Author Archives: Shawn Hudson

Direct Costs for All Advantage Plans

All Advantage Plans will have direct costs in the form of copayments for office visits, daily co-insurance for hospitalizations, etc. Adding a supplemental policy to your Advantage plan to cover these costs is not allowed. Regardless of the type of Advantage plan you choose, keep in mind that you will have to choose between suppliers who accept your specific plan or are ready to pay direct costs. It is very important to remember that coverage in a Medicare Advantage Plan is the same coverage as Medicare Part A and Part B. It is not the same as Part A and Part B with a supplement.  Understanding the benefits on the one hand is not enough to make your decision. Advantage plans have many benefits in addition to their disadvantages; so keep comparing and contrasting until you are comfortable with your choice. Medigap isn’t perfect for everyone, but if you qualify and can afford it, you probably won’t regret your decision.

Some Medicare Advantage plans include rewards not present in the original Medicare, such as glasses, dental coverage, and membership in gyms. Some of the policies include prescription drug coverage. There are many kinds of Medicare Advantage policies; PPO, HMO, POS, and PFFS. Two rewards that are also removed are the Preventive Care benefit as well as Home Recovery benefit, as Medicare determined that these were totally underutilized by the beneficiaries. The final benefit of supplementary plans over Advantage plans is that the price is standardized and has been around since 1992. Advantage plans, on the other hand, change annually. Recently, this has always meant higher prices year after year.

There were certain modifications from the present standardized Medicare supplemental policies by 2010. This was as a result of the Medigap Modernization Act of 2010, the act took effect on June 1st. These changes did not affect persons who were already signed up to the Medigap Plan before this date and apply only to people who enroll on or after June 1st. Medigap policy E, H, I, & J policies are being phased out by Medicare, meanwhile those currently enrolled in these policies may remain in them with no change. For those who simply do not have the funds for a supplemental plan, there are health insurance plans available in most areas that now offer zero cost options. I’m not a big fan of health insurance plans, but if you just don’t have the funds, it could be the way to go. Just consider the limits of your health insurance plan and if you are allowed to leave your network of doctors and hospitals.

Forms and Medicare Part D Drug Plan

Due to the ability of insurance providers to negotiate their own “agreements” with pharmaceutical companies under Medicare part D plans without having to transfer savings to the consumer, forms often contain the drugs that these pharmaceutical companies can negotiate the best price on. If you do not have “credible coverage” from another source, such as an employer plan or the Veterans Administration, and you do not enroll in a Medicare prescription drug plan when you are first eligible, you are likely to be fined for late enrollment The penalty is based on the number of months that have elapsed since you were eligible for enrollment until the final enrollment. A 1% penalty will be imposed per month and will last as long as you remain enrolled in a plan. The fine is based on the average cost of a plan in the year you finally apply. For example, if it has been 50 months since you were eligible to apply and the national average cost of a plan that year was $50, the cost of your plan would be $75, i.e. $ 1.50 multiplied by 50. This fine, again will be assessed every year in the future as long as you remain enrolled in a plan.

Each provider offers three Part D drug plans to choose from, sometimes referred to as good, better, and better, but the federal government also requires each of these plans to be exactly the same from one provider to another. While the Medicare Part D prescription drug program is not perfect or free, it fulfills the goal of providing access to affordable medicines to millions of beneficiaries across the country. Achieving a medication plan as part of your overall insurance package will give you peace of mind for an unknown future.

One of the hardest parts of navigating the new Prescription Drug Plan is the form of various drug plans. Selecting a plan is based on which medications you are taking and which plans provide the best coverage for the selected medications. To select the right plan for them, it is essential that qualified Medicare people understand how these forms work. A form is a list of insured prescription medication that the different prescription drug plans of Medicare must offer to their members. Some plans restrict prescriptions to those on the form, and others may also provide non-form prescriptions, depending on the level of coverage selected by the beneficiary. The medications contained in the form are usually those which are considered to be medically effective and cost effective.

AETNA ADVANTAGE PLANS IN MICHIGAN

Medicare Advantage Medicare Advantage plans have boomed in the last decade. Not only have they taken a step further in providing extra benefits and services to its clients but also reducing the cost of the monthly premiums. The medicare advantage plans are provided by private health insurance companies. These private companies first have to be insured by medicare. Along with managing part A and B of the medicare they also provide part C of the Medicare plan as well. Aetna is one of the biggest insurance companies in the United States, established in 1961. Along with providing one of the most beneficial plans, they are affordable and insures less out-of-pocket expenses as well. Aetna Advantage plans offered in Michigan are discussed below.

  1. Aetna Choice R3887-001 (Regional PPO)

With an overall rating of 4, the plan has a monthly premium of $0. It does not have an annual in-network deductible and the plan has an out of pocket maximum of $5500. There is a $10 copay, whenever you would visit your primary doctor, and a $45 copay while visiting a specialist. The plan does not cover your prescription needs. Emergency ambulance services and air ambulance services are also covered in this plan at a minimal copay and coinsurance. Along with pulmonary rehabilitation services, occupational therapy services, physical therapy, speech and language therapy services are also covered under this plan at $40 copay.

