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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

Click for Medicare Supplement Basics Video

Medicare Information for state of Connecticut

Medicare Part B Coverage

Medicare Part B coverage is medical insurance.  Part B covers doctor visits.  It also covers well visits.  Coverage for medically necessary services and supplies is provided. This coverage includes any service or supply that you require for either diagnosis and or treatment of a medical condition. Part B also covers outpatient services.  Covered services include those provided by either a hospital, doctor’s office, clinic or other health care facility.

Medicare Part B also covers many preventive services to prevent illness or detect them at an early stage.  Together,  Parts A and Part B are known as Original Medicare.

Medicare Part B benefits

Medical services and supplies covered by Medicare Part B include (but may not be limited to):

• Doctor’s visits,
• Urgent care visits,
• Laboratory tests,
• X-rays,
• Emergency ambulance services,
• Mental health services, and
• Durable medical equipment.
• Preventive services, such as pap tests, flu shots, and screenings.
• Rehabilitative services, including physical therapy, occupational therapy, as well as speech-language pathology services.

Part B has a monthly premium associated with it.  The monthly premium is $104.90 in 2016.  If you get either Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill.   Note:   If you did no take Part B when you were first eligible, the cost of Part B will go up 10% for each full 12-month period that you  could have had Part B but didn’t sign up for it, except in special cases. You will have to pay this penalty as long as you have Part B.

Click here to learn how and when to enroll in Medicare.

Are you ready to sign up for Medicare?  You can sign up online.  Click here to enroll.

We are one of  the Northeast’s leading Medicare expert brokerages.  We do not charge consultation fees.  Feel free to contact the office at 203-796-5403 if you have questions.

Click here for a free personalized Medicare quote.

Interested in getting a home or auto quote?  We can help with that as well.  Email us at Admin@CroweAndAssociates.com.  We will send you a personal online link to enter your info and request a no obligation quote.

 What is Medicare Part A Coverage?

Medicare Part A coverage is hospital care coverage.  This plan covers both lab tests and surgeries.  Doctor care during the stay is also covered.  There is also coverage for supplies like wheelchairs and walkers when they are medically necessary to treat either a disease or a condition.  Part A covers in-patient hospital stays.  These plans also cover care in a skilled nursing facility or nursing home care as well as Hospice care and some home health services.  Note:  Part A will cover nursing home care for medical purposes.  Medicare will not cover the expense if custodial care is the only care necessary.

Part A includes benefits for hospital expenses.

Other expenses part A covers are, a semi-private room and meals as well as medications.  There is also coverage provided for nursing services and other supplies from the hospital.  Part A benefits will cover home health care services when deemed medically necessary.  Your doctor must order home health services in order for this expense to gain approval. Skilled nursing facility (SNF) stays coverage will only receive approval by Part A after a qualifying hospital inpatient stay for a related illness or injury. To qualify for SNF care, the hospital stay must be a minimum of three days.  A qualified stay begins on the day you are admitted. The day the hospital dischares you does not count toward the 3 day requirement.  Patients can be kept for observation.  Time spent under observation is considered outpatient.  This time does not count towards your qualifying stay.

If your doctor has certified that you have a terminal illness, you may be eligible for hospice care coverage.   Your doctor will need to determine a 6 month or less life expectancy.  In hospice care, the focus is on palliative care.  Hospice focus is not cure.  The goal is to relieve pain and make the patient as comfortable as possible.

Click here to learn how and when to enroll in Medicare.

Click here for more information regarding Medicare Part A  benefit coverage.

Connecticut residents looking to compare plan options can click here for more details about plans available.  If you still have questions or would like to set an appointment, please call the office at 203-796-5403.  In fact, we are leading Medicare experts in CT and are here to help.  We do not charge for our consultation services.

Click here for a no cost personal and confidential Medicare quote.

Original Medicare Enrollment

Original Medicare Enrollment in parts A and B is automatic for those drawing Social Security.   Those people who are not that are not will need to enroll.

If you’re already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled Medicare Part A .  If you are under 65 and you receive Social Security or Railroad Retirement Board disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits.

You will need to sign up for Medicare part B, if  you are not receiving retirement benefits before age 65 or  if you qualify for Medicare through disability. Please note, you can sign up during your Initial Enrollment Period (IEP). This is the seven-month enrollment period that begins three months before you turn 65.  This enrollment period includes the month you turn 65, and ends three months later.

