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Medicare Advantage Plans
Medicare Advantage Plans are managed health programs that serve as a substitute for both “Original Medicare” Part A and B benefits. There are a number of types of Advantage plans. The majority are either HMO or PPO plans. Medicare Part A provides payments for in-patient hospital services and stays. Part B provides coveage for outpatient services. Doctors visits, lab work, scans and x-rays all fall under part B. Original Medicare claims are processed through the Centers for Medicare and Medicaid Services (CMS). Medicare Advantage plans are offered by commercial insurance companies. They receive compensation from the federal government, to provide all Part A and B benefits to enrollees, but do not pay claims through the CMS.
Most Medicare Advantage plans (sometimes referred to as “Part C”) include the Part D prescription drug benefits, and are known as a Medicare Advantage Prescription Drug plan (MAPD). The government makes seperate payments to the plans offering drug benefits with the advantage plan. Medicare pays the insurance company a set amount every month for members enrolled in the plans.
Medicare Advantage plans
must offer a benefit that is at least equal to Medicare’s and covers what Original Medicare covers. They do not have to cover every benefit in the same way. Plans that require higher out-of-pocket costs than Medicare for some benefits, can balance it out by offering lower copayments for doctor visits or other benefits. CMS limits how much the Medicare Advantage plans can vary from benefits under Original Medicare. Many plans offer benefits which are not covered by Original Medicare. They do this as a value added benefit to entice more people to enroll in the plan.
All Medicare Advantage plans must have out of pockets maximums for medical services.
The limit for 2016 is $6,700 medical out of pocket. This applies to in-network services only. Once the out of pocket maximum is obtained, the plan will pay all additional costs. This assumes the services received are in network. Medicare advantage plan have networks. This means the enrollee must use in network doctors to be covered. There are exceptions to this such as with a PPO plan.
Other ways to get care out of network would be for an emergency or urgent care situation. Enrolling in a PPO plan provides the ability to go out of network. PPO plans permit a subscriber to use any physician or hospital, but at a somewhat higher expense. Certain PPO plans can lead to much higher costs for going out of network. The combined out of pocket max goes up to $10,000 on a PPO. The total is for in and out of network usage.
People can enroll in a Medicare Advantage plan
when first eligilble for Medicare A and B. They must enroll in A and B prior to enrolling in an advantage plan. Under most situations, the member can change plans every January during AEP. There are exceptions to this rule however. Many states have multiple Advantage plans offered by various companies. Some states have over 20 different plans to choose from. Companies will also offer plans by county. They may offer a plan in one county but not another within the same state.
People with low medical utilization tend to migrate towards advantage plans. If someone is going to the doctor a few times a year on average, they tend to look at the low Advantage premiums as a way to save money. Those with higher medical utilization will have a tendency to go with a Medicare supplement plan of some type. Supplements tend to have higher premiums and less out of pocket costs which appeals to someone utilizing care more often. Supplements are also attractive to those that do not want to abide by a network of doctors. Others tend to go with a supplement to avoid the need for prior authorization which is required on advantage plans.
Trial Right–
Medicare Advantage trial rights are rules that allow someone to switch out of their advantage plan. There are two cases in which a trial right is created.
- Taking an advantage plan when first eligible for Medicare. A trial right is created allowing the member to change back to Original Medicare any time in the first 12 months. They can go to Original Medicare with a supplement and/or Rx plan the first of any month
- Taking an advantage plan for the first time. If someone is taking an Advantage plan for the first time. (Even if they have been on a supplement previously). They will have a trial right for the first year they are in the advantage plan. This would allow them to change to a supplement and/or drug plan
AEP- At this time you can change your plan (Advantage to supplement or supplement to advantage) every January 1st during AEP. At this time someone can make any change they would like. Some states will underwrite a move to a supplement however.
MADP- During this period, a person may leave an advantage plan and go back to Original Medicare. MADP runs from January 1 through February 14th every year. They can also enroll in a supplement and/or Rx plan if they would like.
SEP- A Special Election Period allows someone to make a change outside of AEP. Certain circumstances will create a SEP. Moving outside the plan service area, qualifying for extra help, lose of employer coverage. These are all examples that would create a special election.
Additional Resources:
Medicare Basics Video – Click here
For Medicare Advantage Basics Video Click
Medicare Supplement Plans
Medicare Supplement Plans, also called “Medigap” insurance, provides extra coverage for Medicare beneficiaries. People in Original Medicare often take Medicare Supplement insurance to cover the gaps in Original Medicare. Medicare has two parts, Part A and Part B. Both programs have gaps in coverage that a supplement may cover. (Depends on which on is purchased.)
