My Part D USA

This time of year your mailbox is probably full of materials from Medicare Advantage Plans. Most of the drug companies that offer MA’s will be advertising for you to switch from your Traditional Supplelment to a Medicare Advantage Plan.

Please be so careful because you may not be able to totally believe everything the salesperson tells you. They will tell you that Medicare Advantage Plans are as good or better than Original Medicare. Well, that statement can be quite deceiving. They do NOT COMPARE MEDICARE ADVANTAGE PLANS AGAINST A TRADITIONAL SUPPLEMENT!!!

Medicare pays 80% of your doctor and hospital costs. Your Traditional Medicare Supplement pays the other 20%. With a Medicare Advantage Plan you actually are not using your Medicare benefits, but all your bills go through the Advantage Plan company. It may sound better because the premiums are lower, but you may have co-pays for many things. There are many more hoops to jump through to see a specialist, and they just don’t cover every illness as comprehensively as a Traditional Supplement does.

One of the biggest problems people are having is that their doctor that they have seen for years will NOT accept the terms of payment from the MA company. We always tell people, especially if they have an ongoing illness, DO NOT SWITCH TO A MEDICARE ADVANTAGE PLAN.

These are the reasons to consider a Medicare Advantage Plan:

*If you are on disability and can NOT get any other coverage

*If you are in excellent health and want to risk staying in excellent health

REMEMBER: IF YOU JOIN A MEDICARE ADVANTAGE PLAN AND DO NOT LIKE IT, FOR ANY REASON, YOU HAVE 12 MONTHS TO GET BACK ON A TRADITIONAL SUPPLEMENT WITH NO UNDERWRITING. IF YOU WAIT AFTER THE 12 MONTHS, YOU WILL HAVE TO ANSWER HEALTH QUESTIONS, AND YOU MAY NOT BE ACCEPTED BACK ON A TRADITIONAL SUPPLEMENT.

So, readers, please all this this in mind, when you hear the very attractive sales pitch of the Medicare Advantage Plan salesperson.

I am NOT against Medicare Advantage Plans. We recommend them to some people everyday. YOU JUST NEED TO MAKE SURE THAT THIS IS THE COVERAGE FOR YOU AND GET THE FACTS!!!

If you have any questions, just call me, Karyn Blake, toll free at 866-752-1795.

If you would like a Senior Consultant to call you to discuss your options, call us or go to the website and fill out a worksheet at:

www.MyPartDusa.com

In addition to changing your drug plan from Nov. 15 to Dec. 31st you can also change your health plans.

Americans with Medicare can choose to receive their health benefits through Traditional Medicare, the program that allows you to see any doctor anywhere in the USA. 4 out of 5 people choose to use Traditional Medicare benefits.

Another option is the Medicare Advantage Plans or Private Fee For Service Plans. These are managed care plans where rules and restrictions apply.

Some MAP’s have built in Part D Drug Plans and others do not. You should compare the drug plan associated with the MAP to make sure you will save the most money. If you find that the Drug Plan is not the best, you can choose a Medicare Advantage Plan that allows you to have a stand alone drug plan. This means that you can choose which ever Drug Plan will be best for you.

Ask Yourself These Important Questions BEFORE you join a Medicare Advantage Plan:

1. Will I be able to use MY doctors?

If you choose Traditional Medicare, you will need a Medigap policy or Medicare Supplement to pay the 20% that Medicare does not pay. Traditional Medicare covers 80% of your doctor and hospital costs. You may already have this type of coverage through your retirement plan or your spouse’s employment. You will also need a stand-alone drug plan. There are up to 40 plans available in each state. That is why it is imperative that you get a comparison of these plans to make sure every drug you take is on the drug plan formulary and that you are getting the very best prices.

www.MyPartDusa.com can help you sort out all these decisions and help you enroll in the plan of your choice.

If you have been shopping for your Medicare Part D Plan, you have probably been approached by someone or have recieved mail about changing to a MEDICARE ADVANTAGE PLAN. The season for OPEN ENROLLMENT for changing or enrolling in MEDICARE ADVANTAGE PLANS begins January 1 through March 31st of 2008.

