Blog

Extra Help income limits 2024

Medicare Extra Help is a federal program put in place to help individuals whose income and financial resources are limited.  It provides help for those who qualify to pay the costs of their Medicare prescription drugs. The subsidies provided by this program cover premiums, deductibles, as well as co-pays for the costs of Medicare prescription drug plans (Part D).  To qualify for this program, individuals must meet the income criteria set by the federal government each year.  In this post, we will go over the Extra Help income limits 2024.

How to Qualify for Extra Help

1.  Be a U.S. citizen or legal resident

To enroll in Original Medicare, individuals must either be a United States citizen or a legal resident for at least 5 years. In turn, to enroll in Medicare’s Extra Help program, an individual must qualify for Medicare.

Extra Help is crucial for individuals who require assistance with the costs of prescription drugs. Understanding the requirements is the first step to finding the necessary help to ensure the needed coverage is received.

If you like the image in this post and want to view more from this artist, click here

What does Medicare Part C cover

If you watch TV, I’m sure you have heard about Medicare Part C.  Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B).  Private insurance companies offer these plans to beneficiaries.  In this post, we will answer the question; what does Medicare Part C cover.

Medicare Part C plans must cover all of the services that Original Medicare covers (except for hospice care, which is still covered under Part A), and they may offer additional benefits such as dental, vision, hearing, and prescription drug coverage. While Original Medicare (Parts A and B) offers essential coverage, many beneficiaries opt for additional benefits through Medicare Part C.

Basics of Medicare Part C coverage

Hospital insurance (Part A)

This includes inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.

Medical insurance (Part B)

This includes doctor’s services, outpatient care, preventive services, and some DME (durable medical equipment).

Prescription drug coverage (Part D)

Many Medicare Advantage plans include prescription drug coverage.  Part D coverage is not part of Original Medicare.  When it is included in a Part C, Medicare advantage plan, it is called an MAPD plan.  If it is not included, the plan is called an MA only plan.

Additional benefits

Many Medicare Advantage plans offer additional benefits not covered by Original Medicare, such as routine dental, vision, and hearing care, fitness programs, transportation services, and over-the-counter allowances for certain health-related items.

More Medicare Part C Benefits

To view more images by this artist, click here

Eligibility for Medicare Part B

Part B of Medicare provides coverage for medical services like doctors’ visits, preventative services, outpatient medical services, and other medically necessary items and services.  In this post, we will go over the rules for eligibility for Medicare Part B.

To be eligible for Medicare Part B, individuals must meet certain criteria

Medicare Part B is one part or original Medicare. and Part B is an integral part of this coverage. In General, individuals who are 65 or older qualify for Medicare.  However, there are other scenarios when an individual may be eligible to enroll.

Turning 65

The most common way to qualify for Medicare is when an individual turns 65 and is a U.S. citizen or legal permanent resident living in the U.S. for at least 5 continuous years.  This period of time is referred to as the IEP.  It is a good idea to enroll during the IEP (Initial Enrollment Period) to avoid a late enrollment penalty.

Disability

In some instances, individuals under 65 with a qualifying disability are eligible to enroll in Medicare Part B.  Individuals who receive either SSDI (Social Security Disability Insurance) or some Railroad Retirement Board (RRB) disability benefits for a period of at least 24 months may qualify for benefits.

End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

Individuals who suffer from either permanent kidney failure requiring dialysis or a transplant (ESRD) or Lou Gehrig’s disease (ALS) usually qualify for Medicare coverage.  This coverage includes Medicare Part B.

Watch a YouTube video on SEPs. OEP and Late Part B Enrollment

Enrollment periods

When enrolling in Medicare Part B, there are a few different enrollment periods available.  Once you are eligible to enroll in Medicare Part B, it is important to understand when and how to enroll.

IEP (Initial Enrollment Period)

The IEP is the seven-month period that begins three months before the individual turns 65.  It includes the month of their birthday and continues for three months after. As we stated earlier, enrolling during this period is recommended to avoid a late penalty.

SEP (Special Enrollment Period)

Some individuals may qualify for a Special Enrollment Period.  For those who delayed enrollment in Part B due to having employer coverage through their employment or a spouse’s employment an SEP allows them to enroll without facing a penalty.

