compare Medicare plans.

Most people feel overwhelmed when the time comes to enroll in a Medicare plan.  There are a lot of options available whether you are new to Medicare or changing plans during one of the election periods. 

There are couple options when it comes to choosing how to get your Medicare coverage:  

The First option is to take Original Medicare; this means Part A and Part B. If you decide to do this, you have the ability to add a Medicare supplement plan/Medigap plan as well as drug coverage or Part D.  These plans provide additional coverage when paired with original Medicare.   Medicare supplement plans pay the additional 20% of your Medicare approved costs that Medicare does not pay.  These plans do not require you to choose a network of providers and are offered by Medicare approved, private insurance companies.  You can use them with any provider who participates with Medicare.  You do not need referrals to see any doctor or specialist.  

Another option is to choose a Medicare Advantage Plan/Part C.  A Medicare advantage plan includes both Part A and Part B coverage. They take the place of your original Medicare coverage. These plans are offered by Medicare approved private insurance companies.  The Plans also require that you use a provider who participates in your plan’s specific network.  These companies offer either HMO or PPO plans.  Most of them also offer prescription drug coverage as part of the plan. 

CLICK HERE TO COMPARE MEDICARE PLANS

 You may be eligible to receive help paying for your Medicare coverage if you have limited income:

If you are within the eligible income level you may qualify for Medicaid.  Medicaid is both a federal and state program that provides help with medical costs.  There are also MSP programs sponsored by the state government that can help you pay medical expenses.  These programs help pay medical expenses such as; premiums, co-pays and prescription costs as well as deductibles.

Medicare also works with other types of health care coverage you may have such as, employer, union or veteran’s benefits.

There are many things to think about when it comes to your health.

We understand the importance of finding the right health care coverage to fit your individual needs and budget.  We are always happy to help you find the best plan for you.  You can reach us either by phone (203)796-5403 or by email at teal@croweandassocites.com.

Need to sign up for Medicare: Click here

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You Medicare Supplement plan comparison

One you are ready to sign up for Medicare you might want to do a Medicare Supplement plan comparison.  This will help you find the best coverage for your health care needs as well as your budget.

If you are thinking about signing up for Medicare there are many factors to consider.

Those factors will most likely include whether or not you would like to sign up for a Medicare supplement plan.  These plans are a great tool to help provide you with additional health coverage after your original Medicare Part A and Part B pays their part of your approved medical costs.  A Medicare supplement plan will help you pay the 20% of your approved medical expenses that Medicare does not cover.

If you want to sign up for Medicare on line; click here for information

Medigap is another name for a Medicare supplement plan.  The plans a regulated by the federal government and must all offer uniform coverage.  Many different insurance companies are licensed to offer these plans.  That is why you should always do a Medicare supplement plan comparison.  Although the plans offer the same basic coverage, they differ in price and extra coverage options.

Here are a few good reasons to consider a Medicare Supplement plan:

They provide extra coverage for your approved medical expenses.

You can go to any provider who accepts Medicare, that means there is no provider network to worry about.

You do not need to get a referral if you choose to go to a specialist; as long as the provider participates with Medicare.

When you travel anywhere in the U.S. you still have medical coverage.

These plans are guaranteed renewable, as long as you pay your premiums.

CLICK HERE TO COMPARE MEDICARE PLANS

Please contact Crowe and Associates either by phone (203)796-5403 or email at teal@croweandassociates.com if you would like assistance with signing up for Medicare or choosing additional health care coverage.

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Compare Medicare supplement plans

When you are getting ready to sign up for Medicare, you should compare Medicare supplement plans to ensure you get the best coverage for your needs.

What is Medicare supplement insurance:

CLICK HERE TO COMPARE MEDICARE SUPPLEMENTS

Because the plans are standardized by the government, the best way to find the right carrier for your needs is to compare the plans side by side.  This way you can choose a plan that offers the cost and extra benefits that best fit your needs.

