Medicare PPO plans have some attractive features but are they worth considering?

If you are enrolled in Medicare you have some choices to make. You can stay with original Medicare and enroll in Part D, purchase a Medigap policy  and enroll in Part D or join a Medicare Advantage plan that more than likely will include Part D coverage.

If you choose to enroll in a Medicare Advantage plan you may have Medicare PPO (Preferred Provider Organization) plans available.

This article is designed to give you an overview of what a Medicare PPO plan is, the pros and cons of PPO Medicare Advantage plans and give you a profile of who would benefit from this type of plan.

Medicare Advantage Plan – 2012 Enrollment Tips

What is a Medicare PPO plan?

A Medicare PPO is a Medicare Advantage plan also known as Medicare Part C. Medicare Advantage plans are offered by private insurance companies approved by Medicare. The plan will provide all of your Part A and Part B coverage as well as emergency and urgent care coverage.

A Medicare Advantage PPO plan will include a list of doctors, specialists, hospitals and other providers. This list is your Preferred Provider Network.

You are allowed to receive services out-of-network but you will generally pay more. Cost sharing can take the form of co-payments, coinsurance or deductibles.

Most PPO Medicare plans include Part D drug coverage. Plans often include additional benefits not normally found in original Medicare like; dental, vision, hearing, gym memberships and other health and wellness programs.

Compare Medicare Advantage Quotes

Medicare Advantage PPOs come in two varieties:

• Regional Medicare PPO that may be single or multi-State
• Local Medicare PPO that is offered in a single County

To learn more read the official government publication, “Your Guide to Medicare’s Preferred Provider Organizations (PPO) Plans“.

Preferred Provider Organization (PPO) pros and cons

These pros and cons are relative to an individual’s needs and circumstances. What may be a major draw back for one person may be less so for another.

Pros

• Medicare Advantage plans in general often have a lower premium than a Medigap policy and in some case offer a $0 premium.
• A PPO network can give the best of both worlds: lower in-network cost and the freedom to go out-of-network.
• Peace of mind knowing what your services will cost.
• Saving money by choosing a plan with Part D coverage.
• The extra benefits can be of value.

Cons

• If the network is limited you may find yourself paying more out-of-network more frequently.
• Overall costs for services are a little higher for a PPO than for a Medicare HMO plan.
• If you choose a Medicare Advantage PPO plan without Part D coverage you cannot enroll in a stand-alone Part D plan.

Who will benefit by this type of plan?

If you weighed your options between a Medicare Advantage plan and a Medigap policy and decided on the Advantage plan it’s now time to choose between the different types of Advantage plans.

Plans that include a Preferred Provider Network are popular choices because they offer a greater amount of flexibility than a Health Maintenance Organization (HMO).

Below are some characteristics of people who may choose a Medicare Advantage PPO plan:

• Someone who likes the flexibility of a Medigap policy but cannot afford the premiums.
• Someone who likes the idea of Medicare Advantage but doesn’t want to be locked- into a HMO.
• Someone who wants an all inclusive plan that includes Part D as well as some extra benefits.

Your ability to enroll in a Medicare PPO for 2012 is subject to having plans available in your service area.

Finding Medicare Advantage Programs – Navigating medicare.gov

If you are considering enrolling in a 2012 Medicare Advantage plan a PPO may be a good choice. Compare plans online or visit the Medicare website to find plans that may suit your needs.

Undeniably the best Medicare resource – Medicare And You 2011 handbook

The is no shortage of questions when it comes to Medicare. If it wasn’t confusing on its own the changes are enough to keep people asking questions. The official government handbook, Medicare And You 2011 is the best place to start to understand all you need to know about the Medicare program. Once you have the basics down you can intelligently choose a Medicare plan that will meet your needs and budget.

What’s in the handbook?