Learn more about SEPs

GEP (General Enrollment Period)

If an individual missed their IEP and doesn’t qualify for a SEP, they can enroll during the General Enrollment Period.  This enrollment opportunity runs from January 1 to March 31 each year.   It is important to note; late enrollment penalties may apply for those who wait to enroll during this time.

Additionally, Medicare Part B is an important part of healthcare coverage for seniors and other qualifying individuals. Understanding the eligibility criteria and enrollment process is essential to ensure timely access to the benefits that Medicare coverage provides.

Medicare agents, click here to become part of the team at Crowe

A licensed Medicare agent can help navigate the ins and outs of Medicare coverage and ensure beneficiaries receive all the benefits necessary for their healthcare needs and budget.

Click here to see why a licensed Medicare agent is a great asset.

If you like this image and want to see more by this artist, click here

What is a Medicare HRA

If you are in Medicare sales, you may have heard the term HRA.  In this post we will explain what is a Medicare HRA and why insurance carriers use this tool.

What is a Medicare HRA

HRA stands for Health Risk Assessment.  Medicare Advantage plans must do an HRA for every beneficiary within 90 days of their initial enrollment.  MA/MAPD plans require qualified health care professionals to conduct HRAs for existing members once a year.  These assessments are an important tool for both health plans and providers.  Insurance carriers use HRAs to identify the health status of members.  Once the HRA is completed,  insurance companies make risk adjustments and providers can put a managed care plan in place when necessary.  Clients may decide to have the HRA done either in a provider’s office or at home.

The HRA is required by CMS for all members of both Medicare Advantage and traditional Medicare fee-for-service plans.  If the member is enrolled in a traditional Medicare Fee-for-service plan, The member’s initial (welcome to Medicare) or preventative visit is used for the HRA.  When the member is enrolled in a MA/MAPD plan, the member will be asked to have the HRA.  Medicare advantage plans must make a “best effort” to have the member complete the HRA each year.

Click here to watch a quick YouTube video on Medicare Advantage vs. Medicare Supplement plans

HRAs (Health Risk Assessments) help collect important information

The information obtained through a HRA provides a view of the enrollee’s general health, health risk factors, as well as a glimpse into their ability to complete activities of daily living.  All these factors provide a view of overall health as well as find gaps in care and provide a basic diagnosis.

Any information obtained can help providers and health plans to create population health initiatives as well as to put an individual health plan in place.  The plan may include care management, coordination of care, identification of  high-risk individuals and the development of comprehensive care plans with referrals to suitable care team members.

Agents who want to offer Medicare Advantage plans, click here for online contracting

How to conduct a Health Risk Assessment

CMS has not put any specific format in place to conduct the assessments.  In many cases, a health care professional asks the beneficiary a series of questions. The questions cover a large range of topics that include family medical history, the beneficiaries current health, their lifestyle and their willingness to adapt behaviors that can improve their health.  The answers provided all correspond with a numerical value that determines the weighted risk value and health of the beneficiary.

Because Medicare Advantage companies receive payments from Medicare for each enrollee, Medicare uses this information to help calculate the payments. Health plans receive a prospective capitated payment that is based on the projected cost of care for each beneficiary.  Medicare adjusts the payment according to the amount of risk the company assumes per enrollee.  This helps ensure the company is able to cover the costs for the care for it’s enrollees.  That is why so many Medicare Advantage plan carriers offer their agents an incentive to ensure that new plan enrollees have the HRA completed.

For CMS to accept the HRA for the risk-adjusted payment, it must be either documented in the patient’s medical record or performed as a face-to-face visit with a licensed medical provider and the beneficiary.

Learn about CMS’ Part D drug cap

HRAs are an important tool

HRAs along with a good care management team are a great way to identify and support the specific health care needs of the individual to ensure improved health and better quality of life.

To view more images by this artist, click here

United Healthcare OTC catalog 2024

Members of participating UHC Medicare advantage plans have access to the United Healthcare OTC catalog 2024.  There are 3 different types of UHC Medicare Advantage plans that have their own OTC benefit package.  Members of all 3 plan types can access their OTC benefit through their UCard.  The UCard is more than just a member ID card, it is a way to access all the extra benefits UHC members receive.

Members of these plans have access to an over-the-counter credit.  United Healthcare adds the credit to members UCards either monthly or quarterly.  This depends on the plan each member enrolls in.  To find out if your plan offers this benefit and the details, check the evidence of coverage for your plan.

