Saturday, September 5, 2015

Medicare Primer: Advantage or Medigap?












“…The following compares the primary advantages and disadvantages of traditional Medicare and Medicare Advantage plans. But everyone is unique, and it’s impossible to simplify a process that requires each individual to research his or her best options, based on the severity of their health issues, their preferences and financial situation, and the policies available in their state’s insurance market.

“Monthly premiums are the easiest information to compare, and cash-strapped retirees too often base their decisions largely on the premium they’ll have to pay every month. But potential out-of-pocket costs, such as copays and deductibles, might ultimately prove more important, especially as retirees age and are more likely to incur high medical bills. Considering both the premiums and out-of-pocket costs complicates the choice between lower-premium Advantage plans and higher-premium Medigap plus a prescription drug option.









“Part A hospital coverage is free for most people, but everyone enrolled in Medicare pays the Part B premium – the base amount is $104.90 per month in 2015, but higher-income people pay more – which covers doctor visits, outpatient care, lab work, scans, medical equipment and other services.

“In traditional Medicare, beneficiaries pay deductibles and co-pays, typically 20 percent for office visits and other Part B services, and the program does not limit out-of-pocket spending by beneficiaries. Medigap plans – also known as Medicare Supplemental Insurance – cover some or all co-payments and deductibles, and about one-third of traditional Medicare enrollees have Medigap, according to Kaiser. Premiums average about $200 per month and can go as high as $500 and do not include prescription drug coverage. Most people who choose traditional Medicare get a Part D drug plan, which averages $38 a month.

“Growing numbers of Medicare beneficiaries are flocking to Advantage plans (also known as Part C), because the additional premium for these plans, on average about $41 a month for plans with prescription drug coverage, is much lower than premiums for a supplemental Medicare Part D prescription drug plus a private Medigap plan. Advantage plans, typically offered by HMOs, limit out-of-pocket costs to $6,700 or less annually and often provide prescription drug coverage. A 2013 study by Kaiser found that the vast majority of Medicare beneficiaries have access to at least one Advantage plan in their area that includes prescription drug coverage but only half choose them.

“The bottom line on premiums: the average Advantage Plan premium plus the Part B premium equals $146 per month, when prescription drug coverage is included. This is half of the $343 in total premiums a beneficiary would pay for the Part B premium, plus a Medigap and a Part D drug plan, according to Kaiser’s estimates...”

For the entire article, click here.

“…Information distributed by United Healthcare Medicare Advantage PPO, chosen by Illinois politicians, can break retired teachers who believe the broadly stated language in this plan… Why is this information not readily available to all potential members prior to their making a momentous decision?” —Ken Previti, from Illinois Retired Teachers: Are the Details Regarding Our Medicare Advantage PPO Misleading?


5 comments:

  1. from Bob Zahniser:

    The State of Illinois Advantage Program is unique in that members can use any provider that participates in traditional Medicare.

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  2. Bob,
    You just hit the mark that, to me, is misleading and could prove financially disastrous for people in the State of Illinois Advantage Program. I will explain it in a later blog, but the bottom line is this: if you go out of network, despite the wording of "any provider", you, personally, will be billed for a full retail amount that is different from the in-network amount. Once you send the bill to the IAP, they will pay what Medicare would pay, and YOU WILL PAY THE REST of whatever the full bill was for. (I will give you details and sources later.)

    ReplyDelete
    Replies
    1. We will find out soon. We have the UHC Medicare Advantage insurance offered to TRS Illinois retirees. Northwestern Memorial claims to NOT take UHC Medicare Advantage, BUT they were willing to submit our bill to UHC since Northwestern accepts Medicare, and UHC will pay them their Medicare amount. Ken says that I will pay 100% of the original bill, minus the Medicare amount (which will be a pittance). Others claim that I will pay 20%. I should know soon. Stay tuned.

      Delete
    2. from Bob Zahniser:

      "Ken, my wife and I have been in the program from the beginning, and neither of us have experienced problems of the sort you describe. Thanks."

      Delete
  3. Charles,
    I did not say this. "Ken says that I will pay 100% of the original bill, minus the Medicare amount (which will be a pittance)."
    I did say this: "if you go out of network, despite the wording of "any provider", you, personally, will be billed for a full retail amount that is different from the in-network amount. Once you send the bill to the IAP, they will pay what Medicare would pay, and YOU WILL PAY THE REST of whatever the full bill was for."
    Here is my full blog which explains the possible choices for billing that an out-of-network provider has.http://reclaimreform.com/2015/09/05/illinois-retired-teachers-are-the-details-regarding-our-medicare-advantage-ppo-misleading/

    The out-of-network provider's billing department and/or administrators each have the choice of how and what to bill you personally if they do not choose to bill the provider directly. Get it in writing that they agree to bill the provider and not you.

    ReplyDelete