Section one of the Medicare and You 2011 handbook includes information on when and how to sign up as well as the basics of Medicare. Both the costs and coverage of Medicare Part A is explained as well as an expansive listing of Medicare Part B covered services. In reviewing the costs for Medicare Part B , the late enrollment penalty is also discussed.

A list of Medicare Preventive services is also included as well as a detail of what is not covered by Medicare. Knowing what is not covered can help you decide if pursuing a Medicare Advantage Plan is perhaps the right choice for you.

In section two of the Medicare handbook, your Medicare choices are explained. here you will learn the difference between a Medigap policy (Medicare supplement) and a Medicare Advantage Plan (Part C). Medicare Part D is also discussed.

It’s important to note that this is basic information and you will need to consult individual plan information to choose either a Medicare Advantage  Plan or Medicare supplement policy.

Section three gives you important information about getting help paying for your health and prescription drug costs. States have programs that pay Medicare premiums and in some cases help with co-payments, coinsurance and Medicare deductibles. It’s important to note that qualifying income amounts can change on an annual basis.

In section four of the Medicare and You 2011 handbook you learn about your Medicare rights and how to protect yourself from fraud and identity theft.

The fifth section of this Medicare resource discusses planning ahead. Many people falsely believe that long term care coverage is included in Medicare benefits but this is not the case. Although this section is brief it should start you on a quest to learn more about long term care options including long term care insurance.


In section six you will find helpful resources and tools to ensure that you understand your Medicare coverage and can find information easily when it’s required. Medicare related definitions are included in section seven.

The Medicare and You 2011 handbook is specific to your geographic region and section eight will allow you to find and compare plans in your area. Although information is accurate at the time of printing you are advised to visit www.medicare.gov to get the most up to date plan information.

If you are new to Medicare or just need a handy Medicare resource the Medicare and You 2011 handbook is the best place to start.

Is searching for the best Medicare Advantage Plan futile?

Anyone who has ever enrolled in an Advantage plan has hoped that they found the best Medicare Advantage Plan available. But what qualifies for the best Plan? There are countless search queries for some variation of the phrase all in the hope that the name of the best plan will be presented in the search results. The truth of the matter is that there is no “best Medicare Advantage plan” in the universal sense.

That’s not to say that the best plan is not available… out there somewhere for you to find. It’s just going to take a little work on your part. Once you find the best Advantage Plan available you have to ask yourself if it’s the best type of Medicare Plan for you in general.

What I mean to say is, if you have decided that an Advantage Plan is the best way for you to receive your Medicare benefits but you have very few plans available in your area, you have to decide if you have a large enough sample to find anything that will suit your needs. Maybe through you search for the best Advantage Plan you determine that given the limited choice available, you may be better off with original Medicare or original Medicare and a Medicare supplement.

Compare Medicare Insurance Quotes

What determines which Medicare Advantage Plan is best?

The best Advantage Plan for you may not be the best for someone else. Because there are several types of plans available with different costs and benefits you will need to assess your individual situation to choose the best plan. And because Medicare Advantage Plans are annual plans and can change from year to year you will need to re-assess your plan options every year. If the following factors all fall into place you may have found the best plan:

• The plan is affordable both in monthly premiums and in cost-sharing when using the plan.
• Your providers including specialists and hospitals are in network.

• You understand the rules of the plan and can abide by them. For instance, if requesting a referral to see a specialist is not something you are willing to do, do not choose an HMO plan.
• Your drugs should be included in the plan’s formulary if you are enrolling in a plan with drug coverage.
• The plan should include the extra benefits, i.e. dental, vision, etc. that are important to you.
• You should also check with Medicare to see if the plan has been flagged as having been rated poorly.

If you have found a plan that meets with your satisfaction it could be described as the best plan. When considering plans you need to be realistic. If your budget is very limited you may have to settle for what is available. Just remember that the best Medicare Advantage Plan is a plan that is suitable to your circumstances and not a universally accepted plan with a blue ribbon attached.

Get the facts when comparing Medicare Insurance plans – Medigap or Advantage plan?

