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