MEDICARE ADVANTAGE PLANS are good for some people, but you must be absolutely sure you can live with the coverage. There are sales people that will tell you that these plans are as good as original Medicare. This can be very misleading. You actually give up your Medicare benefits, and your doctors and hospitals will be paid directly from the MEDICARE ADVANTAGE PLAN. Many doctors and hospitals WILL NOT ACCEPT THE TERMS OF PAYMENT FROM THESE ADVANTAGE PLANS. You must be certain that your doctor or hospital will accept these plans before you join them.

We have heard from many people that could not continue to go to the doctor of their choice. They had to search for a doctor that would accept these plans. If you are in the middle of health issues, and you can afford to keep your Traditional Medicare Supplement, YOU SHOULD KEEP YOUR MEDICARE SUPPLEMENT. There are many things that may not be covered by your MEDICARE ADVANTAGE PLAN.

An elderly gentleman here in Chattanooga, TN had scheduled a heart surgery and joined a MEDICARE ADVANTAGE PLAN. When he went in to have the surgery, his doctor nor the hospital would accept the terms of payment from his new plan. He had to postpone his surgery, until we could get him back on his Traditonal Medicare Supplement. This was very dangerous for him because he needed the surgery when it was scheduled.

We were able to do this because Medicare rules say that if you join a MEDICARE ADVANTAGE PLAN and are not happy with it for any reason, you have 12 months to get back on your Traditional Medicare Supplement, WITH NO UNDERWRITING. Had he waited after 12 months, he would have had to go through underwriting and all the health questions and would NOT have been able to get back on his Traditional Medicare Supplement. His Traditional Medicare Supplement was accepted at any doctor or hospital and payed the 20% of his surgery expenses and Original Medicare Part B payed 80%.

We recommend MEDICARE ADVANTAGE PLANS only for people on disability that cannot get any other type of coverage. We also recommend them for people who can absolutely NOT afford a Traditional Supplement.

For anyone else a Traditional Medicare Supplement is perferable because there are no hoops to jump through or co-pays to worry about. You know your doctor and hospital will accept them. You can go to a specialst anytime without referral and a Traditional Medicare Supplement is good anywhere in the USA. Many times MEDICARE ADVANTAGE PLANS are regional and do not travel well.

I know we all want to save a dollar where we can, but please, if you can afford your Traditional Medicare Supplement do not be drawn in by the lower or no premium sales pitch of the MEDICARE ADVANTAGE PLANS.

Please read my other blogs with further details about MEDICARE ADVANTAGE PLANS. You can find them on the left side of this webpage under “categories”.

At MY PART D USA we can help you find the best Traditional Medicare Supplement in your state. We can also help you if you feel a MEDICARE ADVANTAGE PLAN is right for you. There are many MEDICARE ADVANTAGE PLANS on the market and we will explain them to you and help you choose the one that benefits you the most.

www.MyPartDusa.com
toll free - 866-752-1795

Today, I got a call from a lady in Ohio saying that she had a salesman coming out to her house to enroll her on a Part D Plan. I would bet you dollars to donuts that he is coming to her house to enroll her in a Medicare Advantage Plan with a built in drug plan called an MAPD. The commission for a salesperson on a Part D plan is very small. I don’t know of a salesperson that would drive all the way out to your home just to talk about a drug plan. Medicare Advantage Plans have the highest commission rate of any kind of Medicare Health Coverage.

Please be careful that you don’t get confused by this and sign up on something you don’t understand. If you already have a Traditional Medicare Supplement and you can afford the premium and you know your Doctor and Hospital will accept your supplemental insurance, you are better off to KEEP your Traditional Supplement. THEN, just enroll in a stand alone drug plan.

Medicare Advantage Plans will sound good for you because in some cases they have a much lower premium or no premium at all. However, you will have co-pays and many times your Doctor will not accept the terms of payment from these plans. I have heard many stories from people who had an ongoing illness, and they had been seeing the same Doctor for years. After they switched coverage, they had to change Doctors and had no choice who they could see. One man had a heart surgery scheduled and changed his coverage to a Medicare Advantage Plan and his Hospital would not accept the payment.

