Blue Medicare PPO
Blue Cross Blue Shield Medicare Advantage Plans
At some point in your life, you may have had insurance with Blue Cross Blue Shield. Whether you had an individual or employer group plan, you probably formed some opinion about the company. If your experience was good and you are Medicare eligible, you may want to check out the Blue Medicare PPO Advantage Plan.
A Medicare Advantage Plan is not Medigap insurance. If you are new to Medicare, you may want to check out the official Medicare website or review your Medicare and You handbook that is mailed to all Medicare beneficiaries.
You can also complete the web form on this page to receive your free mini-course on Medicare Advantage plans.
Blue Medicare PPO may be an option in your service area
Blue Cross Blue Shield offers several Medicare Advantage Plans, but I wanted to take a look at one popular plan available in Florida. If you are a fan of Blue Cross Blue Shield, the Blue Medicare PPO Advantage Plan may meet your needs.
Of course as the name implies, it’s a PPO. So you have a provider network. But, the good news is that Blue Cross Blue Shield typically has superior network coverage, and the Blue Medicare PPO is no exception.
The following are some of the plan’s features for in network service:
- Maximum annual in-network out of pocket expense is $3400.
- Primary care doctor visit is a $10 co-pay.
- A specialist co-pay is $25.
- Hospital out-patient procedures require a $150 co-pay.
- $175 co-pay per day for days 1-7 in-patient hospital stay.
This is merely a brief overview of in-patient plan benefits and you should consult an agent or review the Summary of Benefits for the Blue Medicare PPO Advantage Plan.
One strong point is the co-pay for in-network out-patient procedures. Many Medicare Advantage Plans provide the same 80% coverage as original Medicare. The Blue Medicare PPO offers a decent value in this area, given that so much is provided in an out-patient setting.
The plan includes Part D drug coverage, but requires an annual Part D deductible of $90. In all fairness, they have a disclaimer on their website as it relates to the Blue Medicare PPO drug deductible. It states, This plan does not charge an annual deductible for all drugs. The $90 annual deductible only applies to drugs on certain tiers. Once again, check the plan’s Summary of Benefits to get the whole story.
So maybe you like the plan. Now you have to reconcile the benefits with the monthly premium. In Escambia County Florida, the monthly premium for Blue Medicare PPO is $112.
To compare plan premiums in your area check out the official Medicare site and enter you State and County to search for Blue Medicare PPO or other Medicare Advantage Plans offered by Blue Cross Blue Shield
Medicare Disability Benefit Options
What are the options for those who qualify for Medicare due to a disability?
Most people become eligible for Medicare when they turn 65 years old, but an increasingly large number of people become eligible for Medicare due to a disability. The Medicare disability benefit is activated after someone qualifies for social security benefits due to disability and has completed a two year waiting period from the date of being awarded Social Security disability status.
Unless disability is due to an event that resulted in a large legal settlement, many people who qualify for Medicare disability find themselves without the ability to work and may be in poor financial shape. Often when one becomes disabled and is unable to work, they may draw down their savings while they are engaged in the long process of qualifying for disability benefits. The situation is often compounded by losing health coverage from a former employer or the inability to pay premiums for individual health insurance.
Those with Medicare disability benefits may have an option to purchase a Medicare supplement and stand alone Part D drug coverage. Most Medicare supplement policies are individually underwritten, so taking advantage of the open enrollment period will be very important. Insurance companies can set rates, and rates for those under 65 with Medicare are often higher that rates for those 65 or older. Just as rates are higher for an 80 year old than a 65 year old due to greater insurance risk, companies will often charge those who are disabled and under 65 a higher premium due to higher risk. Because of the cost for a Medicare supplement, many people with Medicare disability benefits will not be able to afford this option.
Medicare Advantage plans are a good fit for those with Medicare disability benefits
As long as you have Parts A and B of Medicare and live in the Advantage plans’ service area, you can enroll in an Advantage plan. When someone becomes eligible for Parts A and B, no matter at what age, they will have a special enrollment period and will not have to wait for the annual enrollment period that runs from November 15th to December 31st of each year.
