Medicare Advantage Plan - Highlights
When the Medicare advantage plans (MA or Medicare part C) and the Part D (prescription Drugs) plans first came out a few years back, it was too confusing to many seniors, and even their pharmacist, and the fledgling program had too many kinks that needed to be mended before it could be easier for the senior population to embrace these enhancements to original Medicare.
Well the Medicare plans have evolved and matured, with many advantages over the original Medicaid/Medicare government programs. Medicare Advantage (MA) plans offer many benefits and cost saving options for the over 42 million Americans age 65 or older. The challenge today is that there are so many plans out there that choosing among the plans and features most suitable to each seniors particular needs, can be extremely stressful and challenging without the assistance of a health insurance agent certified on medicare plans.
Most Medicare advantage plans today are structured like the traditional HMO and PPO plans (managed care) plans offered by many large employers for their employees.
Many Medicare Advantage Plans feature some or most of these advantages over original Medicare:
- Medicare Advantage Plans (MA plans) in many cases offer the following advantages for seniors: 1) More benefits, 2) Less hassles, 3) Better services, 4) More coverage’s, and 5) May cost less or nothing to the senior.
- Free Transportation to and from Doctor’s office.
- Free over the counter products (i.e. toothpaste, blood pressure monitoring devises, etc.) via personal care catalog.
- No cost or lower co-pays associated with primary care office visit.
- No cost or reduced cost on routine physical exam.
- No cost or reduced cost on routine foot care.
- Reduced cost on Prescription drugs.
- Durable Medical Equipment (i.e. wheelchair, etc.)
- Reduced cost or no cost on inpatient hospital.
- A Personal Care manager to help coordinate all of the senior’s needs.
- Prescription coverage with different price structures for the different tiers (Generic, brand, etc.)
- There are usually NO co-pays on preventative care.
- Choose plans (where appropriate) which feature a “Maximum out of pocket” limit, as this protects the senior from possibly incurring extraordinary expenses in a year associated with high hospitalization costs or expensive treatment.
There Are Different Plans for Different Needs:
Note that Medicare plans are not all the same. Some provide free transportation to and from the primary care physician, while others do not. Some provide eyeglasses, others a free gym membership, yet others have co-pays with no monthly fees, while others have monthly fees, with no co-pay (Medicare Supplement plans). The key is to work with a medicare certified health insurance agent who can assist you in selecting the plan with the features most in line with your needs.
Enrollment Periods Are Sometimes All Year Long!
Some plans only take on new enrollments during the specific enrollment periods. For example the annual election period, in 2008 starts on November 15th and ends on 12/31/08. However there are Medicare advantage plans that are available all year round for new enrollment, depending on the insured’s income level, and on whether they have any chronic conditions (such as high blood pressure or elevated cholesterol).
The Choices are Many, so Choose Wisely:
For more information, a free consultation, or if you would like our assistance in helping you select a plan most suitable for your needs, please contact us at;
(201) 868-2828, or email us at frontierins@verizon.net
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FAQ'S
We've put this section together to help answer some of your questions
What is Medicare Part D?
Medicare Part D is the federal government's prescription drug program that covers both brand-name and generic prescription drugs at participating pharmacies in your area. The coverage is available to all people eligible for Medicare, regardless of income and resources, health status, or current prescription expenses. Medicare prescription drug coverage provides protection for people who have very high drug costs.
How does Medicare prescription drug coverage work?
Medicare Part D works in tandem with Medicare Parts A and B. Individuals entitled to Part A or enrolled in Part B can sign up for Part D to receive help paying for prescription drugs. Like other insurance, if you join, you will pay a monthly premium, which varies by plan, and (for most plans) a yearly deductible (no more than $265 in 2007, $275 in 2008). You will also pay a part of the cost of your prescriptions, including a co-payment or coinsurance. Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. Plans also vary in terms of the co-pays, prescription drugs that are covered (this is called the "plan formulary") and the pharmacies that may be used.
If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. Individuals enrolled in both Medicare and Medicaid ("Dual Eligibles") who have not already selected a Part D plan will be automatically enrolled in Medicare Part D by their state agency.
If I am on Medicare do I have to enroll in Part D?
Medicare Part D is an optional plan. No one is required to enroll but if you are eligible and delay enrolling during the open enrollment period you risk paying a penalty in terms of increased insurance premiums when and if you enroll at a later date.
How do I get more information and enroll?
Enrolling in Medicare Part D is easy. Call us at (201) 868-2828 for a free Medicare Part D quote. We can answer your questions and handle your enrollment over the phone and mail or personally deliver an application to you if you wish. Coverage becomes effective on the first day of the month after your enrollment.
What is Open Enrollment?
The Open Enrollment period for Medicare Part D (officially, the Medicare Part D Initial Enrollment Period - IEP) is a one-time event when an individual first has the opportunity to enroll in a Medicare Part D Prescription Drug Plan (PDP). It occurs for most people when turning age 65 and enrolling in Medicare Parts A & B for the first time. For people turning 65 the Part D IEP lasts seven (7) months (same as the : it begins three (3) months prior to your birth month, includes your birth month, and extends three (3) months after your birth month. In addition, people of any age enrolling in Medicare Part B for the first time may apply for Medicare Part D three months prior to their requested effective date for Part B, during the month of their Part B effective date as well as three months after their Part B effective date.
What is the Annual Election Period (AEP)?
The Annual Election Period for coverage effective in 2008 begins November 15, 2007 and ends December 31st, 2007. Anyone who already enrolled in a Medicare Part D plan may change plans during this period each year without penalty. Eligible individuals (people on Medicare) who chose not to enroll during their initial Open-Enrollment Period may enroll in Medicare Part D between November 15 and December 31 each year, but penalties will apply unless the individual had "creditable" prescription drug coverage. Enrollments during this period have an effective date of January 01, 2008.
Remember, no matter what your income, you are eligible. Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. A typical person with Medicare and no drug coverage could see total drug costs drop by about 50%.
You MUST join Part D for coverage to begin. The sooner you join, the sooner your coverage will begin…and the sooner you start saving money!!! You can pay your premiums by deducting them from your Social Security check just as you do your Part B premiums, or pay them through a bank draft.
Even if you are not currently spending a great deal out-of-pocket for drugs, the government is encouraging you to join a PDP as soon as you are eligible. WHY? Because there is a strong probability that as you get older your cost for prescription drugs will increase. In addition, there is a penalty of 1% per month for failing to join a drug plan during your enrollment period.
Coverage begins the month following the month you enroll on a Part D drug plan. Anyone can join a PDP as long as they are enrolled in Medicare Part A and/or Medicare Part B. These drug plans are regulated by the Centers for Medicare.
Remember that after the first year, you can change your plan each year between November 15th and December 31st.
For a free consultation to help you determine which Medicaid/Medicare advantage program is best for you please call Robert at Frontier Insurance Agency at (201) 868-2828, or visit us at 8005 Kennedy Boulevard, North Bergen, NJ 07047. You can also email us on any questions you may have at: frontierins@verizon.net
We promise to respond to your email within 25 Hours.
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