If you are turning 65 and becoming eligible for  Medicare, you need to consider one of the Medicare insurance plans that are available. Very few people become eligible for Medicare and decide that Medicare Parts A and B are enough coverage. There are just to many holes in Medicare not to consider purchasing a Medigap policy or joining a Medicare Advantage plan.

Anyone who has gotten close to Medicare age knows, you are literally inundated with information delivered to your mail box. The important stuff is sent from Medicare and gives you an overview of your options. Publications such as Medicare and You and Choosing a Medigap policy: A Guide to Health Insurance for People with Medicare, include a ton of information, but it may be more helpful to put them on your night stand in case you can’t sleep. Most people find the reading dry and boring.

Insurance companies kill a lot of trees! Just look at all the four color brochures in your mail box. Often, you get a high level overview, but not what you really want, clear language and an idea of cost.

Compare Medicare Insurance Quotes

Comparing Medicare insurance plans

Many people don’t understand that a Medigap policy and a Medicare Advantage plan are two different types of Medicare insurance plans.

Medigap

A Medigap policy (Medicare supplement) is the traditional type of plan that has been around since 1966. It’s called Medigap because it fill the gaps left by Medicare. Medicare Part A requires you to pay a hospital deductible and co-pays for extended stays and Part B requires that you pay 20% of all covered outpatient charges.

Medigap insurance is available as one of several standardized plans. Plans will be the same from one company to the next. When you first become eligible for Medicare, you have an open enrollment period that lasts six months from the first of the month that you become eligible. During this time an insurance company cannot refuse you the opportunity to purchase any policy that they sell.

If the Medigap policy is affordable, this is the best time to purchase. Compare rates with several different companies, knowing that Medigap Plan N or Medigap Plan F will be the same coverage whether you are looking at Mutual of Omaha or AARP.

This type of Medicare insurance plan will also require that you purchase a stand alone Part D drug plan, as it is not included in a Medigap policy.

Medicare Advantage

Advantage plans were introduced when Part D was first made available. Advantage plans are not Medicare supplements. But rather, you are receiving your benefits from an insurance company that is approved and contracted with CMS (The Centers for Medicare and Medicaid) to administer your Medicare. The idea behind this, is that a private insurance company is more financially efficient than the federal government, and they should be able to stretch the money allocated to give you more benefits.

Advantage plans do not fill the gaps, but rather give you set co-pays, co-insurance and deductibles that may control costs and limit your out-of-pocket expenses compared to Medicare. Advantage plans also often include your Part D drug coverage, as well as many additional benefits not included in Medicare, such as dental,vision and hearing.

Advantage plans also have an open enrollment period when you become Medicare eligible. Plans also have an annual enrollment period because companies contract for one calendar year at a time, and can change or discontinue plans each year.

One benefit for people on a limited budget is the low cost of joining an Advantage plan. As an example, AARP Medicare Complete is available in many areas without any monthly premium.

Shopping for Medicare insurance plans

One of the most efficient ways of doing the leg work when comparing Medicare insurance plans, is to do some research online. You can often shop plans and get rates without having to leave your home. Another option would be to meet with a trusted insurance agent. If you choose to do this, make sure your agent represents several companies. Armed with some knowledge, you can avoid costly mistakes and compare the best Medicare insurance plans.

What is Medicare Part C?

Enrolling in Medicare and deciding on a Medicare Plan or Medicare supplement can be a daunting task. To make things even worse, the terminology is new and not very descriptive. Part A, Part B, Part D and now Medicare part C!

Most people know that Medicare Part A is your hospital coverage that requires a deductible and generally speaking, co-pays for extended hospital stays.

Medicare Part B is your outpatient coverage that includes the dreaded 20% cost sharing that is your responsibility and Medicare Part D is the all too familiar and very important prescription drug coverage.

Compare Medicare Insurance Quotes

Do I need Medicare Part C?