An Advantage Plan is a good fit for those people with Medicare disability benefits who are on a limited income. Checking the available plans on the official Medicare website is a good place to start. Those eligible for Medicare due to a disability may qualify for a special needs plan or a plan for those that are dual eligible, having both Medicare and Medicaid.
If beneficiaries are on a limited budget, they may be able to enroll in a plan that does not require a monthly premium. A good example would be AARP Medicare Complete Choice Plan 2 (premiums may vary). This is one of many plan choices, but for those on a limited income it is a good option to look at.
Whether you are interested in a Medicare Supplement or a Medicare Advantage plan, if you qualify for Medicare disability benefits, you need to take advantage of your special enrollment period and make a choice.
Medicare Special Needs Plans
Medicare Advantage for those with special needs
If you have decided to join a Medicare Advantage Plan, you may benefit from a Medicare special needs plan, if you meet the plan’s qualifications. As with all Medicare Advantage Plans, you must live in the plan’s service area and be enrolled in Medicare parts A and B. You also must not have end-stage renal disease at the time of enrollment.
In addition to meeting the general requirements to enroll in a Medicare Advantage Plan, you must also meet the specific qualifications for each type of special needs plan as defined by the plan type you wish to join.
Types of Medicare special needs plans
Types of Medicare special needs health plans include:
- Health plan for people with limited incomes. These plans are for people that are considered to be dual eligible. Dual eligibility means that the person is enrolled in both Medicare and qualifies and is enrolled in their State’s Medicaid program. Medicaid offers additional assistance to people who qualify due to having a low income as defined by their State of residency. Plan’s typically offer services with extremely low or no co-pays for services. Part D prescription drug coverage is included as are extra benefits beyond what original Medicare offers. Extras may include transportation for appointments with medical providers and trips to the pharmacy.
- Health plan for people with specific long term illnesses. This type of Medicare special needs plan is considered to be a chronic illness special needs plan. It is designed to meet the needs of those with specific enrollment criteria, as defined by their having a qualifying chronic illness. Plans may include; cardiovascular disorders, chronic heart failure, diabetes and other qualifying disorders. These plans typically offer a higher level of co-ordinated care than other Medicare Advantage Plans. Part D is generally included as are extra benefits designed with the member’s condition in mind. The treating physician will generally have to verify the condition indicated on the application, as the qualifying condition for enrollment, with the plan provider.
- Health plan for people in nursing homes. The key to eligibility for this plan is residency in a nursing home. The residence must be a qualified nursing home. This is generally for people permanently residing in a nursing home, and not receiving temporary respite care. Services are highly co-ordinated and may include the services of a nurse practitioner. Part D is included, as are additional benefits, such as transportation. These plans have little or no co-pays for services, as many that are qualified are also dual eligible qualified.
Enrolling in Medicare special needs plans
Enrolling in a special needs plan is different than enrolling in a non-special needs Medicare Advantage Plan. When enrolling in Medicare special needs plans, individuals are not limited by the standard annual and open enrollment periods. People who qualify for one of these plans are able to enroll at any time. Qualifying for a plan qualifies them for a special enrollment period by default.
If you qualify for one of these types of Medicare special needs plans, you should consider the benefits of enrolling in one. Your costs may be lower and your benefits enhanced as a member of the plan for which you qualify.
Dual Eligible Medicare Beneficiaries
Medicare Advantage for those with both 
Medicare and Medicaid
Many Medicare beneficiaries are also enrolled in their State’s Medicaid program due to having a lower income. Dual eligible Medicare beneficiaries may have access to Special Needs Plans designed especially for them.
If you qualify for a Special Needs Plan (SNP), as a dual eligible Medicare beneficiary, you should enroll in this type of Medicare Advantage plan over any other. Medicare Advatage Plans typically require cost sharing for the member through deductibles, co-payments and co-insurance. These fees may be more than what would be required if you had only Medicare and Medicaid.