Gaps In Coverage
Part A Gaps:
Medicare Part A (Hospital Insurance) covers inpatient hospital, inpatient skilled nursing facility, home health, and hospice services. The following is a list of gaps in coverage:
- Hospital deductible per stay
- Hospital coinsurance (Medicare covers the first 60 days in full after the deductible has been met. Days 61 to 90 have a copayment, and days 91 to 150 – the “lifetime reserve” – a higher copay.
- No coverage after 150 days.
- Skilled nursing facility coinsurance payments (Medicare covers the first 100 days).
- No coverage after 100 days.
- Home health aide services that are provided on more than a part-time basis.
- Home health nursing and aide services.
See exact amounts for the current year here.
Part B Gaps
Medicare Part B (outpatient coverage) provides coverage for a number of outpatient and physician services. It also pays for durable medical equipment, prosthetic devices, supplies and ambulance. The following is a list of gaps Medicare does not cover.
- Part B deductible (annual deductible of $166).
- Part B 20% coinsurance payment (Medicare pays 80% of the allowable charges).
- Balance billing above the Medicare-approved charge (some physicians and providers charge more than the amount Medicare approves). Billing above Medicare approved amounts not allowed in all states. The amount they can bill above is limited as well.
Who Needs Medicare Supplement Plans?
There are a number of programs that help fill in the gaps of A and B.
- Government Programs such as QMB or Full Medicaid.
- Group Retirement Plans.
- Standardized Individual Medigap Policies. (Means the plans have the same core benefits.)
If you have Medicaid or are a QMB
Medicare beneficiaries with Medicaid (Title 19 or QMB) usually do not need Medigap insurance because Medicaid will cover their out of pocket costs. Chick here for a short video about Medicaid. Not all doctors and facilities will take Medicare however. People who do not qualify for Medicaid may still be eligible for the QMB program. QMB program benefits include:
- The payment of monthly Medicare premiums.
- All costs of Medicare annual deductibles.
- Payment of Medicare coinsurance.
Those not on Medicaid or QMB
People that are not on Medicaid or QMB may want to consider one of the many Medicare supplement plans available. Currently, there are plans A,B,C,F, High F,G,K,L,M and N. Each plan covers different amounts of the gaps not covered by Original Medicare. Plans are standardized which means benefits in a plan must be the same from company to company. Example: Plan F has the same benefits no matter who offers it. A persons health is the biggest factor when choosing between all the options. Price point of a specific plan in an area is a consideration as well. Many people take a Medicare supplement because there is no network to follow. As a result, the beneficiary may see any provider that accepts Original Medicare when using a Medicare supplement plan.
What is the best Medicare supplement plan option?
There is not a perfect plan for everyone. Each individual situation is different and as a result, the right supplement for one person may be wrong for another. In general plans F,N,G,K and High Deductible F have the best price points for the benefit. This is very dependent on the state you reside in however. In most states, the best deal for a supplement is the high deductible F supplement. Most people do not understand how high F works however so they overlook it. CLICK FOR MORE INFO ON HIGH DEDUCTIBLE F SUPPLEMENT Note: call our office at 203-796-5403 or email Edward@croweandassociates.com if you want a quote over the phone or sent to you by email.
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When do you take a Medicare Advantage plan instead?
A Medicare Advantage Plan is not a supplement. Instead,they are very different types of plans. A supplement is secondary to Medicare. A Medicare Advantage plan replaces Medicare and acts as the primary insurance as a result. There are a number of things to consider when choosing a supplement or Advantage plan. What doctors will be used? How often is care received? Does the beneficiary plan to travel? These are just a few things to consider when choosing.
Do they cover prescriptions?
Medicare Supplement Plans do not include Rx coverage. A beneficiary can consider a stand alone drug plan for coverage because they can not buy a supplement with a drug plan. Instead they would buy a part D plan from an insurance company. The part D plan can be from a different company than the supplement company. Part D plans are offered by many companies. They have very different premiums and benefits from one company to the next.
What plans are popular?
It depends on the state you live in but, in general, plans F, N and G are popular choices. The high F plan can be the best choice if the cost is low. Some states have low cost High F plans and others do not. Some states allow you to change from one supplement to another any time. The change can be made without any type of health check. Other states will check health if changing plans outside of a guaranteed issue period.