Click here to visit the Medicare.gov site to learn details.

CLICK HERE TO REQUEST MEDICARE QUOTE INFORMATION.

Still have questions?  We are Medicare specialists.  Please call if you have questions or need help navigating the Medicare enrollment process.  You can either call the office at 203-796-5403 or email us at admin@croweandassociates.com.

We are a full-service brokerage and offer clients not only guidance with Medicare, but all health plan needs.  We offer dental insurance, both long and short term care policies.  Crowe and Asscoiates can help with estate planning by offering several types of life insurance as well as investment opportunities.

New Humana Medicare Plans 2016

New Humana Medicare Plans 2016 –  There are some new Humana Medicare plans that clients can purchase in 2016. The new plans have many great options for members to choose from.  Humana offers Medicare Advantage plans both with and without drug plans in multiple states.  Please note that in some states such as NY, they only offer a stand alone PDP plan while in others they offer both the PDP and Medicare Advantage plans.  They have multiple MAPD plan types with HMO and PPO plans in various states.  Click the link below to review Humana Medicare plans 2016 in all states. The link will also provide PDP Rx summaries.  Please call our office with any additional questions about plan designs, or benefits.

Click for Humana benefit summaries for all states 2016

Humana Medicare is also looking to fill a market void in the Long Island NY region.

This new HMO plan offers to it’s members:

• $37 monthly premium.
• $5 PCP co-pays.
• $30 specialist co-pays.
• $6,7000 Maximum out of pocket (MOOP) cost.
• This plan also includes a Silver Sneakers membership.
• It also provides preventive dental coverage.
• There is also a vision allowance of $200 toward the purchase of new glasses.
• They provide members hearing aid coverage.
• In addition this plan offers optional supplemental benefits (OSB), if you so choose.
• Travel options are built in to allow for in-network benefits in select Florida counties.

The network has been expanded to include the following:

• North Shore Lone Island Jewish Hospitals as in-network participants.
• Both Pro-Health providers as well as surgical centers are in-network participants.
• In addition, the network includes Advanced Urology.

Medicare Supplemental Plan Rates

There are many various options when you decide to purchase a Medicare supplement plan. Medicare Supplemental Plan Rates are listed below. Coverage for Original Medicare, Part A and Part B, include monthly premiums, deductibles as well as co-insurances. There is no limit for out-of-pocket spending.  Long term care, dental and vision are not covered.  To stabilize and or limit some of the cost, many choose a Medicare Supplemental or Medigap Plan.  As you have most likely heard, Medicare enrollment can be complicated.  For your own piece of mind, we recommend speaking with an experienced, licensed health insurance agent.  A knowledgeable agent can help you  to choose the best option for YOU.

There are actually 10 Medicare Supplement Plan options available to you. Each plan has different, yet standardized, benefits and coverage. This means that no matter which insurer you buy from, the benefits of each plan will be the same.

However, while the plans are standardized across insurance companies, the Medigap costs can be vastly different. So even though you will ultimately be getting the same benefits, it pays to shop around to get the best rate.

Click for rates in CT

Click for rates in NY

Do you have questions or concerns regarding your current Medicare plan? If you would like to learn more about future Medicare Advantage, Supplemental as well as Prescription Drug Plan options?   Please contact us either at 203-796-5403 or at admin@croweandassociates.com to discuss your Medicare options in detail.

Medicare Excess Charges Connecticut

Medicare Excess Charges Connecticut:    Medicare excess charges or sometimes called excess billing is applied by doctors that do not accept Medicare assignment.  A doctor who chooses not to accept assignment is able to bill a patient 15% over the allowable Medicare charges.  However, Those providers are not able to bill over Medicare allowable limit on all charges.  Some items that providers cannot use the excess charge on include Durable Medical Equipment. This is true even if they are not accepting assignment.   Non par is another way of saying that the doctor does not have to accept the Medicare contracted price for services.   You should not confuse Non par with a Medicare opt out.  An opt out is when a doctor does not participate with Medicare.   Medicare will not provide any coverage for services rendered by an opted out physician or facility.

Be very careful when you ask a provider if they “take” your insurance!

You might think, if the provider says that they “take”  your insurance they participate with your insurance carrier.  This is not always the case. This only confirms that they will accept payment from your insurance company and they may submit your claim for you.  It does always not mean that they  have a contract with your carrier.

