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Medicare Plans

Who Can You Trust to Help Make Your Medicare Decisions?

by My Senior Health Plan
written by My Senior Health Plan

The many choices and options related to Medicare Advantage and/or Supplement Plans are enough to overwhelm even the most educated among us. You want to make the right selections, but without the proper guidance and direction, these decisions are dizzying.

You’re aware of how easily you could get stuck with a plan you don’t need or want, but you’d probably rather endure a colonoscopy than spend countless hours researching different plans.

Yes, navigating the world of Medicare Advantage and Medicare Supplement Insurance is difficult. But it doesn’t have to be. My Senior Health Plan will help you find you the right coverage at the right price—the plan that truly fits your needs and budget.

Here’s why My Senior Health Plan is the right choice for your healthcare needs.

Understand your options

There are numerous Medicare Advantage and Medicare Supplement Plan options. Not all of these plans are created equal, and each one is designed to address a specific set of medical needs. So which one is right for you?

My Senior Health Plan prides itself on offering a comprehensive, personalized service that addresses these questions directly. Their representatives will work with you to determine what’s important to you and how that translates to a Medicare plan.

They take the time to not just listen but also understand where you’re coming from and why. With this information, they use their expertise to find the right options to satisfy your needs and budget. My Senior Health Plan takes the guesswork out of Medicare coverage by presenting plans that meet your coverage needs at a price you can afford.

Review your current plan

If you already have a Medicare plan in place, My Senior Health Plan will conduct a complimentary review of your coverage to ensure you’re protected. They take the time to get to know every one of their customers so they can offer the absolute right coverage options, no matter what your situation.

As they review your current coverage, they will provide insight on the right times to change your Medicare Advantage or Medicare Supplement Plans. Medicare has stringent rules on when beneficiaries can make changes to their plans, but with My Senior Health Plan, you don’t have to worry. They know when and how to make changes to your plan, and they’ll take care of the heavy lifting for you!

Save money on coverage

Understanding what coverage you need means also understanding your budget. If you’re on a fixed or low income, they’ll make sure you have an affordable plan with low out-of-pocket expenses.

My Senior Health Plan understands the budgetary constraints faced by most seniors. They don’t pressure their customers into buying coverage they can’t afford. They know there are plenty of options available to meet every seniors’ financial needs.

Check prescription coverage

For many seniors, prescription drugs are their biggest medical expense. They’ve got to have these costs covered, but few know how to find the right prescription drug coverage.

The Medicare professionals at My Senior Health Plan are well-versed in the prescription drug plans and will help you find a plan to suit your needs while keeping your out-of-pocket costs low.

Enjoy lifetime support

My Senior Health Plan is here for you, long after you’ve selected coverage. They provide personalized service to ensure their customers are happy and confident in their Medicare coverage selections.

They also understand how situations change and that when they do, needs change, too. An annual coverage review is standard at My Senior Health Plan. Every year, they’ll happily reevaluate your situation and coverage options to provide guidance on if and how you should change your Medicare Advantage or Medicare Supplement Plan.

Contact My Senior Health Plan today to learn more about their services and your coverage options.

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Medicare Plans

How to compare Medigap and Medicare Advantage Costs

by Guest Blogger
written by Guest Blogger

Whether you’re enrolling in Medicare for the first time or taking advantage of the 2021 open enrollment period to explore your options, it can be hard to evaluate whether Medigap coverage or Medicare Advantage make more sense for your wallet. Have you ever thought to yourself, “how much does Medicare cost?” Figuring it out is far from simple. Here, we’ll explain the difference and how to identify which option will work best for you.

Understanding Medigap and Medicare Advantage

Medigap and Medicare Advantage can seem similar, in that both are different options for Medicare coverage and you can only choose one or the other. However, there are core differences between the two.

Medigap is a supplement to Original Medicare that helps pay for what Original Medicare doesn’t — which may include deductibles, coinsurance, and copayments. However, Medigap will also charge an additional annual premium on top of your Original Medicare premium depending on the plan you choose.

Medicare Advantage Plans are replacements for Original Medicare. Rather than supplementing Original Medicare coverage, Medicare Advantage Plans are private insurance plans that offer a variety of coverage levels at different premiums.

You can find Medicare Advantage Plans that offer $0 premiums, as well as plans that cover care Original Medicare doesn’t — such as dental and vision.

Key factors to compare

Are you willing to switch doctors?

