Medicare and Medicaid

When it comes to Medicare and Medicaid lets start with some important distinctions.  I hate to be to basic, but I want to make sure that we understand the difference.  Medicare is a national social security program while Medicaid is a state run governmental program.  You can have Medicare without Medicaid, Medicaid without Medicare, and you can have both Medicare and Medicaid.  I'm going to deal here with the last combination of Medicare and Medicaid.  There are several levels of Medicaid depending on your state of residence as well as your income and assets.  Medicaid helps pay some or all of the costs that Medicare does not pay.  In order to take advantage of both Medicare and Medicaid, you will have to use providers that will accept and file both. 


There are Medicare Advantage programs that work with both Medicare and Medicaid.  One well known company that offers these programs is Wellcare.  Wellcare offers different programs depending on the level of Medicaid coverage that you qualify for.  The advantage to these programs is more provider options as well as additional benefits such as dental, vision, and even transportation.  Just make sure that you sign up on the right one.  TIP:  An easy way to get on to Medicaid is to apply for LIS. Please click here for more information on LIS and Medicaid

Blue Cross Blue Shield Medicare Advantage for 2011

Blue Cross Blue Shield is one of the most widely recognized names in health care.  They are a huge provider of health coverage for a lot of group plans, and this helps them when it comes to their Medicare enrollments.  Unfortunately, the name doesn't always translate to coverage.  One important note is that BCBS is different from state to state.  They are completely separate entities, and operate independent of each other.  So BCBS of Alabama is completely separate from BCBS of Tennessee. 


Start be making sure you are looking at the correct plans for your state and county.  BCBS offers several types of Medicare Advantage  and Prescription Drug Pans depending on your location.  For example, in Alabama BCBS offers a PPO, PFFS, and a SNP while Arkansas only has a PFFS plan available.  Both California and Florida offer a Regional PPO.  A quick review of the Florida Regional PPO shows a premium of $63/month, co-pays of $50 for specialists, $300 a day for hospital stays, and a lovely $150 Part D Drug deductible!  Click here to see another well known company that has started including a deductible for their drug coverage.  These companies should be ashamed of themselves for this kind of robbery.  In this county alone there are three plans that have a zero premium, lower co-pays then those described above, and no deductible on the drug portion of the coverage!

So why would anyone sign up for this type of coverage?  Well, the answer is simple.  People have BCBS when they turn 65 so they migrate to their Medicare coverage, not taking the necessary time to research the best plans for them in their area.  The lesson here is to not always assume that a company with a well known name is going to always provide you with the best coverage.

AARP United Healthcare Medicare Advantage Plans 2011

The AARP United Healthcare plan is the same throughout Florida!  It is also known as AARP Medicare Complete Choice Plan 2.  Probably everybody has heard of United Healthcare as they are a national insurer that covers a lot of group plans as well as individuals.  Most people were probably covered by United Healthcare at some point in their life.  The AARP plan in Florida is a PPO, and is an outstanding value since it has NO monthly plan premium!!  For more info on PPO's versus HMO's click here.

It also contains medicare Part D coverage as well with no deductible and still no premium.  You will be responsible for paying the copays when you use the plan or fill prescriptions.  The plan also contains extras like dental coverage and the wildly popular Silver Sneakers program at no additional cost.  

Since it is United Healthcare providing the coverage, their provider directory is extensive.  Don't fret if you can't find your doctor in the directory as there is coverage for out of network use.  Simply pay the higher co-pay if needed. 

The plan is available in other states, but keep in mind that plans will differ from state to state and even county to county.  The plan also has something unique called the Passport Program.  This program allows you to travel to designated states and still be in-network.  This is a great feature for snowbirds or retirees that love to travel.  For more information on the plan in your area be sure to check medicare.gov or talk to an agent near you!

Humana Medicare Advantage Plans Have some UNPLEASANT Surprises in 2011!!

We've all seen the ads on tv for the Humana Medicare Advantage plans.  And they somehow make them sound so good.  However, a closer look leaves a not so pleasant aftertaste!  Shockingly, they are now including a Part D drug deductible in many of their plans.  While common in stand alone Part D plans, this has not been seen in MAPD or Medicare Advantage plans.  The deductible of up to $310 is found in several of their plans for 2011.  So not only are they charging high premiums for their plans, they are also now including a Part D drug deductible as well.  

Make sure you compare the plans in detail before signing up to avoid finding out after the fact that you now have a deductible to pay that wasn't there before.  For more information on comparing Medicare Advantage plans and the most recent Humana Reader's Digest Healthy Living plan check out my blog at www.medicare-plans.net

HMO VS PPO

There seems to be a lot of confusion out there regarding the different types of medicare plans available.  The majority of the plans are going to be either PPO or HMO. 


