August 4, 2010

BBB shows pros, cons of Medicare advantage plans

Since Tyler Obstetrics & Gynecology DOES NOT participate in Medicare Advantage plans, there have been lots of patients who appear to be unaware about the differences between traditional Medicare and Medicare Advantage. 

Medicare Advantage is a SUBSTITUTE for Medicare not a SUPPLEMENT.  The following news article expresses the Better Business Bureau's insights into the answer to so many of these questions.

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Special to the Progress Jacksonville Daily Progress

JACKSONVILLE — Healthcare legislation seems to be the topic of many conversations lately, triggering many calls to BBB about Medicare Advantage plans.

These plans are health plan options approved by Medicare and are offered by private insurance companies.

They are not considered supplemental coverage.

The plans may offer extra coverage, such as vision, hearing, dental, wellness programs and often include prescription drug coverage, however, some experts say there are disadvantages to Medicare Advantage plans:

“Once someone enrolls in one of these plans, the first thing you lose is your Medicare benefits as your primary insurance carrier, said Wade Emerson, Owner of Emerson Insurance & Financial Services. “The Advantage Plan becomes your primary carrier, and even though you are paying for your Part B premium out of your Social Security check or by sending in your quarterly premium to the government, you no longer have your Medicare benefits to rely on as your primary insurance provider.”

While some individuals may benefit from Medicare Advantage plans, BBB advises consumers to consider the following when deciding whether or not to change their coverage:

Care can cost more than it would under original Medicare.

What is the plan's limit on out of pocket medical expenses?

The average out of pocket maximum for these plans ranges from $3000-$5000.

Take a look at what you have spent for services such as hospital stays or doctor visits to see if the plan is worth enrolling in.

Does the plan cover all of the services you need?

Is your doctor in the plan's network?

If not, then decide whether or not you are willing to switch doctors.

Otherwise, you may have to pay the entire cost of the service.

Bear in mind, many physicians refuse to accept Medicare Advantage Plans.

Those with both Medicare and Medicaid (dual eligible) can encounter higher costs and limited providers.

 “One thing to keep in mind is that although Medicare Advantage plans include prescription coverage, they do not cover all of the doctor and hospital charges”, said Gina Williams, Owner of Ayers Insurance Agency. “I had a client in Athens that had cancer in both kidneys, but had to wait a year to have surgery so that he could switch from an Advantage Plan back to standard Medicare, because his physician did not accept the plan.”

Approximately one-third of Medicare Advantage plans have no cap on maximum annual out of pocket expenditures for services covered under Medicare.

Beginning in 2011, however, the maximum out of pocket cap is set at $6,700.

Likewise, they will be barred from charging higher copayments than the patient would pay for under original Medicare for certain services.

“The rules are becoming more stringent to increase protection for seniors” said Mike Boyter, Owner of Boyter Financial Services.  

Elections made during the 2011 Annual Enrollment Period (AEP) than runs from November 15 through December 31, 2010 will be effective on January 1, 2011. 

Starting in 2011, an Annual Disenrollment Period (ADP) modifies the Open Enrollment Period (OEP). 

In its place, CMS will implement an election period called the Medicare Advantage 45-Day Annual Disenrollment Period (ADP). 

The ADP will run from January 1 through February 14th. 

During the ADP, beneficiaries who are enrolled in a Medicare Advantage (MA or MAPD) plan have one election available and may disenroll from that plan back to Original Medicare. 

Keep in mind, not all Medicare Advantage plans work the same way, so before joining, make sure the plan meets your specific needs.

Make sure you are working with a reputable insurance agent. Go to  www.bbb.org to look at the company's find an insurance agent you can trust.