Many of the lower premium Medicare Advantage plans are HMOs (health maintenance organizations), which only have a network of providers that they provide coverage for. If you want to switch to a Medicare Advantage plan, make sure that either your doctor accepts that insurance, or you’re willing to switch doctors to an in-network one.

How much do you plan to travel?

One of the advantages of Original Medicare is its wide acceptance nationwide at hospitals and private practices. If you plan to split your time between two locations, or if you simply want to spend a lot of time travelling in the future, Medigap may have a more appealing flexibility than Medicare Advantage plans.

What’s your IRMAA?

Some, but not all, Medicare Advantage plans include prescription drug coverage. Those are known as MAPD plans, and if you have a MAPD plan and earned a higher income, you’ll have to pay what’s known as an IRMAA, or Income-Related Monthly Adjustment Amount.

The IRMAA charges a progressive fee to high earners based on their tax returns, and you can be charged an IRMAA on both your Part B and Part D plans. However, as Part D is optional insurance coverage, if you don’t have Medicare Part D or a MAPD plan, you don’t have to pay the additional IRMAA (although you still have to pay one for Part B).

Do you have a pre-existing condition?

If you’re eligible for Medicare for the first time, you have a one-time, 6-month-long open enrollment period where you can buy a Medigap plan without any sort of medical screening.

However, unless you live in CT, MA, ME or NY, Medigap plans can deny you coverage or increase your premiums if you apply after that initial open enrollment window. If you fall into that category, you should fully investigate whether Medigap is worth the investment now so that you can have it for decades to come.

About the Author

Shana Aguilar is a content strategist at a digital marketing agency where she helps companies connect to people through informative and authoritative content. She is currently working with businesses in the healthcare finance sector to help doctors and dentists live their best financial lives.

 

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Medicare Plans

Medicare OEP 2020: How Mrs. Jones Made Changes to Her Medicare Advantage Plan

by My Senior Health Plan
written by My Senior Health Plan

The new year is upon us and so is Medicare Open Enrollment Period (OEP) 2020. Yes, just when Annual Enrollment Period 2020 has finished, it’s time for OEP 2020! We know the Medicare system can be difficult, so today we’re going to follow Mrs. Jones through the Medicare Open Enrollment Period.

Mrs. Jones is a little confused since the Medicare rules can be complicated. But we’re here to help!

What is Medicare Open Enrollment Period?

Mrs. Jones wasn’t happy with the Medicare Advantage Plan she chose in the fall during AEP, and she’s been waiting for January 1st so she can make a change to her Medicare coverage. She has until March 31st, and she’s allowed to make just one change to her plan.

During the Medicare Open Enrollment Period, she:

CAN switch from one Medicare Advantage plan to another Medicare Advantage Plan

CAN disenroll from a Medicare Advantage Plan and return to Original Medicare (with or without a Part D drug plan).

But Mrs. Jones:

CAN’T switch from Original Medicare to a Medicare Advantage Plan

CAN’T add or switch a Medicare Prescription Drug Plan (if enrolled in Original Medicare).

If Mrs. Jones was in the first three months of her Initial Enrollment Period, she would also be able to:

Change to another Medicare Advantage Plan (with or without drug coverage)

Or go back to Original Medicare (with or without a drug plan).

What kinds of changes can be made during OEP?

Mrs. Jones changed her Medicare Advantage Plan during AEP. That plan became active on January 1st. But just a month after her new plan began, she realized that plan doesn’t cover her prescription drug needs.

Fortunately for Mrs. Jones, she can make a change because it’s Open Enrollment Period. She’s choosing to switch from the Medicare Advantage Plan she chose during AEP to another Medicare Advantage Plan that covers her prescription drug needs. This is a one-time change for Mrs. Jones that will go into effect on March 1st.

But what if her new Part D plan begins, and she finds she doesn’t need the coverage? Unfortunately, she’ll have to wait until AEP on October 15th to make additional changes.

But she may qualify to change her coverage during a Special Election Period (SEP). Here’s how.

What is a SEP?

A Special Election Period is a time when you can make changes to your Medicare Advantage and prescription drug coverage outside the typical AEP and OEP periods.

SEPs are granted for many different circumstances. A few of these are:

  1. A change of address that impacts your coverage
  2. Residency in an area affected by a FEMA-sanctioned emergency or natural disaster during a previous enrollment period (either for the beneficiary or caregiver)
  3. Moving into or out of an institution.