An HMO is a Health Maintenance Organization, and differs quite a bit from the PPO.  When you are comparing plans this year in 2011 make sure that you are comparing apples to apples.  HMO's are always going to be cheaper than PPO's, and there is a good reason for this.  HMO's are more restrictive than PPO's and are more difficult to use. 

Here are the primary two differences. 

HMO - Requires a referral from the PCP or Primary Care Physician
PPO - Does not require a referral from the PCP

HMO - You must pay 100% of the cost out of network
PPO - You have coverage out of network, but usually pay a higher amount when you are out of network

So, if you don't mind the referral hassle, you can save some money by going the HMO route.  If network is the most important thing to you, than you are probably better off on a PPO unless there is an HMO with an extensive network!  Be sure to check out my post Medicare Advantage Do's and Don'ts for more information on choosing a plan http://www.medicareupdate.info/2010/10/medicare-advantage-dos-and-donts.html

Medicare Supplement or Medicare Advantage in 2011

You may be wondering what kind of Medicare coverage makes more sense for you next year.  You really have two options to consider.  They are Medicare Advantage and Medicare supplements.  The Medicare supplement works as a true supplement to medicare and pays things that medicare does not pay.  How much depends on the plan letter that you choose.  This coverage comes with a price, and the price is determined by your location, the company you choose and the plan letter.  The biggest benefit of this kind of coverage is that it is accepted anywhere Medicare is accepted. 


The alternative is Medicare advantage. With Medicare advantage you choose a company that is going to be most likely a PPO or HMO which means you will be working within the confines of a network.  The biggest advantage is that in many areas these companies offer little to no plan premium.  Instead you pay co-pays when you use it.  This means that if you are healthy and rarely go to the doctor, you could save a substantial amount of money by joining a medicare advantage plan.  These plans also offer extra benefits that medicare and supplements do not such as drug coverage, dental, vision, and many times health club memberships.  It's really simple, if you are healthy and not anticipating any procedures in the upcoming year than medicare advantage makes a lot of sense; but on the other hand if you are unhealthy or have some planned procedures coming up, you should probably be looking at a supplement!

Thank you Medicare Advantage for my Golden Ticket!!

Experiencing a lot of medical issues recently?  Tired of paying all of those pesky co-pays?  Just when you thought it couldn't get any worse you get a letter from your Medicare Advantage company saying they are leaving town!  Oh, the humanity!!  But wait!  That letter could be your golden ticket!!  That's right, your Medicare Advantage plan leaving town is just what the doctor ordered. 

When you lose coverage, CMS (Centers for Medicare and Medicaid) grants you something called an SEP or Special Election Period.  This SEP guarantees your coverage!  That's right, you are now able to go anywhere you want to for coverage.  In short, you are now able to go sign up for original Medicare and a supplement.  You can choose any supplement you desire and not have to go through the underwriting process.  Without the "Golden Ticket" this would not be possible.  So, don't despair; instead take advantage of the situation, and turn a bad thing into your "Golden Ticket"

Medicare Changes for 2011

"We change, whether we like it or not" - Ralph Waldo Emerson

Wow, Medicare has never undergone changes like we've seen this year!  From Part D to Medicare supplements to Medicare Advantage or Part C.  Just about every part of Medicare has seen some major changes.  You might just want to pay attention, or it could cost you!

A Medicare supplement re-alignment was completed mid-year for the first time in 16 years.  This re-alignment eliminated a few plans that were similar to other plans, but more importantly added new plans M and N that may end up being the new future of Medicare insurance coverage.  The re-alignment deserves it's own dedicated post which I will do in the near future so check back often for this vital information.

Part D is undergoing an overhaul with the "coverage gap" being closed over time.  This year anyone who hits the gap will receive $250.  In 2011, you will pay 50% instead of 100% while you are in the coverage gap.  For more detail on this topic see my post, "Where's my $250 rebate?"

Medicare Advantage or Part C has seen changes with many of the PFFS plans packing up and leaving town while the enrollment periods are being cut wreaking havoc on seniors' ability to manage their health care!  You can read more about this in my post "Medicare beneficiaries are losing their rights"

Medicare Advantage Do's and Don'ts

Now more than ever it is imperative that you do your due diligence when it comes to selecting your Medicare coverage.  I have compiled a quick and concise list of do's and don'ts that should help you when selecting the best Medicare coverage for your situation.