Click here to sign up for Medicare on line

Please contact us if you would like help in choosing the best Medicare coverage options for you.  You can reach us either by phone at (203)796-5403 or by email at teal@croweandassociates.com.

What is a High Deductible F Plan

If you are ready to take your Medicare benefit, you might want to know; What is a High Deductible F Plan.

Although the High Deductible Plan F 2020 will not be available for new beneficiaries, there is a similar plan called Plan G.  Plan G has most of the same coverage benefits as Plan F, with the exception of the plan B deductible payment.

Humana over the counter catalog

If you are a member of Humana, you will want to know how to get your Humana over the counter catalog.  Please remember, only some of the Humana plans have an OTC benefit.

For an OTC order form, Click here.

If you have questions about how to use your OTC benefit, you can call Humana Pharmacy at 1-855-211-8370.  There are Customer Care representatives available from Monday to Friday, 8 a.m. to 11 p.m.  They are also available on Saturdays from 8 a.m.  until 6:30 p.m., Eastern time. 

There are a few ways to order your OTC items:

You can order by Mail.  Just Fill out the Health and Wellness Products Order Form (download a copy here) send the order form to:
Humana Pharmacy
PO Box 1197
Cincinnati, OH 45201-1197

You can Fax your order into Humana. Once you download and fill out the order form, fax the pages to 1-800-379-7617.

How much is the OTC benefit allowance?

Compare Medicare Advantage plans

If you are new to Medicare, you should Compare Medicare Advantage plans to find the one that fits you best.  Some people refer to Medicare Advantage plans as either Part C or MA Plans.  These plans are used as an alternative to original Medicare.  If you choose to participate with a Medicare Advantage plan, you do not lose your Medicare benefit.  These plans include your Medicare Part A and Part B and in most cases a prescription drug plan or Part D.

How does a Medicare Advantage Plan work with Medicare:

Private insurance companies must have their plan approved by Medicare before they can offer them to clients.  Medicare has very strict guidelines that insurance companies must follow.  Once Medicare approves the plan, Medicare will pay a certain amount to these insurance companies every month for your care.

Every plan has different charges, costs and rules for services you receive.  Some plans require you to get a referral before seeing a specialist and weather or not you have to go to certain approved providers for your medical care for non emergency care.  Insurance companies change there policies every year.  That means you should check your policy each year during open enrollment to be sure it is still the best option for you.

Compare Medicare Advantage plans to be sure what services are covered:

Although Medicare Advantage Plans cover all the services that original Medicare approves, some Medicare Advantage plans offer additional extra coverage.  The options can include things like; vision, hearing and dental coverage.  The cost for each plan also varies depending on the company you choose as well as your location and a few other things.  Click here for more cost information.

Click here to compare Medicare Advantage plans in your area.

Medicare Advantage plan prescription drug coverage:

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What is Medicare Part D

If you are thinking about signing up for Medicare, you will need to ask the question; What is Medicare Part D.  Medicare Part D is prescription drug insurance.  This insurance will cover your medication needs. If you choose a Medicare Part D plan, you will pay a monthly premium to an insurance carrier for your coverage. The insurance carrier will send you an ID card to use at your  insurance provider’s network of pharmacies to fill your prescriptions. In most cases, you will not pay full retail price for your medication, you will pay a copay (a percentage of the drug’s price).  And, the insurance carrier pays the remaining balance.

The federal government controls the Medicare Part D program:

Medicare Part D is administered through private insurance companies. These companies provide beneficiaries prescription drug coverage. This program began in 2006 and offers Medicare recipients a valuable benefit that saves them thousands of dollars on medication each year.  Beneficiaries can choose 2 ways to receive this benefit.

1.  They can enroll in a standalone prescription drug plan along with a Medigap/Medicare Supplement plan.
2.  Or, they can choose a Medicare Advantage(Part C) plan that includes prescription drug coverage.

All Medicare Part D plans must follow guidelines set by the federal government.  This means, every insurance carrier who participates must submit it’s plan to the CMS/Centers for Medicare and Medicaid Services.  The carriers have to do this every year to have their plans approved before they can offer them to clients.