More info about Medicare Supplement plans.
Supplements will only cover services allowed by Medicare. If Medicare does not approve the care, the supplement will not cover it either. An example is acupuncture which is not covered by Original Medicare. The supplement will not cover the charges either. Medicare supplement benefits do not change every January like they do with an Advantage plan. The premium is subject to change but the benefits do not. Medicare supplement plan F will no longer be available as of 2020. As a result, the plan G supplement will be the closest option to a plan F. This is not a big issue because those in it already can keep it but no one can buy a new plan F as of 2020.
Looking for Medicare information in Connecticut?
Click here for a no cost, confidential Medicare quote.
Anthem MediBlue Select HMO
Anthem MediBlue Select HMO is a Medicare Advantage plan with prescription drug coverage (MAPD). In fact, Anthem Blue Cross Blue Shield offers this plan only in Hartford county in the state of Connecticut. This, like all HMO plans, require that participants use in network providers. If you choose to use out of network providers, this plan will not cover your expenses. An exception to this would be urgent or emergency care which allows of of network services.
The plan has a monthly premium of $26. This would be in addition to the part B premium of $121.80. There are no referrals required for this plan. Co-pays for a primary doctor are $15 and $40 for a specialist. The plan has an annual out of pocket max of $6,100 per year. Annual maximum indicates the most the insured would need to pay in medical claims for the year. You can not apply either Monthly premiums or cost-sharing for part D prescription drugs to the maximum out of pocket amount.
You can add dental services to the plan for an additional premium. In Addition, Silver Sneakers is included in the $26 monthly premium and pays a local gym membership monthly fee. If you use approved diabetic supply vendors your diabetic supplies are covered at 100%.
This plan offers prescription drug coverage with $220 annual deductible. This deductible applies only to tiers 2-5. The plan excludes both Tiers 1 and 6 from this deductible. There is no limit to how much the plan will pay.
A Medicare Advantage plan should not be confused with a Medicare Supplement plan (also called Medigap).
MAPD plans offer both medical and drug benefits combined with the insurance company as the primary insurance. With a Medicare Supplement, original Medicare is primary. The insurance company would be the secondary insurance. As a result, a Medicare Supplement plan does not have a network. Because members may see any provider that participates with Original Medicare, it is different from an Advantage plan.
HMO summary of benefits Anthem MediBlue Select
Anthem MediBlue Selelct HMO application
Click here to request a personal Medicare review.
Aetna Medicare Plan HMO Connecticut
Aetna Medicare Plan HMO Connecticut is a Medicare Advantage Plan (MAPD). This plan is offered in Fairfield, New Haven, and New London counties. Aetna refers to this plan as the Shoreline plan. They also offer a similar version of it called “inland”. The inland plan includes Hartford, Litchfield and Tolland counties. The Aetna Medicare Plan HMO Connecticut is an HMO plan. Members must use in network providers (except for emergency and urgent care). If you choose to use an out of network provider in an non emergency or urgent care situation, there will be no coverage at all. Medicare A and B will not provide the standard 80% part B coverage when going out of network on a Medicare Advantage plan.
In addition to a $6,700 maximum out-of-pocket contribution (for medical expenses only), this Aetna plan is a $0 premium offering and requires referrals to see specialists. You only need to obtain a referral once per specialist each calendar year. The plan features very low co-pays for a $0 premium plan. With a $10 primary doctors copay and a $40 specialist copay. Most other co-pays are also low compared to other plans offered in the same market such as a $600 inpatient hospital co-pay and a $150 major radiology copay (basically means MRI’s, CAT and PET scans).
The prescription drug plan (included with benefits of plan)
is one of the few that does not have a deductible on tier 3, 4 and 5 drugs. Overall, this is a solid plan with a large national network of providers that can be accessed anywhere in the country. The one benefit that should be noted with this plan is the fact that it does have an annual deductible of $1,000 for some services such as Inpatient hospital, major radiology, Outpatient surgery, ambulance and some other services. A plan summary has been provided below for review.
CLICK HERE FOR AETNA MEDICARE PLAN HMO CONNECTICUT PLAN SUMMARY
Click here for a free Medicare review and quote.
United Healthcare Medicare Complete Plan 2 Connecticut
United Healthcare Medicare Complete Plan 2 Connecticut is a Medicare Advantage plan with Prescription Drugs (MAPD) offered by United Healthcare Medicare. Medicare offers the Complete Plan 2 in Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland as well as Windham counties. This plan is a HMO and has both a $29 monthly premium and an annual out of pocket max of $6,000 (Medical only). It features co-pays of $15 for primary doctor visits as well as $40 for specialist visits. Subscribers do not need specialist referrals.