These salespeople will tell you that an MAPD is better than orignial Medicare. They say this because they may add in some minimal vision or dental coverage, but truly they are not better than Original Medicare that pays 80% of your doctor and hospital costs and your Traditional Supplement that pays the other 20%.

Remember, if you join an MAPD and are not happy with it or feel you had been misled or did not understand the plan, YOU CAN CANCEL IT AND GET BACK ON YOUR TRADITIONAL SUPPLEMENT WITH NO UNDERWRITING, within 12 months. If you stay on the MAPD over 12 months, you must go through the underwriting process to be able to get back on a Traditional Medicare Supplement. This may cause you to be turned down for coverage because of your health conditions.

If you ONLY WANT A STAND ALONE DRUG PLAN, STICK TO YOUR GUNS!! Remember as I said before, YOU ARE THE BOSS OF YOU!!

There are some people that could use a Medicare Advantage Plan and it would be a good decision for them. Many people on Medicare Disability could use a Medicare Advantage Plan before they become fully vested in the Medicare Health Benefits. If you absolutely cannot afford the premium on a Traditional Supplelment and you know your doctor will accept the plan, or you have very few health issues and don’t expect to have any, an MAPD might be right for you. Remember, your Doctor can refuse to accept the terms of an MAPD at ANYTIME.

If you would like more information, please read my other blogs listed in the left hand categories on Medicare Advantage Plans or call me, Karyn Blake.
toll free 866-752-1795.

I don’t mean to sound like a broken record, yet again, but please be careful if someone is trying to sell you a Medicare Advantage Plan!! I talk to so many people everyday that are not aware of the differences between what they now have, a Traditional Medicare Supplement and the new Medicare Advange Plans.

You must be informed of what you are getting yourself into. Please read my other blogs about Medicare Advantage Plans. It is a whole new ballgame! Your doctor may not accept the terms of this plan. You will lose your choices about your doctors, hospitals and sometimes pharmacy. They are NOT better than Original Medicare. If you can afford your premium on your Traditional Supplement you are better off keeping that coverage.

There are people who can use an Advantage Plan and I have outlined this on other blogs.

It may sound good to have a lower premium and sometimes not a premium at all, but you need to understand that Medicare Advantage Plans do not work like your Traditional Supplement. There are many more hoops to jump through.

Please read my other blogs on Medicare Advantage Plans for the whole story!

DURING THE ANNUAL ELECTION PERIOD OF NOVEMBER 15 THROUGH DECEMBER 31, PEOPLE ARE ABLE TO SWITH PLANS OR ENROLL IN MEDICARE PART D PRESCRIPTION DRUG COVERAGE.

You can also join or change your MEDICARE ADVANTAGE PLAN. Some of these MA’s have a built in PDP, or Prescriptions Drug Plan. Please get a comparison of the built in Drug Plan on your MAPD. Sometimes they are not the best choice. Remember, YOU CAN get a Medicare Advantage Plan and choose a stand alone drug plan.

Also, please check to see if your doctor accepts the terms of payment from the MA or MAPD BEFORE you join. This will save you tons of headaches. Also, realize that your doctor can stop accepting your plan at anytime.

If you have other questions about Medicare Advantage Plans please refer to my other blogs about this for extra details.

This is your time to make sure you are getting on a plan that has your best interests in mind. ONLY YOU CAN MAKE THAT CHOICE!!!

If you need to speak with a Senior Consultant with more questions please call toll free: 866-752-1795

Have you found out that your Doctor does not accept the terms of payment from you Medicare Advantage Plan? Do you feel like you are paying too much in premium for your Medicare Supplement?

If you have any problems with your current coverage and want to know your choices or wish to make a change you can do so during the AEP and also January 1st to March 31st you can change your Medicare Advantage Plan.

Please refer to my other blogs about the details of what a Medicare Advantage Plan will do for you. You can choose from the categories on the left side of the home page.

There were many seniors who thought that the Medicare Advantage Plan would work the same way as their Medicare Supplement and were disappointed in the benefits they recieved.

Also, if you joined a Medicare Advantage Plan and felt misled, or you are unhappy in any way, you have 12 months to get back on your Traditional Medicare benefits and Supplement with NO UNDERWRITING!!