Dual eligible SNP benefits
Benefits of enrolling in a Dual Eligible SNP are typically much richer than other types of Advantage Plans. This type of plan is generally a network based plan and not a private fee-for-service plan. Most often there are no deductibles, co-pays or co-insurance as long as the member remains in network.
These plans often include additional benefits, such as transportation to and from doctor visits and the pharmacy. Transportation will generally be limited to a certain number of one way trips. Many plans also include a catalogue of health related items as well as vitamins and supplements, that the member may order from and receive either a substantial discount, or in some cases, a quarterly allowed amount to use toward purchases.
Enrolling in a Dual Eligible SNP
Medicare beneficiaries who are dual eligible are not subject to the restrictions of the Annual and Open Enrollment Periods. Dual eligible members can enroll in a SNP at any time during the year. They are also able to change plans at anytime.
If a Medicare plan member qualifies for their State’s Medicaid benefit and they are in a traditional Advantage Plan, they should not wait for the annual enrollment period, as their becoming Medicaid eligible affords them a special enrollment period.
If you are a dual eligible medicare beneficiary and do not have a SNP, you should contact your Advantage Plan’s customer service and ask if they offer a dual eligible plan. If they do not offer a dual eligible plan, you should contact your State’s Medicaid office and ask them for a referral. It’s important that if you are a dual eligible Medicare beneficiary, you have the right plan.
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Too Late For Medicare Advantage Enrollment?
Missed the Medicare annual enrollment period?
The Medicare annual enrollment period (AEP) starts November 15th and ends December 31st. If you didn’t make a change during this time, you missed the AEP. But don’t worry, there may be another way to take part in Medicare Advantage enrollment. The Medicare open enrollment period (OEP) starts January 1st and runs through March 31st.
During the open enrollment period you are allowed to make one like to like plan change. Switching plans on a like to like basis is defined by the Part D component of your existing plan.
Defining like to like plan switches
The following outlines existing plans that you may have and what allowable changes you are able to make to your Medicare Advantage enrollment. Keep in mind that only one change during the OEP is allowed.
If you have a MAPD (Medicare Advantage that includes Part D), you are allowed to switch to:
- Another MAPD with drug coverage included in the plan.
- A private fee-for-service (PFFS) Plan without drug coverage and join a separate Part D drug Plan.
- Original Medicare and join a Part D Plan.
If you have a MA (Medicare Advantage without drug coverage), you are alowed to switch to:
- Another MA Plan, but cannot enroll in a Part D Plan.
- Original Medicare, but cannot enroll in a Part D Plan.
If you have Original Medicare with a stand-alone drug Plan, you are allowed to switch to:
- A MAPD with drug coverage included.
- Switch to a private fee-for-service MA (without drug coverage) Plan, but must keep your existing Part D Plan.
- You are not allowed to switch your existing Part D for another Part D, while keeping original Medicare.
If you have original Medicare without a Part D Plan, you are allowed to:
- Stay with original Medicare.
- Switch to a MA only plan without drug coverage.
If you have a PFFS Plan with a separate Part D Plan, you are allowed to switch to:
- A MAPD with drug coverage included.
- Original Medicare and must keep your Part D.
- A PFFS Plan without drug coverage, but must keep your Part D.
- Cannot change existing Part D for new Part D.
If you have a PFFS Plan without drug coverage, you are allowed to switch to:
- MA only plan without drug coverage and cannot join a Part D Plan.
- Can return to original Medicare but cannot join a Part D Plan
As you can see, all of the allowed changes during the OEP are defined by whether or not you have the Part D drug Plan. The OEP is more restrictive than the annual enrollment period, but you are able to make the changes outlined. Make sure that you are comfortable with your change during the OEP because only one switch is allowed.
The above restrictions do not apply to Medicare beneficiaries that may have a special enrollment period. A SEP is a time when some change in status has taken place; i.e. first becoming eligible for Medicare, losing employer coverage, moving out of a plan’s service area, etc. . During a SEP you have more freedom as it relates to Medicare Advantage enrollment.