  1. Aetna Honor (PPO)

With an overall rating of 4, the Aetna honor plan has a monthly premium of $0. It is a preferred provider organisation plan, which lets you choose a healthcare provider of your choice. In this plan, you don’t even have to get a referral to see any special doctor. The plan has no annual deductible, and an out of pocket maximum of $5500. Under this plan, you have to pay a $10 copay for visiting your primary doctor, and a copay of $45 for specialist. Aetna Honor plan provides added services like dental coverage, oral exams, vision care, hearing services, and chiropractic services. You are also entitled to fitness, and over the counter benefits. However, the plan does not cover prescription drug services and you have to enrol in a Part D plan separately.

 

  1. Aetna Value Plus H8087-002 (PPO)

With an overall rating of 4.2, the plan is offered at a monthly premium of $15.60. The plan has an annual deductible equal to the Part B deductible amount mentioned in medicare, and an out of pocket maximum of $6700 for in-network providers. You have to pay a coinsurance of 20% while visiting your primary health care provider or any specialist. The plan covers prescription drug coverage with a deductible of $260. The deductible amount is applicable to generic, preferred brand, non preferred drug and specialty tier. For generic and brand name drugs you have to pay a 25% coinsurance. The plan also covers cardiac and pulmonary rehabilitation services, occupational therapy services, physical therapy services as well as speech therapy services at 20% coinsurance. Along with covering up to 40 meals over a span of 20 days, transportation services are also included in the plan.

 

  1. Aetna Choice H8087-001 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $19. The plan has no annual deductible and an out of pocket maximum of $5900. While visiting your primary doctor you have to pay a copay of $20 and for a specialist, you have to pay a copay of $45. The plan covers an in-hospital stay for both acute as well psychiatric stay, at a $0 copay after the sixth day. You can also avail any urgently needed service at a copay of $45. The plan covers oral exams, eyewear, eye exams, glaucoma screening, routine hearing exams, hearing aids, fitness benefits, over the counter benefits, SilverSneakers program, meals, as well as chiropractic services.

 

  1. Aetna Choice R3887-002 (Regional PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $119. This regional PPO plan has no annual deductible, and a maximum out of pocket expense of $5300. You have to pay a $15 copay while visiting your primary doctor, and a copay of $45 while visiting a specialist. The plan does not cover your prescription drug coverage. The plan covers your annual lab tests, therapeutic radiology services like a CT scan or MRI scan, outpatient surgery services and rehabilitation services as well. The plan also covers meals, which is an added benefit. It covers up to 40 meals, for 20 days.

 

  1. Aetna Choice SNP-DE H8087-003 (PPO D-SNP)

With an overall rating of 4 stars, this plan is offered at a monthly premium of $0. This gold plus plan is Special needs Plan which is specially added for people with particular chronic diseases. Not everybody is allowed to enrol in such plans. If you have a chronic disease like heart failure or end-stage renal disease, you can enrol in this plan. The special needs plan is specifically designed to cater to your needs depending on your particular situation. You have to pay a $0 copay while visiting your primary or specialty doctor. The plan also covers in-hospital stay and several chiropractic services as well. Along with covering the transportation costs, dental services, vision services, hearing services, over-the-counter benefits and fitness benefits are also covered in this plan. The plan also covers all of your prescription drug cost as well, provided you use the in-network pharmacies. The plan also provides preventive and home health care services at $0 copay.

Medicare Advantage Plans Have Wide Spread Coverage

 Medicare AdvantageAdvantage plans are now offered in 98% of the country’s municipalities. This is a long way since 1996, when only 15% of the municipalities offered them. According to the 2007 Medicare Advantage plan statistics, the average citizen pays $736 per month in premiums, although actual monthly payments between states range between $500 and $800 per month.

Holders of Medicare plans that do not have end-stage renal disease or kidney failure may qualify for a Medicare benefit plan, but in some municipalities there are offers especially for people with kidney failure.

In 1965, the government created a social security program called Medicare. This program focuses on the health benefits of its citizens and taxpayers in retirement. To qualify, you must be over 65, have a citizen or have at least one permanent legal residence in the country for 5 years and they or their spouses have been able to pay their taxes or contributions for at least the last ten years. The Medicare program is divided into different plans to help determine the specific program for the beneficiary.

One of the biggest differences between the two types of plans has to do with the freedom to change your coverage. A supplement can be changed at any time of the year. Advantage plans have an annual enrollment period at the end of the current year for coverage beginning January 1 of the following year. If you enroll in a Medicare benefit plan and don’t like it, you only have until February 14 to return to the original Medicare. By February 15, if you have not changed yet, you will be trapped in the plan for the rest of the year. When choosing between a Medicare supplement and a Medicare Advantage plan, for most people, the deciding factor is usually the cost of the monthly premium. If Advantage Plan has the providers you need and a suitable price for your budget, it may be the right option.

A Medicare Advantage plan can be a health plan, a PPO plan, or a particular service charge or a particular service charge. The HMO Advantage plan remains a popular option, especially for Medicare beneficiaries who want to pay only as little as possible from their pocket and low or no monthly premiums. However, Medicare HMO benefit plans are only offered in metropolitan areas with a large number of Medicare beneficiaries. In contrast, a Medicare PFFS or Private Fee for Advantage Service plan allows the Medicare recipient to visit any doctor, any hospital of their choice. Not surprisingly, this type of Medicare benefit plan is enjoying great popularity among Medicare beneficiaries.