United Healthcare pays %100 of preventative care as part of this plan. This includes; annual physicals, mammogram, cardiovascular screenings as well as certain vaccines. Plan 2 includes; home health care, podiatry services, hearing services, vision services and also basic dental services. The drug plan has a 5 tier copay plan with a $200 deductible for Tiers 3,4 and 5 only.
Like all other part D and MAPD drug plans in CT, there is a Coverage Gap ( donut-hole) that applies to this RX benefit. Although it is an HMO plan, the Medicare Complete Plan 2 does offer the 2016 UHC Passport Program at no additional cost. The Passport program provides access to doctors in other states on an in-network basis. Although the CT plan includes Passport, every state does not offer the Passport progam. For an additional premium, your coverage can include a dental benefit rider.
Please note:
A Medicare Advantage Plan with Prescription Drugs (MAPD) is NOT a Medicare Supplement plan (Also called Medigap). With an MAPD plan, Medicare is not the primary or secondary insurance. The company offering the MAPD is your primary insurance and services must be obtained through participating providers in most cases. A Medicare Supplement plan is secondary to Original Medicare and does not include Part D prescription drug coverage. With a Medicare Supplement there is not a network, instead, the insured would go to any provider that accepts or participates with Original Medicare.
A 2016 Summary of benefits and 2016 application are available in the links below. You can send applications back to us either by email at Admin@croweandassociates.com or by fax at 203-567-6235.
Click here for a UHC Plan 2 Summary of Benefits – Connecticut
To download a UHC Plan 2 application – Connecticut Click here
Click here for a no-obligation Medicare quote.
CT Medicare Advantage and Supplements
There are many choices when it comes to CT Medicare Advantage and Supplements. These choices can confuse anyone. We can help you feel comfortable not only with your choice of health care plans but the cost as well. Crowe and Associates is one of the region’s leading Medicare brokerages. Are you looking for CT Medicare Advantage and Supplement information in Connecticut? We can help. Crowe and Associates is an independent brokerage agency that works with all major Medicare Advantage and supplement plans. We work with clients everyday to help them understand the difference between Advantage plans and supplements. We use that knowledge to choose the best plan and company for them. The insurance companies pay us so you will never receive any type of bill or fee for our services.
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Medicare Advantage Plan Connecticut
This post is for Medicare Advantage Plan Connecticut – A Medicare Advantage plan is an insurance plan offered by a private insurance company. Advantage plans are also called Part C plans as they are filed under Part C of Medicare. When someone enrolls in a Medicare Advantage plan, they are taking a plan that replaces original Medicare A and B. This means that when they receive medical services, the providers will bill the Medicare Advantage plan and not Original Medicare. If the member discontinues the Advantage plan, they will go back to original Medicare A and B.
Medicare Advantage plans are copay plans.
The member would need to pay copays for medical services received from providers. Copays vary in amount depending on the type of service received. Some examples based on plans in Connecticut…
Primary doctor visits- copay ranges from $10 to $30 a visit depending on the company
Specialist doctor visits- copay ranges from $30 to $50 a visit depending on the company
Major Radiology- Can be a 20% cost share or copay ranging from $100 to $275 depending on the company.
This is just a quick example. (There is a link below to all the plan benefit summaries for Connecticut plans below. )
Medicare Advantage plans also come with drug coverage (They include a Part D drug plan with the coverage). These Part D plans are very similar to many of the Part D drug plans you would purchase on a stand alone basis.
Bottom Line: With a Medicare Advantage plan you include your medical as well as your drug benefit in one package. In fact, in Connecticut, there are 5 companies that currently offer Medicare Advantage plans. Finding the right one can take some time.
CLICK HERE FOR BENEFIT SUMMARIES AND APPLICATIONS
CLICK HERE TO SEE HOW AN ADVANTAGE PLAN IS DIFFERENT THAN A MEDICARE SUPPLEMENT
Medicare Advantage and Medicare Supplement Comparison Connecticut
In this post we will give you Medicare Advantage and Medicare Supplement Comparison Connecticut. Medicare Advantage plans and Medicare Supplement plans (also called Medigap plans) are very different. There are positives and negatives of each depending on an individuals medical needs. This post will provide a description of both and compare them in order to make an educated decision when choosing a plan. The plans outlined in this post are applicable to Connecticut and may not be available in other states.