Member can shop in over 55 thousand participating stores.  Participating stores include CVS, Kroger, Walgreens, Walmart as well as Meijer, Sam’s Club and Save A Lot.
Shopping in stores provides a greater product selection for members that include both generic and Brand-name items.  Members also have the option to order items online, by phone or through the mail.

Please note:  This year the OTC catalog is too large to add as a download to the blog, that is good for plan members!  Members can call the member services number on the back of their card to request a copy be mailed to them.

The best way to see the OTC items is either online or through the mobile app.

View the catalog with the UHC Mobile app  – click here for instructions

Click here to access the OTC store finder

Unused benefits for Plans that provide a monthly combined credit for OTC/Healthy Foods/Utilities expires at the end of each month.

Ways to order OTC items

Members of participating UHC MAPD (non-SNP plans) have 4 ways to order OTC items with their UCard or prepaid card. In 2024, 68% of all non-DSNP members have access to the OTC benefit.

UHC 2024 OTC (Non-SNP) brochure

1.  Order in store at one of over 55k participating locations.

2.  Purchase OTC items online whenever it’s convenient for you 24/7.

3.  Use the phone to order OTC items.

4.  Use the mail order form in the OTC catalog to order items.

Please note, items ordered either online, over the phone or by mail will usually be delivered within 2-3 days of receipt.  Orders over $35 are eligible for free shipping.

Click here to download the 2024 UCard Quick Reference Guide

Information for C-SNP members

UHC 2024 OTC and Healthy Foods (CSNPs) brochure

C-SNP members have access to a monthly credit for OTC benefits as well as healthy foods benefits on their UCard.

Members have a few ways to shop for OTC items.

1. In store
2. Online through the member portal
3. Use the catalog and purchase items by mail.

Delivery is free on orders of $35 or more.

C-SNP members can choose from thousands of healthy food items including meat, fruit. vegetables, dairy bread cereal and much more.  There are a few ways to shop for healthy foods using the monthly allowance on the UCard.  Delivery is free with Walmart or Roots.

In 2024, there are 42 C-SNP plans that offer the OTC healthy food card.  In past years, this benefit was only available on the DSNP plans.

1. Shop for healthy foods in store
2. Choose from the items online through the member account,
3. Use the UnitedHealthcare mobile app to check your account balance or locate local retailers.  Use the scan to find available products and check outin stores without your UCard.

Orders can be placed by calling 1-888-628-2770 (TTY: 711). You can talk to an agent Monday to
Friday, from 9 AM to 8 PM local time. Please have your order ready before you call. 

OTC benefit information for D-SNP members

UHC 2024 OTC, Healthy Foods and Utilities Credit (DSNPs) members

OTC benefits for D-SNP plan member in 2024 include over-the-counter items as well as healthy foods and utilities benefit.  This benefit is loaded onto the UCard each month and member can choose to use it in any of the ways mentioned above.  Credits are loaded onto the UCard each month

D-SNP members can decide to use their benefit to shop one of the following ways.

1. In one of the thousands of participating stores.
2. They can also choose to shop online through the member portal.
3. Members may also use the catalog to order items through the mail using the form in the catalog.

Members can purchase Healthy Foods in one of the following ways:

1. Members can shop in-store
2. Online through the member portal
3. They may also use the catalog to choose food items and have them shipped to their home, the same as with OTC items.  Home delivery is free with Walmart or enrollees may choose Roots for fresh produce and premade meal delivery.

The utility benefit can help members pay electric bills, water and sewer usage, sanitation, heating or internet service. FOr utilities, the service address must be the same as the member’s home address that is on file with United healthcare.

Member can request a replacement catalog online or by contacting member services. 

The number for each plan’s member services team is found on the back of the member ID card.

Medicare agents- get contracted to sell United Healthcare plans

Additional information

In most cases, United Healthcare will answer member inquiries.  There are some benefits supported by different vendors depending how the member orders the product.  Items that are ordered online, over the phone or with the catalog will be filled by Solutran.   Some orders are supported by Walmart.

To view more images by this artist, click here

Part D catastrophic coverage

In 2023, when a beneficiary’s out-of-pocket spending for prescription drugs reaches $7,400, they reach the Part D catastrophic coverage level.  If this happens, the beneficiary pays 5% co-insurance for prescriptions covered by Medicare Part D for the rest of the year.