If you have questions you can always reach us toll-free at 866-752-1795.We can guide you through the process of finding out about all your choices for coverage and select the plan that will be best for your needs. Everyone has differenent situations and the idea that one plan fits everyone is simply not true.

Traditional Medicare Supplements V.S. Medicare Advantage Plans
The Battle Begins
At My Part D USA we want you to be informed about all aspects of your Medicare Benefits. As you know the Annual Election Period is coming up soon for enrollment or changes to your Medicare Part D Drug Plan. All the plans change pricing and the drugs they cover each year and it is very important to get a comparison to see if you are on the plan that will cover your drugs for the lowest co-pays and premiums. You can go to www.MyPartDusa.com for your comparison and enrollment.
For nursing homes, Doctor offices, case workers, pharmacies and other professionals we now have www.MyPartDusa.org

You are invited to join us to get your free comparison and Part D drug plan Nov. 15 thru Dec. 31! GOOD INFORMATION=GOOD DECISION!!

The “great controversy” in 2007 for Medicare coverage is the aggressive advertising of the new Medicare Advantage Plans or Private Fee for Service Plans. Many Medicare beneficiaries are confused about the differences between Traditional Medicare and Medicare Advantage Plans, and do not know which type of plan would be best for their doctor and hospital costs or what plan would be best for them. Please do not confuse Medicare Advantage Plans with Traditional Medicare Benefits and Medicare Supplements!

IMPORTANT FACT: If you have joined a Medicare Advantage Plan and are not happy with it for any reason, you have 12 months to get back on your Traditional Medicare Supplement policy with NO UNDERWRITING, no health questions. You cannot be turned down for coverage within that 12 month period. The Medicare Advantage Plans do not tell you this!!At
www.MyPartDusa.com we can consult with you to find out how you can get back on a Traditional Supplement.

Since 2006, the state Office of the Insurance commissioner has received 300 consumer complaints about Medicare Advantage Plans, sometimes known as Part C. Some consumers said agents misled them or misrepresented themselves as government workers. Others complained about high-pressure sales in homes or group settings or that they were enrolled in plans without their consent. If you think you were misled call 800-633-4227 for the Centers for Medicare.

This summer the marketing and sales of Medicare Advantage Plans was suspended due to the many misunderstandings and outright unlawful sales tactics used by companies and salespersons pushing Medicare Advantage Plans over the Traditional Medicare Supplement policies. They have recently been placed back on the market, after Medicare has imposed new language that all companies and salespersons must use when giving their presentations. The new language is as follows:

“A Medicare Advantage Private Fee-For-Service plan works differently than a Traditional Medicare Supplement policy. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies.
Doctors, hospital and all providers may make this decision on a patient-by patient basis and visit-by-visit basis.”

This means that your doctor could accept your Medicare Advantage Plan at one visit and refuse it at the next visit if they so choose. If you have been going to a doctor you prefer and do not wish to change your doctor or hospital to one that accepts these terms, you will have much more security of coverage with a Traditional Medicare Supplement.

“Medicare Advantage Plans are offered by private insurance companies. Medicare Advantage Plans are NOT the same as Original Medicare that is offered by the Federal Govt. Medicare Advantage Plans do NOT work like a Traditional Medicare Supplement, Medigap, Medicare Select or stand-alone PDP plans. A Medicare Advantage Plan does not pay after Medicare pays its share. CMS/Medicare is not involved in individual transactions.”

In other words, when you elect to join a Private-Fee-For-Service plan they do not cover the 20% that Medicare does not cover. Even though you will pay the $93.50 per month for Part B Medicare, your coverage is NOT with Medicare, but only by the Medicare Advantage Plan you joined. You must have Part B Medicare to join an Advantage plan. However, Medicare pays the private insurance plan a fixed rate per beneficiary, regardless of how many or how few services the beneficiary actually requires.

With a Traditional Supplement you can choose any doctor or hospital you prefer with no referral for specialists. You will have a monthly premium for your supplement. Medicare will pay 80% of your doctor and hospital costs and your supplement will pay the other 20%. There are no hidden costs, co-pays or hoops to jump through. In addition to your doctor and hospital Part B Traditional Supplement, you will need a stand-alone Part D drug plan to cover your prescriptions. These are the only two policies you will need when you join Medicare Part A and or Part B.