Each year the drug plan providers make changes to benefits; this includes the formulary, in network pharmacies, providers as well as costs.  The changes go into effect on January 1st.  Be sure to check your coverage during open enrollment every year.  This is important if you need to change your insurance provider.  If you do not check, it could end up costing you a lot.

Find the best prescription drug plan for you, click here

If you need help finding the right plan for you, please contact us either by phone at (203)796-5403 or by email at teal@croweandassocites.com.

Click here to sign up for Medicare A & B

Looking for a Medicare Quote?   Click here to Quote, Compare and Apply!

Agents

If you are an agent looking to work with an FMO, click here to see what we offer.

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Anthem OTC catalog

This post will give you the information you need to access the Anthem OTC catalog. That way you can use your OTC benefit. Beneficiaries can use the benefit to purchase certain non-prescription, over-the-counter items such as; vitamins, pain relievers, first aid supplies, and orthopedic support braces, as well as other items to help with minor health concerns.  You can use the benefit one time each quarter.  Any benefit that you do not use during the quarter, will not rollover to the next quarter.  If you do not use the entire OTC benefit amount for the year it will not roll over to the next calendar year.

THIS BLOG HAS BEEN UPDATED – CLICK HERE FOR UPDATE

If you are a member of  a participating Anthem Medicare Advantage plan:

You will receive an OTC card.  This card is called Healthy Benefits Plus.  This card is used for select over-the-counter item purchases. Beginning in January 2019, beneficiaries can use this benefit to purchase OTC supplies in Walmart stores and in a few states, such as California, New York and new Jersey you can shop in CVS stores.

To get a copy of the OTC catalog, just call the customer service number on your member ID card

There are a few ways to order over the counter items.

1.  In-Store – to use your OTC card in store, simply purchase eligible items and use the card as your form of payment 2.  Order items online either at Walmart.com or in the App.  You must first download the app to use it. If you want to place an order online at Walmart.com, once you create an account you can sign in and place items in you cart and then check out using your OTC card number as a gift card for payment. 3.  You can call 866-413-2582 to place an order by phone.

When can you collect Medicare

There is one important question many people need the answer to; When can you collect Medicare.

When can you collect Medicare:

If you are going to turn 65, you should plan to sign up for Medicare.  You are eligible to receive Medicare at the age of 65.  In fact, if you delay your enrollment you will be charged a penalty that will last the entire time you receive Medicare benefits.  If you are disabled you can sign up for Medicare any time otherwise, you must be 65 years old to receive Medicare benefits. Unfortunately, many people think you can get Medicare when you are eligible for Social Security benefits. Unfortunately, if you retire early at age 62 you still have to wait until 65 to claim Medicare benefits.

You can sign up for Medicare three months before you turn 65 and for the 3 months after. If you already receive Social Security benefits, you will automatically be enrolled in both Medicare Part A & B the beginning of the month you turn 65.

There are many choices to make when you sign up for Medicare:

Medicare has four main parts:  The first part is Medicare Part A, Part A  covers hospital stays.  Second is Medicare Part B , Part B covers doctors fees and medical expenses.  The third part is Part C also know as; Medicare Advantage. If you choose to use a  Medicare Advantage plan, it will take the place of both your Medicare Part A as well as Part B. This means it will cover hospital care and doctor visits. The last part is Part D. Part D covers prescription medications. There are also plans called Medigap or supplements that you can purchase to help pay the 20% of Medical costs that Medicare A & B do not cover.  So you can cut down or eliminate your out-of -pocket expenses.

If you are still working and receive health insurance from an employer:

You may not need to sign up for Medicare Part B immediately. It is important to meet with your employer to find out whether the employer’s plan is the primary insurer. If you will have Medicare, for your primary insurer, then you need to sign up for Part B. Either way, you still need to sign up for Part A.  This can help with some of the costs your group health plan does not cover.