Medicare Advantage Plans (CLICK HERE FOR MEDICARE ADVANTAGE APPLICATIONS)
Medicare Advantage Plans are offered by private insurance companies. They offer medical and Rx benefits in one plan and act as the primary insurance instead of original Medicare. There are 5 companies offering Medicare Advantage plans in Connecticut. The companies are Connecticare, United Healthcare (with and without AARP logo), Aetna, Anthem BCBS and Wellcare.
Positives:
- Many have $0 monthly premium. You will still pay your part B premium to Medicare however.
- They include the medical and Rx benefit in one package. You do not need/cannot purchase a separate Part D Rx drug plan when you have a Medicare Advantage plan. The Medicare Advantage plans include the Part D Rx coverage in the benefits.
- Extra benefits- some Medicare Advantage Plans provide for extra benefits such as dental, visions, podiatry visits, gym memberships, etc….
Negatives:
- Medicare Advantage plans have networks. Since the Advantage plan is your primary insurance, the provider must be in network in order for his servicesnto be covered by the plan. There are a limited number of Medicare Advantage Plans in Ct that provide out of network coverage as well.
- Copays- You do not pay a monthly premium with Advantage plans but you do pay copays for medical services such as doctors visits, lab work, inpatient stays, etc….
- The last negative is that Medicare Advantage plans are able to make benefit changes every January. This means that they may have a major increase in co-pays and cost share on renewal in January. You are able to make a plan change every January. Although, you cannot change your plan after February 14th.
CLICK HERE IF YOU WANT MORE INFORMATION ABOUT ADVANTAGE PLANS
CLICK HERE FOR MEDICARE ADVANTAGE PLAN APPLICATIONS
Medicare Supplements (Also called Medigap Plans) (CLICK HERE FOR SUPPLEMENT APPLICATIONS)
Medicare Supplement plans are secondary to Original Medicare. When someone purchases a supplement, the provider will bill Medicare first and then the supplement will cover a portion or all (depending on the supplement you choose) of the remaining costs. Medicare Supplement plans cover Medical services only and do not include Rx coverage. Those that want Rx coverage purchase a stand along Part D drug plan. Supplements are standardized in Connecticut. This means that there is no variance in benefits from insurance carrier to insurance carrier. In Connecticut there are 10 supplement plan options with plans F, N and L being the most popular.
Due to the fact that the benefits are standardized, purchasing a supplement usually comes down to who has the best rates. Currently in Connecticut the United Healthcare AARP branded Medicare Supplements have a large rate advantage over all the other companies. In other words, it really doesn’t make sense to purchase a Medicare supplement through a different company.
Positives:
- Medicare Supplement plans are secondary to Medicare. This allows you to see any doctor that accepts Medicare. There is not a network to follow. As a result, Medicare supplements are very convenient for people that travel.
- You can determine how much coverage you want. For example, if you want 100% medical coverage, Plan F supplement would provide it or for 75% coverage you could use a plan L.
- Medicare supplement do not have prior authorization requirements
Negatives:
- Medicare Supplement plans have monthly premiums in addition to the Part B premium. For example, the lowest cost plan F in Connecticut is $220 a month. (cost is per person)
- Medicare Supplements do not include Rx coverage. You must purchase Rx coverage separately with a Part D Rx plan. Part D plans range in monthly price from $14 a month to $100 a month depending on the plan chosen.
- Medicare Supplements will only cover a procedure that is covered by Original Medicare.
CLICK HERE TO LEARN MORE ABOUT MEDICARE SUPPLEMENTS
FOR MEDICARE SUPPLEMENT APPLICATIONS – CLICK HERE
Please contact us if you have any questions. You can either call Crowe and Associates at 203 796 5403 or email us at Edward@Croweandassociates.com.
AARP Medicare Complete is a general name given to a number of different United Health Care Medicare Advantage plans with the AARP logo. United Healthcare also offers a number of different Medicare Complete plans without the AARP logo.
United has an AARP Medicare Complete branded product in most states. In some states they have multiple plans. The AARP branded Medicare Complete plans come in three types: HMO, POS and PPO. The plans all have the same basic copay structure and more or less operate in the same manner with the only real difference being that the POS and PPO plans have out of network coverage.
Do you have other questions or do you want to see more detail on these plans? I have a number of blogs on this topic or you may contact the office for more information.
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