If you missed the AEP, you may still have Medicare Advantage enrollment options by taking advantage of the open enrollment period.
Medicare HMO
Pros and cons of a HMO Medicare Advantage plan
As the premiums for Medicare Supplement plans continue to rise many Medicare beneficiaries are turning to Medicare Advantage Plans.
One popular type of plan is a Medicare HMO Advantage Plan. People looking to to lower their health care premiums may bristle at the perceived lack of freedom with a Medicare HMO Advantage Plan. A HMO plan requires you to have a primary care physician that coordinates your care and typically refers you to HMO network specialists and facilities to receive your care.
On the surface this seems like less freedom of choice. But even those people who have original Medicare or original Medicare and a Medicare Supplement choose a primary care physician and generally accept their recommendations as it relates to care with a specialist or health care facility.
Whether or not less choice is a factor depends more on how comprehensive the HMO network is than whether you can choose from all providers that accept Medicare assignment or only the ones in the HMO network.
So the network for a Medicare HMO Advantage Plan can be either a pro or a con. It all depends on whether you feel you will have enough choice in network.
Benefits of a Medicare HMO Advantage Plan
The main benefit for most people, and the one that draws them to a HMO plan, is the low monthly premium, or in some cases, no monthly premium. This benefit is coupled with the fact that unlike a Medicare Supplement, you will have cost sharing in the form of deductibles, co-pays and co-insurance.
The good news is that the co-pays for many services are affordable for most people. In fact, cost sharing for a Medicare HMO Advantage Plan is often less than for a PPO or private fee-for-service Medicare Advantage Plan.
Another benefit is that all providers in the network will accept your plan. One big disadvantage of a private fee-for-service plan is that there is no network and providers can accept your plan on a visit by visit basis. It’s nice to save money on premiums, but it’s more important that you have coverage when you need it.
A Medicare HMO Advantage Plan is often rich in benefits that go beyond what original Medicare provides. Many HMO plans include generous vision, dental and hearing benefits. Some plans include discounts from a catalogue of medical related supplies and supplements. Gym memberships are a popular addition to Medicare HMO Advantage Plans.
In the end you need to weigh the savings in monthly premium against your potential for some out-of-pocket cost sharing. One feature of a Medicare Advantage Plan that ads some peace of mind is that typically you have a maximum calendar year out-of-pocket amount that you would be responsible for. This feature will limit your liability when it comes to your share of the cost.
Choosing a plan
It’s best to do your homework. Check out the official Medicare website to compare plans in your area. Go to the plan website and search for the provider directory in your area to see if the HMO network will meet your needs.
If saving some money by lowering your monthly premiums is your goal, you may find a Medicare HMO Advantage Plan to be a viable option for you.
AARP Medicare Complete
AARP Medicare Advantage Plan from Secure Horizons
A quick visit to Medicare’s official website will list dozens of plan options in most areas of the county. In today’s post we’re going to take a look at the AARP Medicare Complete Advantage Plan offered by Secure Horizons.
In many cases, the AARP Medicare Complete plan has become the go to plan for insurance agents representing Secure Horizons since the Secured Horizons private fee-for-service plan is non-renewing for 2010 in so many service areas.
Benefit Plan selections are numerous. AARP Medicare Complete plans include HMOs, PPOs and Point of Service (HMO-POS). Plans vary from one service area to another, with HMOs being most popular in large metropolitan areas.
Moving from one plan to another
Many of the AARP Medicare Complete plan members that were enrolled in a HMO in 2009, simply let their plan renew for 2010. The big change, as reported by agents across the county, has been from the 2009 Secured Horizons PFFS plan to one of the PPO plans available for 2010.
One popular plan that is widely available is the AARP Medicare Complete Choice Plan 2. This plan is a regional PPO and has a fairly credible network of providers available for members.
One benefit of a PPO is the availability for the member to go out of network if they desire. Cost sharing will be lower if a network provider is utilized, but it’s nice to know that you have the freedom to choose your own doctor.