• Do review all of the available plans on Medicare.gov before signing on the dotted line. 
• Don't sign up over the phone.  And I mean NEVER
• Do check your drugs against the formulary to confirm coverage and pricing.
• Don't sign up for a plan based on ancillary benefits (gym membership, dental, etc...)
• Do check Physician and Hospital directories to confirm your preferred providers are listed.
• Don't take the plan's word for it that the doctor is in the plan or accepts the plan.
• Do call your doctor and have them confirm they accept the plan. (This can be tricky because you could get someone who is ignorant on the phone.  Always ask to speak with the person who files the insurance!
• Don't settle for inadequate coverage. 
• Do look at maximum out of pocket or MOOP for each plan to determine your worst case scenario.
• Don't let a captive agent (one who represents only one company) talk you into their plan
• Do look at the co-pays that would likely apply to you over the next year when making your decision

These are the must do's and don'ts when choosing the Medicare coverage that makes the most sense for you.  Keep checking back for more hints and tips!

2011 Medicare Advantage Plans Now Available

The 2011 Medicare Plan Information is now available on www.medicare.gov.  This is a great tool for comparing the different plans available in your area.  The site can still be cumbersome, but your primary objective here is to just compare co-pays between the plans.  When you find one you want, you will need to visit that company's site and search for your providers to make sure your doctor is included in the network.  As I stated in a previous post, the assistance of an agent who works with and understands all of the plans is an absolute must!

Where's my $250 rebate?

Perhaps you've heard your neighbor, golf partner, friend, etc.. gloating about receiving a $250 check in the mail from the gov't.  Don't be too envious because that check comes with a price!!  As part of the Affordable Care Act the government is slowly closing the "infamous" coverage gap in Medicare part D that seniors loathe!  This is a several step process that consists of a $250 AUTOMATIC rebate that is sent to those Medicare beneficiaries who hit the part D coverage gap in 2010.  You do not have to do anything to claim this rebate which means no need to fill out forms or file any paperwork.  In 2011 the rebate goes away and all of your brand name prescription drugs are discounted by 50%.  This discount happens at the drugstore with no rebate or paperwork! 

Medicare Plans are Leaving in 2011

If you have not already, you may soon be receiving a letter in the mail from your friendly Medicare insurance company saying they are leaving town!  This has already happened in my area, and is sure to be coming to a town near you.  The assumption from some clients is that these companies are going out of business; however, that probably is not the case.  For example Universal which was operating as a PFFS in our county did not get approval for this year so it is no longer available here.  They are still in business in other counties in the state.  The impact though is significant for those of you that have a plan that is leaving or is no longer available. 


You will NEED to shop for another plan ASAP.  You will not be left without coverage because CMS (Centers for Medicare and Medicaid Services) will automatically enroll you into another plan if you do not select one.  Do you really want the government selecting your health care for you?  Well, I'm sure they would select the best one for you so on second thought, no need to rush out and choose one for yourself (wink, wink).


Anyway, a great source of information for shopping the 2011 Medicare Advantage plans is http://www.medicare.gov/.  Here you can compare plans, and at least get an idea of the best one.  I still recommend using a local agent to help you, and I would also try to find one that works with several of the plans versus one that is representing only one of the plans.  That way the agent should not try to steer you to one plan versus another.  I'll do a separate post on why you should use a good agent instead of trying to do this on your own.

Medicare Beneficiaries Are Losing Their Rights in 2011

Thanks to recent legislation you now have less time to make a decision on your Medicare coverage!  In previous years you had the AEP or Annual Enrollment Period and the OEP or Open Enrollment Period.  The AEP ran from November 15th to the end of the year while the OEP ran from January 1st until March 31st.  These enrollment periods applied to Medicare Part C also known as Medicare Advantage. 

Unfortunately, Medicare beneficiaries are slowly losing their rights.  In 2011, you will no longer have the OEP in order to make a change.  This enrollment period was essential because it allowed you to be able to "try" out the plan that you had enrolled in.  If that plan was not to your liking, you could always sign up with a new plan through the end of March.  Congress, in it's infinite wisdom has done away with this necessary enrollment period and in it's place instituted the MA Disenrollment Period.  This period runs from January 1st through February 15th. 

 At first glance one might think that they just shortened the period, but in reality during this time period you may only drop your plan!  You only have the option of going back to original Medicare and a PDP (Prescription Drug Plan).  Not really much of an option unless you're willing to shell out the big bucks for a Medicare supplement! 

So, after you finish writing your congress person, make sure you do your due diligence when it comes to selecting your Medicare plan for 2011.