2024 catastrophic cost change

On January 1, 2024, the 5% co-insurance payment in the catastrophic phase will end.  Beneficiaries who reach $8,000 in out-of-pocket spending on Part D prescriptions in 2024 will automatically receive catastrophic coverage.  Medicare Part D plan provider will have to pay 20% of the total drug cost instead of the 15% they paid in the past. Once beneficiaries reach this level, they no longer have to pay either copayments or co-insurance for covered Part D prescriptions for the remaining part of the year.

Learn more about Medicare Part D plans

This updated rule applies to Part D enrollees who do not have an LIS (low-income subsidy).  When a Beneficiary reaches the catastrophic level in Part D coverage. they no longer pay 5% of their prescription costs.  In other words, there is a cap on Part D out-of-pocket spending for enrollees in 2024. the catastrophic threshold is $8,000.

How the catastrophic limit is calculated

The catastrophic limit includes the prescription costs paid out-of-pocket by Part D enrollees, as well as the value of the manufacturers price discount on brands of medications in the coverage gap phase.  In 2024, a Part D enrollee who uses only brand-name drugs and spends about $3,250 out-of-pocket pays no additional amount for their prescriptions.  The remaining part of the $8,000 catastrophic limit is taken from the manufacturer’s price discount for the medications.

What this means for beneficiaries

For beneficiaries who do not qualify for LIS and require expensive medications to maintain their health, annual out-of-pocket costs can be as high as $15,000 annually.  This cost applies to individuals who may take some lifesaving cancer medications.  This cost on top of fighting for their lives adds a terrible amount of stress for them. Once a beneficiary reaches the catastrophic phase, eliminating the 5% coinsurance in 2024 means that Part D enrollees who require high-cost medications covered by Part D can save thousands of dollars.

Click here to watch a quick video about the Part D changes

Changes in costs for Part D plan providers

Due to the end of the beneficiaries required 5% coinsurance payment in the catastrophic coverage phase, Part D plans will have to pay 20% of total drug costs during the catastrophic phase in 2024.  This is 5% over the 15% they currently pay in 2023 and in previous years.

Changes for 2025

CMS is putting a hard cap of $2,000 on out-of-pocket, prescription drug spending in 2025.  They will also end the coverage gap phase (donut hole).  Part D plans will have a greater responsibility for prescriptions in the catastrophic phase and more manufacturer price discounts will be added.  These measures will reduce the liability for Medicare in this phase of coverage.  There will be changes to Part D plan costs as well as manufacturer price discounts in the initial phase of Part D coverage.

Please note: the drug cap does not apply to out-of-pocket costs for Part B prescription drugs.

Medicare Savings Plan CT 2024

The Medicare savings plan CT 2024 could make a big difference in the lives of many people struggling to pay their health care costs.

Connecticut provides financial assistance to eligible Medicare enrollees through Medicare Savings Programs.

Qualified beneficiaries receive help through one of three available Medicare Savings Programs.  qualification for each level depends on your income. If you qualify for any of the three levels, DSS will pay your monthly Medicare Part B premium. In some cases, enrollees receive help paying both Medicare deductibles and co-insurance. Medicaid funds the MSP program in CT.

The three levels of Medicare Savings Plan help

Each level of extra help is decided by your gross income.  If you are married, your spouse’s income is included. Every level of the MSP program pays for your Part B premium.  The monthly income limits are effective from March 1, 2023, until February 29, 2024.  After that date, the new income limits take effect.  When CT releases the new amounts, will add them in.

QMB – This level of help pays your Part B premium.  Part B covers doctor visits, some preventative care and outpatient hospital services.  QMB also covers your Medicare deductibles.  The deductible is how much you pay before your Medicare insurance starts to pay. QMB benefits also cover Co-insurance payments. Co-insurance is the part of Medicare approved services that beneficiaries are responsible for paying.

The QMB is the only level of the Medicare Savings Program that acts like a Medicare Supplemental or Medigap plan.  It will cover the costs of the deductibles or co-pays of Medicare Part A and Medicare Part B up to the Medicaid approved rate.  It will also pay the premium for Medicare Part A for qualified adults 65 years of age or older when they are not eligible for premium free Medicare due to work earnings.  You are protected by federal law from being “balanced billed” or billed for services after Medicare Part A and B pays its portion of the bill, if a provider agrees to treat you, whether or not the provider is a Medicaid provider.