You must name a network provider as your primary physician, but are not obligated to use them. In addition, referrals are not required to see a specialist.
Checking the benefits
The AARP Medicare Complete Choice Plan 2 in particular does not require a monthly premium (other than continued payment of your Part B) and does include the Part D prescription drug benefit with no annual deductible.
Co-pays for doctors and out-patient services are reasonable and the per day hospital co-pay is only required for the first six days at an in-network hospital.
One less than positive feature is the much higher co-pay for an out of network hospital stay and an increase in the number of days that the co-pay is required. It’s important to check the provider directory to make sure that you are comfortable with the hospitals that are in network.
Some members are not too concerned that the co-pay is higher out of network, recognizing that given today’s technology, hospital stays are becoming shorter and shorter.
Value added benefits
The plan includes value added benefits, such as; vision, dental and hearing services. Theses services are not going to cover 100%, but they are beyond what original Medicare will cover. The Silver Sneakers gym membership is also available in many service areas.
You can compare the AARP Medicare Complete plans with other Medicare Advantage plans in your area by visiting Medicare’s offical website or by consulting the Medicare publication, “Medicare and You”.
Medicare Health Insurance Options
Know your Medicare health insurance options
Medicare options are confusing. Original Medicare, Part A, Part B, Part C, Medicare Advantage plans and Medicare supplement Plans! You have choices and to best protect yourself, you need to understand your Medicare health insurance options.
Medicare beneficiaries generally have three options when it comes to Medicare health insurance.
- Original Medicare
- Medicare Supplement Insurance, aka…Medigap
- Medicare Advantage Plan
Original Medicare
Original Medicare consists of Part A which generally covers hospitalization and Part B which generally covers out-patient services. Part A for 2010 has a $1100 deductible for the first 60 days of hospital stay. If you are admitted to the hospital overnight or up to 60 days, you will be responsible for paying this deductible. There are co-pays beyond 60 days.
Medicare Health insurance also includes out-patient coverage though Medicare Part B. Generally speaking, Medicare covers 80% of out-patient services and you are responsible for the balance of charges consisting of 20% of the provider’s fee.
Most medicare beneficiaries pay a Part B premium or $96.40 per month that is deducted Social Security benefits.
Original Medicare does not cover prescription drugs, and a stand alone Part D drug plan must be purchased from an insurance company.
Medicare Supplement Insurance
Medicare Supplement insurance policies are a form or Medicare health insurance that has been around for over forty years. Policies consist of standardized plans available from private insurance companies. the level of coverage and premium varies from plan to plan. Plan coverage is the same from one insurance company to the next. What generally varies is the monthly premium and the level of customer service offered by each company.
A Medicare Supplement policy is also known as Medigap coverage. They are the same thing and represent one type of medicare health insurance. Plans, to varying degrees, fill in the gaps of what original Medicare does not pay. For instance, the supplement will pay the hospital deductible and some level of out-patient charges depending on the plan.
The Part B premium in addition to the supplement’s monthly premium must be paid and Medicare Supplements do not offer drug coverage, so a stand alone Part D prescription plan must be purchased.
Medicare Advantage Plan
A Medicare Advantage plan is another way of receiving your Medicare health insurance. You are still in Medicare and need to continue to pay your Part B premium, but your coverage is administered and your medical claims are paid by a private insurance company the is approved and contracted with the Centers for Medicare and Medicaid (CMS).
The general idea is that a private insurance company is assumed to be more efficient than the federal government and this may result in greater benefits for Advantage Plan members. In any case, Advantage Plans are to be at least actuarially equivalent to original Medicare.
There are several types of Medicare Advantage Plans. Plans may or may not include Part D prescription drug coverage and there may or may not be a monthly premium. Medicare Advantage Plans generally include cost sharing through co-pays and can include deductibles. Extra value enhancing benefits, such as, dental, vision, hearing, gym memberships and discounts on health related products are often included.