With a Medicare Advantage Plan you may have a built in Prescription Drug Plan that you must use. Please make sure to compare the drug plan, if this is the case, against your choices for stand alone drug plans.
If you find better coverage with a stand alone drug plan you may need to reconsider enrolling in that particular Advantage Plan. You may be able to choose the drug plan that is best for you if the Advantage Plan you are considering allows you to have a stand-alone.

The Medicare Advantage Plans can lure you in with either no premium or very low cost premiums. However, they can be better than no coverage at all for persons on disability and those that cannot afford to pay the premiums on a Traditional Medicare Supplement. You could also consider a Medicare Advantage Plan if you are in good health and your current doctor and hospital is willing to accept the terms. You should certainly ask your doctor if he or she is planning to continue to accept the terms of the Advantage Plan before you join. Some Medicare Advantage Plan’s do have limited vision and dental coverage that Traditional Medicare does not offer. Some of them have even offered gym memberships or healthcare classes to increase enrollment. Another benefit of Advantage Plans is they have no health questions or underwriting. The only exception for joining is end stage renal disease. They do have annual limits on your out of pocket costs as well. Please weigh all these options carefully when selecting your health coverage. Also, if you have continuing health issues, there may be additional co-pays and expenses for services that are not covered by the Advantage Plan. If security of coverage and selection of doctors is important to you, a Medicare Advantage Plan may not be the kind of coverage you need.

At My Part D USA our Senior Consultants are standing by to help you answer these questions for your individual needs. You can call toll free: 866-752-1795.

If you are new to Medicare and this is your first enrollment into a Traditional Supplement or Advantage Plan remember that this is the only time you can get a Traditional Supplement with no underwriting. If you join an Advantage Plan and keep it more than 12 months and develop health problems or your Doctor decides not to accept the terms of payment, you may not be able to get a Traditional Supplement due to the health questions involved. Also, if you move out of the area of your Advantage Plan’s territory, you will lose your coverage. You can use your Traditional Supplement at any time, anywhere in the USA. If your Medicare Advantage Plan ends its Medicare contract and does go out of business, they must give you notice. You will have 63 days from the date your coverage ends to enroll in another Medicare Advantage Plan or a Traditional Supplement with no underwriting or health questions.

HELP FOR LOW INCOME: There are government assistance plans available for people who qualify so they don’t have to pay the Medicare Part B fee of $93.50. If your income is below $1,561 (single) and your resources are below $4,000 (single)you can contact your local Social Security office to complete the QMB application for extra help. The limits are higher for a married couple. You can also get on the Part D Assistance Program for limited income. If you qualify you would have no donut hole or premium and your co-pays would be between $1 and $5. We can help you apply to SS online by calling toll free 866-752-1795. It only takes a few minutes to find out if you qualify.

The most important aspect in learning about your Medicare options is to realize that all Traditonal Supplement Plans are regulated by the Centers For Medicare. The only difference is that one insurance company will charge you a higher premium for the same benefits as another company.
YOU MUST COMPARE PRICES!! Some of these companies have huge advertising budgets and want you to become of “member” of their organization. Please don’t be fooled into believing that they will have the lowest prices and the best coverage. Many times they do not have the best prices, but since their name is so recognizable, seniors enroll before they check or compare.

You should also call to speak to their customer service department before you enroll and see what kind of help you receive. This is not the enrollment department salespeople. If you ever have a question or a problem, such as filing an appeal for a service they have denied after you enroll, you will be transferred to another customer service department for assistance. Can you understand this person? Are they willing to help you with consideration? Do you have a long wait time? Many companies are out-sourcing their customer service to other countries and have employees that are under trained to be of valuable help.

My Part D USA is your continuous resource for Medicare information. You can also visit our blog for the latest news at www.blog/MyPartDusa.com We hope this article has helped you understand your benefits more clearly, but as always, if you have any questions you can reach us toll free at 866-752-1795 or write us at KBlake@MyPartDusa.com One of our caring and highly trained Senior Consultants will be happy to help you.

Karyn Blake V.P.
My Part D USA