Medicare Advantage Plans PDP Medicare Drug Plans Medicare Supplement Plans

Medicare Advantage, Drug Plans, and Supplements

Medicare Drug & Advantage Plans - For those who have Medicare Parts A and B, there are several choices of plans that provide both drug coverage as well as help control the beneficiary costs associated with Hospital and Doctor care.

Over the past few years Medicare has moved to introduce many changes in how Medicare is administered. There is a move away from the traditional Medicare plan methodology towards using private payors to take care of administering more Medicare aspects each year. Add to that the introduction in 2006 the Medicare Drug Plans. Medicare implemented these plans in such a way as to cause virtually every Medicare recipient to sign up for a plan or pay a penalty for each month in which they do not sign up.

The Medicare Plans vary by county. Some counties are saturated with plans offering numerous choices. Other counties have very limited choices. Unfortunately, this often becomes confusing to everyone involved.

Still around is the more traditional Medicare Supplement plan. We work with several different carriers who offer these products.

There are a host of different plan types:

There are Medicare Drug Plans (PDP or Medicare Part D) and these plans cover the cost of a very large set of drugs that Medicare decides will be covered each year.

These plans often charge a premium, have different co-payment levels based on different classifications of drugs.

Some cover the notorious doughnut hole which in 2007 is from $2400 to $3850.

These plans can be purchased by anyone with Medicare A & B and are able to be combined with virtually any other kind of Medicare plan, except one which also includes drug coverage.

There are Medicare Advantage Plans, which include HMOs, PPOs, and most recently PFFS plans. All of the plans have certain common traits many of them protect the Medicare beneficiaries. Among these features are no medical underwriting, the right to change plans once per year, and for those choosing a plan for the first time an option to return to a supplement plan without underwriting within certain guidelines.

These plans are as follows:

HMO Plans (Health Maintenance Plans) - These plans require the use of a specific network of physicians and hospitals. Out of network care, unless emergent in nature is usually not covered and then becomes the responsibility of the patient. These plans typically are best for individuals who do not travel much instead remaining within a single geographic area all year. Usually these plans include Medicare Drug coverage.

PPO Plans (Preferred Provider Plans) - These plans require the use of a specific network of physicians and hospitals. Out of network care may be available at a much higher cost share to the patient. These plans typically are best for individuals who do not travel much instead remaining within a single geographic area all year. Usually these plans include drug coverage however there are some options that allow separate drug plan selections.

PFFS Plans (Private Fee For Service) - These plans are essentially where Medicare is administered by a private insurance company. Medicare pays a premium and in some cases the enrollee also pays a premium to the plan. Benefits are provided with a set of different co-payments depending upon the service. Some plans have few co-payments while others have co-payments for every benefit. These plans cap the maximum cost of co-payments in a year to a set amount. This limits total out of pocket costs for the member. These limits are a huge benefit to the member over what is afforded under straight Medicare where there is no maximum on patient responsibility. These plans vary widely in their inclusion of drugs within the plan. When drug coverage is not included a freestanding drug plan should be chosen as a companion plan.

Medicare Supplement Plans - These plans have been around for a very long time. There are several varieties of supplement plans each covering a different set of benefits, however the benefits are based on a set of standard plan designs shared by all carriers. Generally they pick up costs not covered by Medicare and require a monthly, quarterly, or annual premium be paid by the beneficiary. Note that not every carrier offers each plan design and these plans may require medical underwriting except under specific circumstances.

Dual Eligible Plans - These can take any of the HMO, PPO, or PFFS forms. They can have included drug coverage or allow a separate selection of a freestanding drug plan.

There are very specific time frames for enrolling in these plans:

The Annual Enrollment Period is from November 15 until December 31 each year.

The Open Enrollment Period is from January 1 to March 31 each year. During this period changes between different carriers can be made.

Individual's aging into Medicare Eligibility have 3 months before, the month of their 65th birthday and 3 months after their birthday in which to enroll in a plan.

Call our office to consult on which plan is best for you. We set up a time to present the plan to you explaining all featured of the plan and then help with the enrollment. This is all at absolutely no cost to the insured.