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COMPARING MEDICARE ADVANTAGE PLANS WITH PQSeniorBenefits.COM

Most Medicare Advantage plans are coordinated care plans that have a network of providers. Using the plans service providers helps subscribers to pay less out-of-pocket for care. The following plans will be compared thus:

  • The Health Maintenance Organization (HMO) Plans: this plan uses a network primary care provider to help coordinate care. HMO plans mostly only pay for providers in the plan’s network except for emergency care, out-of-area urgent care, and out-of-area dialysis.
  • Point of Service Plans (POS): Point of service plans have the benefits of an HMO, but with more flexible provider choice. In this type of plan, costs are generally lower for using in-network.
  • Preferred Provider Organization (PPO) Plan: This plan is offered by a private insurance company and it covers providers both in and out of the network, unlike the HMO plan. The PPO plan pays a portion of the cost of using an out-of-network provider. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network but pay more if they are outside the plan’s network.
  • Special Needs Plans (SNPs): Special needs plans have benefits that cover special health care or financial needs. Under this plan, membership is limited to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices. Drug formularies to best meet the specific needs of groups. This plan is quite distinct from the other plans as it pays particular attention to people with specific health care needs.
  • Private Fee-for-Service (PFFS) Plans: PFFS plans may or may not have a provider network, but usually cover any provider who accepts Medicare. The plan determines how much it will pay doctors, other health care providers, and hospitals and how much you should pay when you get a car. The plan may not include prescription drugs, so you may have to enroll in a stand-alone part D plan separately.

There’s also a Medical Savings Account Plan that combines a high-deductible health plan with a special savings account. Medicare deposits funds that are withdrawn tax-free to pay for qualified health care services, so you can afford to see any provider you want. Like PFFS plans, MSA plans don’t cover for prescription drugs, but you can enroll in a separate standalone part D plan.

WHICH IS THE BEST MEDICARE ADVANTAGE PLAN?

Choosing the right Medicare advantage plan is dependent on certain factors such as financial status, medical history, coverage area, and age. It is important, therefore, to take the following into consideration when choosing a plan: coverage and benefits, provider choice, cost, customer service, information, and communication, as well as billing and payment.

Private insurance companies offering Medicare Advantage plans were rated based on recent performances and the following came tops: Highmark, Kaiser Foundation Health Plan, Humana, and UnitedHealthCare.

Choosing the right plan should thus be dependent on what rightly matches your specific needs.

WHAT IS THE DIFFERENCE BETWEEN MEDICARE & MEDICARE ADVANTAGE PLAN?

Original Medicare may appear similar to the Medicare advantage plan given that both plans give you basically the same set of Medicare part A and Part B benefits, there however have certain differences that will make an intending subscriber choose one over the other.

The original Medicare which was established as a government health insurance program to incorporate:

  • Medicare Part A which is hospital insurance and generally covers care at skilled nursing facilities and nursing homes sometimes
  • Medicare Part B is medical insurance designed to cover preventive care, doctor visits, lab tests, durable medical equipment, and more.

Conversely, Medicare Advantage plans provide an additional way to get part A and B coverage. Private insurance companies approved by Medicare offer Medicare Advantage plans which provide prescription drug coverage and other benefits such as routine vision and dental care.

The prescription drug coverage is more flexible under the Medicare advantage plan as it is incorporated in most of the plans, the Original Medicare, however, includes limited prescription drug coverage in certain situations. It doesn’t necessarily cover the prescriptions you take at home.

Also, extra benefits like routine vision or dental services, routine hearing services, membership in fitness programs, and more are covered in the Medicare advantage plans (though extra benefits may vary from one plan to another), while the original Medicare does not provide any of such benefits

For beneficiaries who decide to travel outside their plan’s service area, the Medicare advantage plan does not cover for them except in emergency situations, the original Medicare, however, provides coverage for beneficiaries anywhere within the USA.

For the choice of Doctors who take Medicare assignment, beneficiaries under the Medicare advantage plans (Part C) can afford to choose between doctors in the plan’s network, while the original Medicare provides beneficiaries with one particular doctor.

Out of pockets payment limits may apply under the Medicare advantage plan, though the amount may vary among plans and might change year to year. Whenever beneficiaries reach such a limit, the plan may cover medical expenses for the rest of the year. This, however, does not apply under the original Medicare.


MEDICARE ADVANTAGE

Medicare Advantage is a form of health insurance plan operated within the United States where Health services are provided to individuals through private-sector health insurers.

In other words, a Medicare beneficiary pays a premium to the government and in turn receives coverage for Medicare Part A and B services.