This is a general summary of your Medicare health insurance options. You can learn more by visiting the official Medicare website. You can also complete the form below to receive a free mini-course on Medicare Advantage Plans.
2010 Medicare Advantage Premiums
Medicare Advantage premiums increase in 2010
How much is too much? 2010 Medicare Advantage premiums have in several instances increased. Some of the premium increases make you wonder whether you would be better off taking your chances with original Medicare. If premiums are approaching $200 per month in some cases, would you not be better off putting the premiums in the bank and hoping for the best?
Although you may be tempted to take this course of action, the better alternative would be to take advantage of your Annual Enrollment Period (AEP) and compare 2010 Medicare Advantage Plans in your area.
Keeping saved premiums may make sense to you when you consider how much co-pays for providers will cost through out the year, but one Medicare Advantage benefit should deter you from this course of action.
Medicare Advantage out of pocket maximum
The out of pocket maximum is one benefit that many Medicare beneficiaries overlook. Annual out of pocket maximums range from the mid-two thousand dollar level to the upper four thousand dollar range.
For 2010 the Part A Medicare deductible will be $1100.00 to cover hospitalization for the first 60 days and of course, the 20% cost sharing for out-patient services will still be in effect.
So, if you choose to pocket the premiums you could save by not choosing a Medicare Advantage Plan, you are potentially exposing yourself to some undetermined financial risk. $1100.00 is $1100.00, but on the out-patient side; 20% of what? That’s right original medicare has no out of pocket maximum.
Better course of action
If you have decided that a Medicare Advantage Plan is right for you, it would be best to do your homework now while you are in the AEP. Take a look at your Medicare and You publication, or visit Medicare’s official website to compare plans.
If you cannot find a reasonably priced Medicare Advantage plan for 2010, then maybe you should consider a Medicare Supplement policy. You will pay a higher premium and will need to select a stand alone Part D prescription drug plan, but you will generally eliminate much of the cost sharing associated with a Medicare Advantage Plan.
Best Medicare Advantage Plans For 2010
Compare 2010 Medicare Advantage Plans
How do you find the best Medicare Advantage plans for 2010? The best way to do research is to review the Medicare publication, Medicare and You. Normally when you shop for insurance you may meet with an insurance agent that represents more than one company or product. This may be the case with Medicare Advantage Plans, but an insurance agent is not allowed per CMS guidelines to do a side by side comparison between two plans using the plan’s brochure or summary of benefits. Comparisons can only be made using Medicare’s material. This is why the Medicare And You publication is so valuable.
The best Medicare Advantage plan
Now that you have the resource for plans in your area, it’s time to go to work. What’s best for one person may not be best for you. Things to consider, are the type of plan available, the plan’s premiums (if any), co-pays and any extra benefits that are important to you.
The type of plan refers to whether the plan is a private fee-for-service plan, PPO or HMO. When considering a private fee-for-service plan, be aware that you can go to any provider that accepts Medicare and accepts the plan’s payment terms and conditions. And they can choose to accept the plan on a visit by visit basis.
PPOs and HMOs are network based plans. The PPO offers more flexibility, as you can go out of network if you are willing to pay a little more than you would in network. HMOs are generally more restrictive about out of network visits.
Premiums for 2010 Medicare Advantage plans vary wildly. You may find a plan with premiums approaching $200 per month and plans that include Part D prescription drug coverage that have no monthly premium.
A popular plan where I live is the AARP Medicare Complete Choice Plan 2 offered by Secure Horizons. I am not endorsing this plan, per se, but it has no monthly premium, includes Part D coverage and has the extras like Silver Sneakers.
Do you homework
I recommend that you meet with an insurance agent that is authorized to discuss Medicare Advantage plans with you and ask some questions.
- What type of plan is this?
- Which providers can I use?
- What are the premiums for this plan?
- What are my co-pays?
- What extra benefits will be available?
Everyone has different interests and needs, but when you are shopping for the best Medicare Advantage Plan for 2010, you need to ask questions and be armed with your Medicare and You publication.