If you don’t have employer health insurance, or when your employer coverage is secondary to Medicare, you must enroll in Medicare Part B during your initial enrollment period.

Important;  Medicare does not consider Cobra, retiree coverage or VA benefits as a health insurance plan.  In order for a plan to be considered health coverage by Medicare, you must be actively working for an employer with 20 or more employees.  You must either have an approved health plan or you must sign up for Medicare Part B in order to avoid penalties.

If you delay signing up for Part B:

You will be subject to a penalty of 10%  for every year you were eligible and did not sign up for Part B benefits. In addition, you will have to wait for the general enrollment period to enroll. The general enrollment period starts  January 1 and goes to  March 31 each year. If you enroll during this period, your coverage will begin on July 1.

When can you collect Medicare, Medicare Part C, also called Medicare Advantage:

Before you enroll in Part C /Medicare Advantage plan, you must be enroll in Medicare Parts A and B. Medicare Advantage Plans provide all of your Part A and Part B coverage.  Some of these plans offer options, such as vision, hearing, dental, and wellness programs such as discount gym memberships. Many of these plans include Part D/prescription drug coverage.

After you consider deductibles, copays and exclusions, There are a good portion of medical expenses that Medicare does not cover. Medigap or Medicare supplement plans can help you pay the health care costs left over after Medicare pays their portion. If you would like more information on these plans, please contact us either by phone (203)796-5403 or email at teal@croweandassociates.com.

When can you collect Medicare, Medicare Part D:

Medicare part D is prescription drug coverage. If choose not to sign up for a Medicare Advantage plan with prescription drug coverage, you should enroll in a prescription drug plan.  You should enroll in Part D coverage when you sign up for Part A & B. If you do not sign up for some type of Part D coverage, you will receive a 1% penalty for every month you wait to sign up after your initial enrollment period.  You will not receive a penalty if you have drug coverage from a private insurer (retirement plan).  This is referred to as credible coverage. Check with your insurer to verify that your coverage is credible.

CLICK HERE TO QUOTE AND COMPARE MEDICARE ADVANTAGE, SUPPLEMENT AND PART D PLANS

This is a lot of information and it can be confusing, please feel free to contact us with any questions. Click here to learn more about Crowe and Associates

How do I apply for Medicare

If you are like most people who are almost 65, you might be wondering How do I apply for Medicare.  A common misconception is that you can get Medicare as soon as you claim Social Security benefits, which can be as early as age 62. Unfortunately, if you retire early and claim your Social Security benefit, you’ll have to wait until 65 before you’ll be eligible for Medicare benefits.

In cases where you already receive Social Security retirement benefits, you will automatically be enrolled in both Medicare part A & B when you turn 65.  You will receive your Medicare card a little before you turn 65.

If you are not receiving Social Security retirement benefits when you turn 65, you will need to apply for Medicare.  This is easy to do on line at www.SocialSecurity.gov. It can also be done by phone 1-800-325-0778 Monday-Friday, 7 am to 7 pm, or in-person at your local Social Security office. Your initial enrollment period starts three months prior to your 65th birthday and ends three months after the month you turn 65.

Enrolling in Medicare can be confusing, because of all the plan options available.  Finding an experienced Medicare agent can make it easier to find a plan that both suits your needs and budget.

Already enrolled?  Click here to look up your Medicare number.

First:

As we stated above, the initial enrollment period for Medicare starts 3 months before the month you turn 65 and ends 3 months after the month you turn 65. That gives you seven months to complete your enrollment. In other words, it is best to get yourself enrolled as soon as possible to get your benefits in place so you avoid any coverage gap that might occur when you lose your current health coverage.

Click here to enroll in Medicare A & B on-line

Third:

If you choose a Medicare Supplement/Medigap plan, you need to find a drug plan or Part D coverage.  If you take any medication now or may need to in the future, this is an important thing to consider.  There are many companies that offer Par D coverage.  Because of this,  you will need to check each company’s formulary to find the best coverage for your needs. This is something your insurance agent can do for you.