What will it be for 2010, Original Medicare or an Advantage plan? Typically, the average person turning 65 and about to be enrolled into Medicare is unclear on just how to receive his or her benefits. Do you choose Original Medicare or one of the many private, Medicare Advantage plans? 2010 is a year of great financial change for many Medicare insurance companies due to the recent health insurance reform of the Obama administration. However, this will not affect the actual working of either traditional Medicare or the privately managed Advantage plans.
Medicare Advantage plans in 2010
The essential working of the plans, whether they are Medicare Advantage PPO plans, HMO plans, or private fee for service plans, remains largely the same as the Advantage plans in 2009. One significant difference for 2010 is that the costs premium and out-of-pocket costs appear to have generally increased from 2009, and that there are far few plans offering zero premium options, and more plans whose cost sharing more closely mirrors that of Original Medicare.
Just how do Medicare Advantage plans work? Basically the plans must provide you with the same services that Original Medicare (the Medicare program managed by the Federal government) offers but do so according to their policies and procedures. They determine your out-of-pocket costs for all your Medicare covered benefits and are free to add additional benefits such as dental, vision, and hearing aid coverage that Original Medicare does not pay for. It is important to understand that Advantage plan coverage is not the same thing as Medicare supplemental insurance plans. The Medicare Advantage plans in 2010, just as in 2009 and the years before, actually "channel" your Federal benefits through a private carrier. That means they pay instead of Medicare, and that all Medical charges must be sent to the Advantage plan, and that traditional Medicare will not pay while you are in a private plan.
Medicare Advantage PPO Plans and HMOs
Two of the most common sort of Advantage plans are the Medicare Advantage PPO and HMO. These sorts of plans suit people who expect to receive most of their care in the same, general area as where they live. Both the PPO and HMO have networks of health care providers their members can use, but in an HMO, members must use the provider network in order for claims to be paid. In a PPO, members can go out-of-network without a referral to any doctor they choose as long as the provider agrees to submit claims and accept payment from the insurance company. In both kinds of plan, as with any Advantage plan, you can expect to pay all costs yourself if you receive care outside of the plan service area. The only exception to that is receiving emergency and urgent care. In those situations, the Advantage plans must accept the claims.
Most Advantage plans, whether they are a PPO or HMO include coverage for medication. The drug coverage benefit is often referred to as Part D, and in 2010 the rules are practically the same as in 2009. One important change is that in 2010, if you enter the coverage gap, also known as the "donut hole," you will receive a $250 rebate. If you plan on joining an Advantage plan and want drug coverage, you must join a plan that bundles Part D into its package of benefits. In other words, if you join a PPO or HMO, you will not be allowed to join a separate, stand-alone prescription plan.
It is difficult to know how to make the best decision. Some people, willing to pay more for private coverage, may feel more secure. However, the core Medicare benefits remain the same. Typically, beneficiaries in better health and with uncomplicated health histories generally fare better in Advantage plans then people with more extreme conditions. If you are considering Advantage plan enrollment, then you may want to call the plan or plans of interest to discuss your health needs and expectations with representative to see if the plan is likely to work for you.
Medicare Advantage plans in 2010
The essential working of the plans, whether they are Medicare Advantage PPO plans, HMO plans, or private fee for service plans, remains largely the same as the Advantage plans in 2009. One significant difference for 2010 is that the costs premium and out-of-pocket costs appear to have generally increased from 2009, and that there are far few plans offering zero premium options, and more plans whose cost sharing more closely mirrors that of Original Medicare.
Just how do Medicare Advantage plans work? Basically the plans must provide you with the same services that Original Medicare (the Medicare program managed by the Federal government) offers but do so according to their policies and procedures. They determine your out-of-pocket costs for all your Medicare covered benefits and are free to add additional benefits such as dental, vision, and hearing aid coverage that Original Medicare does not pay for. It is important to understand that Advantage plan coverage is not the same thing as Medicare supplemental insurance plans. The Medicare Advantage plans in 2010, just as in 2009 and the years before, actually "channel" your Federal benefits through a private carrier. That means they pay instead of Medicare, and that all Medical charges must be sent to the Advantage plan, and that traditional Medicare will not pay while you are in a private plan.
Medicare Advantage PPO Plans and HMOs
Two of the most common sort of Advantage plans are the Medicare Advantage PPO and HMO. These sorts of plans suit people who expect to receive most of their care in the same, general area as where they live. Both the PPO and HMO have networks of health care providers their members can use, but in an HMO, members must use the provider network in order for claims to be paid. In a PPO, members can go out-of-network without a referral to any doctor they choose as long as the provider agrees to submit claims and accept payment from the insurance company. In both kinds of plan, as with any Advantage plan, you can expect to pay all costs yourself if you receive care outside of the plan service area. The only exception to that is receiving emergency and urgent care. In those situations, the Advantage plans must accept the claims.
Most Advantage plans, whether they are a PPO or HMO include coverage for medication. The drug coverage benefit is often referred to as Part D, and in 2010 the rules are practically the same as in 2009. One important change is that in 2010, if you enter the coverage gap, also known as the "donut hole," you will receive a $250 rebate. If you plan on joining an Advantage plan and want drug coverage, you must join a plan that bundles Part D into its package of benefits. In other words, if you join a PPO or HMO, you will not be allowed to join a separate, stand-alone prescription plan.
It is difficult to know how to make the best decision. Some people, willing to pay more for private coverage, may feel more secure. However, the core Medicare benefits remain the same. Typically, beneficiaries in better health and with uncomplicated health histories generally fare better in Advantage plans then people with more extreme conditions. If you are considering Advantage plan enrollment, then you may want to call the plan or plans of interest to discuss your health needs and expectations with representative to see if the plan is likely to work for you.
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