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What is a Medicare Advantage Plan

Original Medicare includes benefits for Part A (hospitalization) and Part B (doctor visits).  However, not all of a beneficiary’s needs may be satisfied.   (Click here to learn 5 things that are not covered.)  A Medicare Advantage Plan, also known as Medicare Part C or MAPD, can be an effective and financially smart way to ensure that senior citizens have the medical coverage they need going into their golden years.

While not part of the original federal health plan, Medicare Part C became law in 1982. The way it works is that the federal government pays private insurance companies a specific amount of money per person to bundle the original Medicare benefits. Many companies also add prescription drug coverage, or Medicare Part D, in their advantage plans. Some of these plans cover additional services than original Medicare, making them a smart choice for many senior citizens.

Because many Medicare Advantage plans work like private insurance plans, the options for them include:

• Health maintenance organization plans (HMOs)

• Preferred provider organization plans (PPOs)

• Private fee-for-service (PFFS)

Because of their connection to the federal plan, Medicare usually sets the fee for both the provider and the individual enrollee. But, for a PFFS plan, the private insurance company sets those fees. Medicare Advantage plans must follow Medicare rules and guidance from the federal government, though each private company can have different out-of-pocket costs or access to services. In addition, insurance companies can, and do, change the rules of their Medicare Part C (Advantage) plans each year.

Already a certified Medicare agent?   Work with a better FMO.   In addition to $500 monthly lead dollars, we offer every agent state of the art quoting, enrollment and tracking tools at no charge. Click here to get started.  

PPO

If you are or ever have been in the market for a healthcare plan you will most likely come across the term PPO.  A PPO is a preferred provider organization. These plans offer a network of healthcare providers for their members to use for medical care at a negotiated rate.  PPO plans allow members to see any in-network health care provider they choose without requiring a referral.

More PPO information:

If you choose to join a PPO, in most cases, you will not need to choose a primary care provider.  You will be able to use any provider within the company’s network of providers. All your in-network healthcare services will be covered at the negotiated rate.  You will also have the option of using out-of-network providers, although they will be covered at a lower rate. It is always a good idea to make sure your provider participates with your health plan in order to avoid receiving a higher than expected medical bill.

In most cases you will have a deductible to meet each year before your medical bills are covered by the insurance company.  There is also the matter of co-pays for certain services.  Some services will require you to pay a percentage of the total medical cost. These are things you should be aware of, if possible, before you go for medical care.

PPO Providers:

PPO plans have a number of in-network doctors and medical facilities you can choose from. In this way the plans are similar to HMOs.  It is always more cost effect to use an in-network provider when seeking medical treatment. Providers who participate with your insurance company have an agreement to accept lower payments and in return, receive access to patients who participate with the insurance company’s network.  One advantage to a PPO is that beneficiaries do receive coverage for some out-of-network care. If you decide to use an out-of-network provider you will most likely have to pay a higher rate for your care but the insurance carrier will pay some of the cost.

Another benefit of joining a PPO is that you will not be required to get a referral to see a specialist.  You can choose from any in-network provider for medical services

PPO plans might be a good fit for you if:

• You do not want to get a referral before seeing a specialist.
• Sometimes you want to use an out-of-network provider.
• It is important for you to have the choice of where you receive your medical care.

If you would like help choosing a Medicare plan, click here

To set up an appointment with a sales rep, please contact us either by phone (203)796-5403 or by email teal@croweandassociates.com.

A number of our clients want to know how a Medicare Advantage plan works and how it is different from Medicare A and B and/or a Medicare Supplement plan.  The fact is that Medicare Advantage plans are very different from standard Medicare A and B and a Supplement. Read more

The  Anthem Mediblue Preferred PPO became available in CT on 1-1-12.  The plan offers advantages  over all competitors in CT. The key features of the new plan are $0 monthly premium, $0 copay for primary doctor and $0 copay for Generic Drugs. To further strengthen the offering the In network and Out of network Out of Pocket Max will be $3,400 combined. The hospital copay is $250 a day for a max of 6 days both in and out of network.

The plan offers many less high profile but non the less,  important benefits such as Major Radiology copay of $100, expanded Rx list including the Barbituates classed drugs, ect…..

The plan is not perfect as it does have a $60 Rx deductible for name brand drugs but the other benefits are so much better than the competing plans for 2012 that will not have much impact. The key will be to see if they are able to maintain these benefits for more than one year. It makes one wonder how they are going to be able to offer such a strong program compared to other large carriers in the market such as United Healthcare and Aetna.

Time will tell if they are trying to buy membership for one year just to make major benefit downgrades for 2013

Application and Summary of Benefits available below

Anthem PPO summary of benefits

Anthem Medicare PPO application

For additional information or questions call: 203-796-5403

Applications may be submitted to Edward Crowe for Processing:

Fax submissions:  203-567-6235

Email submissions: Edward@croweandassociates.com

Mail: Crowe & Associates, 155 Main Street, suite 205, Danbury, CT 06810