SLMB – This level of extra help pays your Part B premium only.

ALMB – This level of extra help also provides payment for your Part B premium only. Help on this level is available on a first come first served basis as it is subject to available funding.   Beneficiaries who receive Medicaid are not eligible for this program.

Click here to download a quick benefits guide.

Every level of MSP automatically enrolls you into LIS (Low Income Subsidy) also referred to as Extra Help.  Extra Help either pays the entire cost of a benchmark Medicare Part D plan, or part of a non-benchmark plan.  It also covers the annual deductible, co-insurance and co-pays. Extra Help coverage stays the same even in the coverage gap (donut hole). Beneficiaries who receive the LIS also have additional SEPs to change Medicare Part D or Medicare Advantage plans if they want to.

How to Apply for MSP

You can apply for these benefits online, through the mail or by brining your application to a local DSS office. If you need help completing the application, you can authorize someone to do the application for you.

 Click here for a list of local offices.

To apply for benefits online, go to www.connect.ct.gov, look for the ‘Apply for Benefits” and go from there.  To apply for MSP only, complete the Medicare Savings Programs application/redetermination form below:

Medicare Savings Program Application (W-1QMB)

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)

Click here to learn about Medicaid redetermination

To view more images by this artist, click redetermination.

Medicare AEP vs. OEP

Because the Medicare enrollment periods can be so confusing, in this post we will explain the difference between Medicare AEP vs. OEP.    It is helpful to understand the different enrollment opportunities available to make any plan changes to help optimize your Medicare coverage.

Please note:  no one is required to change plans during either enrollment period.  It is purely optional.  It is however a good idea to review your plan benefits and consider all your options during AEP.

We will start with the AEP (Annual Enrollment Period):

In Medicare, these two enrollment periods have 2 different windows of time to enroll in a plan. To differentiate between the two, you need to know the dates available to make changes for each enrollment period.  The AEP runs from October 15 through December 7 each year.  During this period, Medicare enrollees have the opportunity to make many types of changes to their Medicare coverage.  These changes allowed during the AEP include:

1. Changing from one Medicare Part D (prescription drug plan) to another.
2. You can change from Original Medicare which may include enrollment in a Medicare Supplement and or a Prescription Drug Plan into a Medicare Advantage Plan.
3. If you are in Original Medicare, you may want to add a Part D (prescription Drug) plan.
4. Change from one MA/MAPD (Medicare Advantage Plan) to another.
5. Disenroll from a MA/MAPD (Medicare Advantage) Plan and enroll in Original Medicare.  This gives you the opportunity to enroll in a Supplement Plan as well as a Part D (Prescription Drug) Plan. (Medicare supplements may be subject to underwriting)

More information about AEP:

During the AEP, Medicare plan providers use the enrollment period to announce plan updates and changes to their benefits for the following year.  These changes may include plan costs, deductibles, co-pays and coinsurance amounts. The carries send out their ANOC (annual notice of change) to their beneficiaries in hopes that they can add beneficiaries and grow the strength of their plan.  Once enrollees get their ANOC, they can decide whether to keep their current plan or consider making a change.  The AEP is the best time to compare plans and make sure you are enrolled in the plan that provides the coverage options you are looking for.

AEP allows you to make several plan changes.  Keep in mind, the last plan change you make is the one you will be enrolled in.  The plan you enroll in during AEP will begin January 1st of the following year.

Now we will discuss the OEP (Open Enrollment Period):

The OEP (Open Enrollment Period) is sometimes referred to as the MAOEP or Medicare advantage Open Enrollment Period., This enrollment period runs from January 1 through March 31 each year. The OEP differs from the AEP because only members of MA/MAPD (Medicare Advantage Plans) are able to make plan changes during this enrollment period. Member cannot change Original from Original Medicare/Medicare Supplement plans or switch from one PDP plan to another. Only changes to Medicare Advantage plans is permitted.

Enrollees of Medicare Advantage plans can make the following changes:

1. Switch from one Medicare Advantage plan to another one that provides the coverage you need.
2. Dis-enroll from you current Medicare Advantage plan and enroll in Original Medicare (this may include a supplement and PDP plan).

