This is the time of year when many senior citizens have important health insurance decisions to make for upcoming year. With a change in health care reform on the horizon, many insurance companies have taken steps to protect themselves. This has included dropping certain plans from their options (in Pennsylvania- Keystone Complete will be eliminated) or raising premiums drastically. This has caused a great deal of concern as has been expressed to me and the other podiatrists at our Podiatry Care Specialists, P.C. offices.
Many insurance companies now offer Medicare Supplemental or Medicare Advantage programs. It is imperative that you do your homework on theses various plans.
Traditional Medicare will pay 80% of their approved amount to physicians that accept assignment. The remaining 20% must be paid by the subscriber or will usually be paid by enrolling in a Medicare Supplemental Plan. Many insurance companies participate in this and Medicare Advantage plans such as Humana, Cigna, United Health Care, Aetna, and the various Blue Shield organizations.
What does Medicare Advantage mean? The following has been taken from Wikipedia:
With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, "Medicare+Choice" plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as "Medicare Advantage" (MA) plans.Traditional or 'fee-for-service' Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited on the providers they can receive services from without paying extra. Typically, the plans have a 'network' of providers that patients can use. Going outside that network may require permission or extra fees.Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan's network or 'panel' of providers.
You must make sure you compare apples with apples for all these options. The following should be checked:
1- Your primary care physician is a participator of the plan
2- Your main specialists are also participants
3- Make a list of your medications and see what these plans cover each generic or trade name prescription you take and what the copays are
4- Do they require 90 day prescriptions
5- Is there a deductable for Doctors Visits, Hospitalizations, and Emergencies
6- Is there a maximum out-of-pocket expense for theses services
Hopefully this information will help you explore your options and get the best health care possible for your needs at a reasonable cost.
Yours for better health,
Bradford J. Jacobs, DPM