It would sound like with Parts A, B and D, you would have things covered, Right? Well maybe. But if you are unable to afford a Medicare supplement, Part C may be very important.

Medicare Part C is another name for a Medicare Advantage Plan. This is often confusing because it is mistaken for the standardized Medigap Plan C, which is a completely different thing.

A Medicare Advantage Plan is another way to receive your Medicare benefits. A private insurance company contracts with and is approved by CMS to administer your Medicare benefits. Insurance companies are able to design plans that meet the minimum guidelines set by CMS, while offering you benefits that will give you value. If you choose their plan because of perceived value, they then make a profit by administering your Medicare.

Medicare Part C is not for everyone, but many people find it to be an affordable alternative to purchasing a Medicare supplement. Some of the benefits of Medicare Part C include:

• Often times lower monthly premiums than purchasing a Medicare supplement. Some plans have no monthly premium.
• Your Part D drug coverage is often included in the Part C Advantage Plan.
• Having fixed cost sharing, particularly by having set co-pays for various services like doctor’s visits. This eliminates the uncertainty of the 20% cost sharing for outpatient services.
• Medicare Part C plans generally have an annual maximum amount out-of-pocket. Original Medicare does not have a maximum. The question often becomes, “20% of what?”.
• Most plans include many benefits beyond what original Medicare offers. These benefits can include; dental, vision, hearing and often gym memberships and transportation to and from medical and pharmacy visits.

Medicare Part C plans are offered by many private insurance companies. You can find plans available in your County by going to the Medicare website and searching for plans your area.

Now that you know that Medicare Part C is is another name for a Medicare Advantage Plan, why not do your homework to determine if a plan is right for you?

Medicare modernization act brings about new additions to standardized Medigap options

If you signed up for the free mini-course offered on the web form to the right and read the daily lessons, you know the difference between a Medicare Advantage Plan and a Medigap insurance policy (aka: Medicare Supplement).

This article is going to look at one new plan in particular; Medigap Plan N.

Compare Medicare Insurance Quotes

A brief overview

Most people know Medigap by its more common name, Medicare supplement insurance. A Medicare supplement is not an Advantage plan. A supplement is offered by a private insurance company to fill the gaps that original  Medicare Parts A and B leave for the beneficiary. Normally this would be the hospital deductible and the 20% coinsurance for outpatient services.

You must maintain your Parts A and B (and pay the Part B premium) while paying the insurance carrier a premium for your supplement. An Advantage Plan, on the other hand, is when a private insurance company contracts with the government to administer your Medicare Plan. You still maintain Parts A and B and pay the Part B premium when you elect an Advantage Plan.

Originally, the benefit with an Advantage Plan was that you avoided the high monthly premium  of a Medicare supplement. You also had some affordable cost sharing in the form of deductibles, coinsurance and co-pays with an Advantage Plan. Or, if there was a premium, in many cases it was considerably smaller that a premium for a supplement.

Reasons to consider Medigap Plan N

Here are some good reasons to consider Medigap Plan N. Keep in mind that everyone has different needs and not all features will appeal to everyone.

• No network restrictions. Use any provider that accepts Medicare.
• Plan design allows premiums to be lower than many Advantage Plans.
• No out of pocket costs for hospital stays. Part A deductible is paid by the plan ($1132 for 2011).
• Foreign travel covered in emergency situations.
• Skilled nursing facility coinsurance covered.
• Includes 100% Part B coinsurance (no 20% responsibility), except up to a $20 co-payment for office visit and up to $50 co-payment for ER.
• Generally no underwriting except for renal disease question.
• Premiums lower than most other standardized plans and often lower than an Advantage plan.
• No restrictive enrollment periods.

This plan is almost a hybrid. You have the benefits of a supplement and the convenience of an Advantage Plan. The co-pays for office visit and ER are a small price to pay for a substantially reduced premium.

What’s the catch?