One important difference between the AEP and OEP is that; you may make one plan change during the OEP and that is all.  OEP is also a good time to correct any MA/MAPD plan changes you made during AEP that you are not happy with.  Any changes made during OEP will go into effect the month after your application is submitted.

Be aware that once you make a plan change during OEP/MAOEP you will not be able to make changes until the next AEP.  This rule does not apply to individuals with an SEP.

Learn more about the Medicare Advantage Open Enrollment Period

Please note:

Beneficiaries of Medicare Supplement (Medigap) plans are not subject to either of these enrollment periods.  They have their own enrollment rules.

Are you a Medicare agent?  Learn why you should join the team at Crowe and Associates

Click here to view more images by this artist

Medicare Advantage Pros and Cons

If you watch T.V., you have probably heard about Medicare Part C also known as Medicare Advantage plans. Private insurance companies contract with Medicare to offer Medicare Advantage plans. These plans must provide the same level of coverage as original Medicare. If you are considering a MA/MAPD plan, you should think about the Medicare Advantage pros and cons before signing up.

Because your healthcare is a very important decision, there is a lot to consider when choosing between Original Medicare and a Medicare Advantage plan.

 We will go over some of the features Medicare Advantage plans offer that may or may not provide the type of coverage you are looking for.

Medicare Advantage Pros:

Low premiums and cost shares

Many Medicare Advantage plans offer $0 plan premiums. There are plans with a premium, but they are usually quite reasonable.  It is important to note; you must continue to pay your Medicare Part B premiums when you enroll in a Medicare Advantage plan.  If you opt for Original Medicare and a supplement, the premium will cost you substantially more and you will also need to purchase a separate PDP (prescription drug plan).  Paying for two plans can add up especially compared to a $0 MAPD plan that also provides prescription drug coverage.

Some in-network doctor’s visits have a low or no cost share with a MAPD plan.  While the same visit with Original Medicare may leave you with a 20% co-insurance payment.

Medicare Advantage plans provide an annual maximum out-of-pocket expense limit. This means, when you reach the maximum, your plan pays 100% of your covered medical expenses for the rest of the year. You pay nothing.  There is no maximum out-of-pocket cap with Original Medicare.  In other words, there is no limit to what you could spend for medical treatment in any given year.

Comprehensive coverage

Medicare Advantage plans provide the same benefits Original Medicare, both Part A & Part B, offers. MA plans also provide additional benefits not offered by Original Medicare. Some MA plans offer vision, hearing, dental, OTC and more.  MAPD plans offer comprehensive prescription drug coverage.

Beneficiaries of MAPD plans only need 1 plan and 1 card for medical, hospital and prescription coverage. This is a convenient way for beneficiaries to cover all their needs.

Several Value-added benefits:

Medicare Advantage plans provide many additional benefits above and beyond what was already mentioned.  Some plans include fitness benefits like gym memberships or incentives for active lifestyles. Many plans offer rides to and from medical appointments to ensure you get the care you need. MA plans may also offer incentives for wellness visits or preventative services they may also cover chiropractic services or acupuncture.  These services are not usually covered by Original Medicare.

Please note:  additional benefits vary by plan and provider.  Beneficiaries should check their plan’s summary of benefits to view the full range of benefits available.

Some Medicare Advantage plans operate as managed care networks or HMOs.  This means beneficiaries must use in-network providers who often work together to coordinate care and can in turn save beneficiaries money. Plans also offer telehealth consultations with healthcare providers.

Medicare Advantage Cons:

Must use only in-network providers

Beneficiaries enrolled in Original Medicare or Original Medicare and a Medicare supplement plan can use any provider who accepts Medicare assignment.  On the other hand, enrollees in Medicare Advantage plans are limited to seeking care with in-network providers. Any services received out-of-network can be either denied coverage or may result in a higher co-pay amount. Additionally, the cost of your care may not apply to your out-of-pocket maximum.

Additional costs

Medicare Advantage plans may include additional costs.  These costs include co-pays, deductibles and co-insurance. These out-of-pocket costs can add up if you visit the doctor often.  The costs depend on the plan, provider, and the services received.