Medicare Part A covers Hospitalization which includes inpatient care in a hospital, along with skilled nursing facility care, hospice care, and home health care while Medicare part B covers necessary medical and preventive services which covers supply services necessary for a doctor to diagnose and treat a medical condition) Medicare coverage can be gotten in 2 ways:

  • Original Medicare
  • Medicare Advantage

MEDICARE SUPPLEMENTS

Medicare supplement is a supplementary plan that provides alternative options not catered for in the original Medicare. Original Medicare pays for much but not all of the cost for covered health care services and supplies.

So, Medicare Supplement fills in the gaps in basic benefits left behind by Original Medicare Part A and Part B, such as deductibles, coinsurance, and copayments.

To be eligible to enroll in a Medicare Supplement insurance plan, you must be enrolled in both Medicare part A and Part B.


WHAT IS MEDICARE ADVANTAGE PLAN?

Medicare advantage plan refers to medical health insurance plans offered by private sector health insurance companies that contracts with Medicare to provide inpatient and outpatient services.

As an alternative to the traditional Medicare run by a government program, Medicare advantage enables beneficiaries to receive health care services from private insurance companies.

As provided by law, all Medicare Advantage plans should provide the same level of coverage as the original Medicare’s part A and B with exception to Hospice care.

Also, Medicare advantage plans often provide additional benefits such as; prescription drugs, hearing, routine vision and dental, or health wellness programs. The most common types of Medicare Advantage plan available include:

  • Health Maintenance Organisations (HMO) Plans
  • Preferred Provider Organisation (PPO) Plans
  • Point of Service (POS) Plans
  • Special Needs Plan (SNP)
  • Private Fee for Service (PFFS) Plans
  • Medical Savings Account (MSA) Plan

DIFFERENCE BETWEEN MEDICARE ADVANTAGE AND MEDICARE SUPPLEMENT

Medicare supplement also known as Medigap provides coverage of healthcare which the original Medicare does not include. While Medicare advantage primarily pays for your healthcare bills, Medicare supplement further covers certain cost-sharing expenses required by Medicare, such as copayments, coinsurance and deductibles.

Also, Medicare supplement helps with other costs such as Medicare Part B excess charges or emergency medical coverage when you’re traveling outside the country. Medicare supplement (Medigap) generally don’t cover long term care, vision or dental care, hearing aids, and private duty nursing

Medicare advantage plans on the other hand, are an alternative to the original Medicare that provides coverage of Parts A and B (hospital care and outpatient services), and often covers prescription drug coverage, dental vision and hearing coverage as well as other additional perks such as fitness membership.

Most Medicare Advantage plans operate as health maintenance organizations or preferred provider organization insurance.


WELLCARE MEDICARE ADVANTAGE

WellCare Medicare Advantage plans offer extra benefits meant to take care of all aspects of your health. They are quite affordable and provide coverage that goes beyond original Medicare.

WellCare plans provide Part A and Part B coverage, including dental, vision, hearing, wellness, and fitness programs, as well as Part D prescription drug coverage. Most plans are usually very region-specific, and WellCare does not offer all plan types in a particular area.


WHY ARE SOME MEDICARE ADVANTAGE PLANS FREE?

You must have noticed some pages advertising a free monthly premium charge for some Medicare advantage plans. This is because some Medicare advantage plans offer a $0 monthly premium charge to be enrolled in the plan, thereby making zero-premium Medicare Advantage plans an attractive offer for those looking to save money on Monthly Medicare costs.


CIGNA MEDICARE ADVANTAGE 2020

Cigna Medicare is a health services company committed to achieving the major objectives of the Medicare advantage plan and aiding beneficiaries live healthier, more active lives through personalized, affordable and easy-to-use health care solutions.

The Cigna Medicare advantage plan 2020 covers 100% of original Medicare benefits with no or low monthly plan premiums and no or low copays.

The plan goes beyond the original Medicare to provide extra benefit options which include coverage for: prescription drugs, dental, hearing, vision, fitness program, and health information line, as well as out-of-pocket protection. It, however, does not provide a supplemental plan.


UNITEDHEALTHCARE MEDICARE ADVANTAGE PLAN 2020

UnitedHealthCare offers the largest Medicare advantage network in the United States with up to 6 million enrollees. As part of its strategy to serve the needs of more boomers, UnitedHealthCare will expand their offerings to provide more people access to more plans with all their unique and varied preferences in mind.

As part of its 2020 plan, UnitedHealthCare is collaborating with Walgreens to usher in the new AARP Medicare Advantage Walgreens plans from UnitedHealthCare. The plan is designed to deliver lower prescription drug costs and convenient access to medications.

The plan will feature $0 premiums and $0 copays on primary care visits, preventive care, and tier 1 prescription drugs. The plan also intends to provide access to lower-cost drugs through Walgreens, its preferred retail pharmacy.

UnitedHealthCare 2020 plan will further enhance Renew Active fitness program with a new personalized fitness plan; enhanced over-the-counter benefits that will give over 2 million people access to over-the-counter health items through mail order; vision and hearing coverage as well as expanded dental coverage.