If you are looking for a zero dollar Advantage plan, this is not it. But in the long run, you may pay less with Medigap Plan N than an Advantage Plan. Just the fact that you will not pay a deductible or a copay, for a limited number of days, if you are hospitalized is huge! Not to mention that many Advantage Plans now offer the same benefit for outpatient surgery and durable medical equipment as original Medicare. That is, they pay 80% and you pay 20%. Think about it. You have an Advantage Plan with little or no premium but you have to pay 20% for outpatient surgery. You may reach your maximum amount out of pocket quickly (which will most likely be more than the annual premium for Medigap Plan N.

The second thing to consider is that Medigap Plan N, like all Medicare supplements, will not include prescription drug coverage. You will need to purchase a stand alone Part D plan. I encourage you to explore your options to determine if a Medigap Plan N is right for you. This plan option becomes available starting with June 2010 effective dates.

To learn more about your plan options, you can visit the Medicare website or speak with a local agent who specializes in Medicare insurance plan options.

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.

Compare Medicare Insurance Quotes

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 $6700.
• Primary care doctor visit is a $15 co-pay.
• A specialist co-pay is $50.
• Hospital out-patient procedures require up to a $150 co-pay.
• $225 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 $150.  Check the plan’s Summary of Benefits to get complete information on benefits and costs.

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 $150 for the 2011 plan.

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 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.

Compare Medicare Insurance Quotes

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 coordinated 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 coordinated 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.

Understanding the 2012 Medicare Advantage enrollment periods

When Medicare Advantage Plans and Medicare Part D was introduced in 2006 Medicare Advantage enrollment periods were pretty straight forward. But things have changed in the last couple of years.

The Medicare Annual Enrollment Period (AEP) for plans with a January 2012 effective date  begins October 15, 2011 and ends December 7, 2011.

The Open Enrollment Period which ran from January 1 to March 31 has been eliminated. You have a six week window to research and choose the best Medicare Advantage Plan for your needs.

Compare Medicare Insurance Quotes

Annual Dis-enrollment Period

You are able to dis-enroll from a Medicare Advantage Plan beginning January 1 through February 14. Your only option is to return to original Medicare. You can purchase a stand-alone Part D Plan or a Part D Plan and a Medicare supplement (underwriting may apply).

If you enrolled in a Part D Plan during the AEP and would like to switch, you are in most cases, out of luck. You must keep the plan through the end of the year.

Exceptions to the rule

• When you become eligible for Medicare you have a 7 month window where you can join a Medicare Advantage Plan. The period begins 3 months prior to the month you turn 65, the month you turn 65 and 3 months after the month you turn 65.
• If you move out of your plan’s service area you are entitled to a Special Enrollment Period.

• If you qualify for extra help due to low income you are entitled to a Special Enrollment Period.
• If you live in an institution such as a nursing home you also qualify for a special Enrollment Period.
• Losing your employer group health coverage also qualifies.

Other reasons you may be able to switch plans outside of the Annual Enrollment Period includes misrepresentation or a plan defaulting on their obligation to provide coverage.

If you are enrolled in a Medicare Advantage Plan it’s important to keep in mind that your plan is an annual plan and can change from year to year. Because of this you should mark these 2012 Medicare Advantage enrollment periods on your calendar and compare plans at the appropriate time.

AARP Medicare Complete Advantage Plan from Secure Horizons

A quick visit to Medicare’s official website will list dozens of plan options in most areas of the Country. 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 Secured Horizons private fee-for-service plans did not renew for 2011 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.

Compare Medicare Insurance Quotes

Moving from one plan to another

Many of the AARP Medicare Complete plan members that were enrolled in a HMO in 2010, simply let their plan renew for 2011. The big change, as reported by agents across the county, has been from the 2010 Secured Horizons PFFS plan to one of the PPO plans available for 2011.

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 as little as 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 otherMedicare Advantage Plans in your area by visiting Medicare’s official website or by consulting the Medicare publication, “Medicare and You”.