See below for some situations that can raise the out-of-pocket cost for a MA plan:

1. Beneficiaries may have a copayment for doctor’s visits.  Co-pays also apply to some prescription drugs.
2. In some instances, there may be coinsurance cost for some services.  This may apply to specialist visits or DME (durable medical equipment).
3. Out-of-network charges.  Anytime a beneficiary visits an out-of-network provider there may be higher out-of-pocket costs (co-pays, coinsurance or the entire cost) for services received.
4. Many plans have an annual deductible.  Beneficiaries must meet the deductible before some medical expenses are covered. This may also include cost of specific the prescription drugs.  This will depend on the tier of each medication.

Please remember; beneficiaries should be aware of the MA/MAPD plan’s summary of benefits to understand the potential costs associated with any plan.

Prior authorization

Because Medicare Advantage plans try to assure their plans are not misused, beneficiaries may need to have prior authorization for hospital stays, home health care, and some medical procedures as well as medical equipment. This may include a primary care doctor’s referral before a specialist visit is approved.

Additionally:

Because there is so much to consider, it is a good idea to seek the advice of a licensed Medicare agent when considering all your plan choices and comparing all the benefits that are important to you.

Click here for Generic Scope of apt

Agents who have questions – take a look at our YouTube channel

What is Medicare Part C

Many people see television ads telling them they need Medicare Part C.  In this post we answer the question; What is Medicare Part C and do you actually need it.

Medicare Advantage (Part C), gives Medicare beneficiaries an alternative coverage option to Original Medicare.  Medicare A & B provide coverage for essential health care benefits such as; doctor visits and hospitalization.  Part C (MA plans) take the place of your Medicare Part A & Part B benefits and are available through private insurance companies.  They also provide many value added benefits such as prescription coverage (Part D), dental, hearing, vision, OTC benefits and more.

More details about Part C:

All Medicare Advantage (Part C) plans are offered by private insurance companies.  MA/MAPD (Part C) carriers are regulated by CMS and must provide beneficiaries the same level of medical coverage that Original Medicare (A&B) provides.

Most Part C (MA/MAPD) plans offer a very competitive premium, many plans have a $0 premium as well as low out-of-pocket costs.  This gives people a very cost effective way to get the healthcare coverage they need.

If you opt for a MA/MAPD (Part C) plan, you should be aware of the plan’s provider network and confirm that your doctors are in-network with your selected plan.  Even if you choose a PPO plan, using an out-of-network provider can be a costly mistake.

Each year, during the AEP, you have an opportunity to either enroll in or out of your current Medicare plan.  The AEP starts on Oct. 15th and ends on Dec 7th.  If you are enrolled in a MA/MAPD, you have an extra opportunity to change your coverage options starting Jan 1 and ending March 31 each year; this is called the OEP.

Summary – Why Choose a Medicare Advantage Plan (Part C):

Part C (MA/MAPD) plans provide comprehensive coverage including additional benefits such as; dental, vision, hearing, prescriptions, OTC, rides to appointments and more. They also cover Medicare A & B charges for doctors and hospitals. Many plans include Part D, prescription drug coverage.  All you need is one card to cover your medical costs.

Because MA/MAPD plans have annual out-of-pocket maximums, beneficiaries can feel safe knowing the cost of their annual healthcare has a limit.  Plans also offer clear costs for services.  Some carriers offer coordination of care benefits which is a great way for all our providers to stay in the loop on your care needs.

There are several different plan options to suit your personal needs including; HMO, PPO, PFFS, DSNP, ISNP, etc.

A Medicare Advantage plan (Part C) is not for everyone:

It is important to consider many factors before choosing Medicare Part C coverage.  Some things to think about are; your personal healthcare needs as well as your budget. With careful research and an understanding of the plan’s features, you can make an informed decision that supports your health and well-being.

One of the most important points is to make sure our providers are in-network with the plan you choose.

Consider any medical conditions you may have an dhow often you will require medical attention.  It may be a better bet to join a Medicare Supplement and prescription drug plan depending on your personal health needs.  There are co-pays, deductibles and out-of-pocket maximums to think about with a Part C plan.

Make sure you are aware of the plans Star Ratings to be sure yo consider a good quality plan.

Remember; plans change every year.  Benefits are added and taken away.  That is why it is important to work with a knowledgeable, licensed Medicare agent to help you sort out all your plan options during the AEP or OEP enrollment periods.

Click here to learn more about Crowe and Associates

Visit our YouTube channel and review the Medicare AEP marketing rules

To view more images by this artist; click here