If you want to be sure, you should always ask healthcare providers if they are contracted as a participating provider with your insurance carrier.  Unfortunately, there are some providers out there who will mislead you with their wording in order to get your business.  This is more common than you would think. For this reason you must ask the right questions to avoid costly situations.  Your carrier cannot protect you from any carrier they do not have a contract with.

Fortunately, Connecticut does not allow excess charges or billing from doctors that are non par.  Some Medicare supplement plans cover excess charges.    That benefit is not necessary in CT and should not factor into deciding which plan you should choose.

Click here to access the government site on Medicare.

If you have questions or need additional information regarding your current or future Medicare needs, call the office at 203-796-5403 or email us at admin@croweandassociates.com.  Allow us to use or many years of experience and in-depth knowledge of all Connecticut Medicare plans and providers to help you navigate the Medicare process.

Cigna Medicare (Loyal American) Plan G

Cigna Medicare plans allow participants to use any healthcare provider that accepts Medicare; no referrals required. That is one of the reasons Cigna Medicare (Loyal American) Plan G may be the right fit for your insurance needs.  Please read the plan details below and decide if this is the plan you need to get the coverage you want.

Medicare plan G allows for basic benefits, covers the Part A deductible, includes emergency foreign travel coverage and some Part B excess coverage for a moderate monthly premium (Connecticut Monthly premium for 2015 is $219.54). Read more

Medicare Part D Connecticut

In this post, we want to explain some things about Medicare Part D Connecticut.  We want you to understand as much as possible about the coverage that is available to you.  This way you can make an informed decision.  In fact,  Medicare Part D plans are Medicare drug plans offered by private insurance companies.  Medicare offers these plans either on a stand alone basis or as part of a Medicare Advantage plan.   Multiple insurance companies offer various part D plans.  The plans range in monthly premiums from as little as $12 a month up to $140 a month in Connecticut.  The Benefits (copays for drugs) also range greatly.  The prices for drugs vary from pharmacy to pharmacy.  You should make a list of all your medications and check which insurance plan includes the medication that you use.

Many people incorrectly think

That there is a Part D plan offered by the Government or Medicare.  Medicare only established the guidelines of what the base part D benefit and premium should be.  They do not have an actual Medicare Part D plan that a consumer can enroll in.  This must be done with a private insurance company.

Members are eligible to enroll in a Part D Rx plan when they turn 65 or first become eligible for Medicare.  They may also add, drop or make a change to an Rx plan every January during the Medicare Annual Election Period.

CLICK HERE FOR MORE MEDICARE INFORMATION AND RATES

Crowe and Associates is a full service brokerage.  In addition to Medicare, we offer clients a full range of medical, dental, life, home and auto insurance products.  We also offer advice on investment products including annuity and bridge loan products.

Please feel free to contact us with any insurance or investment questions.  We are here to help you.  You can contact us either by phone at (203)796-5403 or by email at admin@croweandassociates.com.

Should You Buy Medicare Part B

Medicare Part B becomes available to people when they turn 65.  Unless, they are eligible prior to 65 due to permanent disability. If you are turning 65 in the near future, you may ask yourself; Should You Buy Medicare Part B.   Part B of Original Medicare covers outpatient services.  These services include doctors visits, lab work, testing, outpatient surgery and most medical procedures done on an outpatient basis.  In general Medicare Part B covers 80% of the cost of services after you meet the annual deductible.

There is a cost for Medicare Part B

There is a standard Part B cost for most people, although it can be higher for those earning higher income. There is also a penalty for those that do not purchase Medicare Part B when they are first eligible for it.  Most people will pay the penalty if they enroll late.  There will not be a penalty for someone 65 or older if they receive coverage from their employer and are actively working.  The penalty also would not apply to the spouse on the plan.  If someone is 65 or older and getting coverage from an employer but is NOT actively working, they will pay a penalty for not signing up for part B when first eligible.

As a result, it is advisable to purchase Part B when first eligible.  Unless you fall under the actively working and getting coverage category.  You cannot purchase a Medicare Supplement or Advantage plan without Part B of Medicare.  This is another good reason to purchase it when you are eligible.

If you would like more information about health insurance plans. Please contact us either by phone at (203)796-5403 of by email at admin@croweandassociates.com.  We are here to help you feel comfortable with your insurance coverage.   We will find  you a plan that fits both your medical needs and your budget.

To learn more about Crowe and Associates, click here