 

Also, if you lost your previous insurance, whether it’s Medicaid or employer-provided, you may be eligible to enroll in Medicare Advantage during an SEP.

Medicare is complicated, but MySeniorHealthPlan.com is here to help you confidently navigate your health insurance decisions.

If you have questions or need to talk to a licensed Medicare specialist, visit our website or call (877) 255-6273. You’ll be able to talk to a knowledgeable member of our team who will help you find the right plan for you.

 

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Health Insurance

Sosa Insurance Group Can Assist with Annual Enrollment Period for Medicare

by Guest Blogger
written by Guest Blogger
ATTENTION:
It’s that time of year again:
The Annual Enrollment Period for Medicare is here!

The Annual Enrollment Period (AEP) begins on October 15th and continues until December 7th. During this time, you can make changes to certain aspects of your Medicare health coverage:

  • Change from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan to Original Medicare.
  • Change from Original Medicare to a Medicare Advantage Plan.
  • Enroll in a Prescription Drug Plan or change your Prescription Drug Plan.
  • If you’re new to Medicare, you might have a different election period; reach out to us to review your options.

 

The Sosa Insurance Group, located at 450 Pleasant Valley Way in West Orange NJ, is dedicated to assisting our Medicare eligible consumers throughout their Medicare journey.

We specialize in Medicare Supplement, also known as Medigap, Medicare Advantage, Medicare and Medicaid, Stand-Alone Part D Prescription, Dental, as well as Final Expense, Individual and Long-Term Care Plans.

We also understand that everyone’s situation is different and you might qualify for a special enrollment. For example:

  • You are retiring and getting Medicare
  • You are disabled and under 65 and have Medicare
  • You are turning 65
  • You have Medicare and Medicaid
  • You are receiving Assistance for their part D prescriptions
  • Or you recently moved to the state of NJ and have Medicare

 

Below is a list of dates that we’ll be having informative meetings at our office where you can learn more about your options during AEP:

These are the dates we’ll be open during Oct 1st thru Dec 7th

  • Mondays starting on 10/19 from 9:30am till 7:00pm
  • Tuesdays starting on 10/20 from 9:30am till 3:30pm
  • Wednesdays starting on 10/21 from 9:30am till 7:00pm
  • Thursdays starting on 10/15 from 9:30am till 3:30pm
  • Saturdays starting on 10/03 from 10:00am till 5:00pm

 

Due to COVID-19, besides our normal face-to-face appointments either at the privacy of your home or at our local office, we are now also available virtually and remotely through ZOOM or by phone in order to assist our Medicare eligible consumers review the basics of Medicare and assist them in choosing the right plan for them.

These are the dates we’ll be having virtual meetings during Oct 1st thru Dec 7th

  • Every other Monday starting on 10/12
  • Every other Wednesday starting on 10/14
  • Every Saturday starting on 10/10

 

Call for details on times and Zoom information

You can also visit our website at www.thesosainsurancegroup.com 0r email us at info@thesosainsurancegroup.com and request a quote

Call us at
973-902-5445
to speak to one of our expert agents.

“We pride ourselves in assisting Medicare eligible consumers with selecting a Medicare plan option that will meet their needs,” said George Sosa, President of The Sosa Insurance Group.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Medicare Plans

Understanding the 2020 Policy Changes to Medicare

by Jagger Esch
written by Jagger Esch

The beginning of a new decade is upon us, and significant changes are happening. Understanding the 2020 Medicare Advantage Open Enrollment Period could bring you great benefit.

The enrollment period provides an extra opportunity for you to get the best coverage. Medicare is full of many parts, and it may be challenging to keep up with all the new rules.

Different enrollment periods have varying guidelines. Regulations include specific dates.

Beneficiaries can forget about the old Medicare Advantage Disenrollment Period. The new and improved Medicare Open Enrollment Period is the replacement.

The last time to enroll, according to federal law, allows you a final chance to switch Advantage plans. Yet, you must be a Medicare Advantage enrollee to use this option.

Understanding the 2020 Medicare Advantage Open Enrollment Period

The new chance to switch Medicare Advantage plans is happening right now in 2020. It starts January 1 and runs until March 31.

Beneficiaries with an Advantage plan may now use this time to switch. Another option is to drop a current Advantage policy and go back to Medicare and buy Part D.

In 2010, the ACA law put an end to the Medicare OEP. Replacing the OEP was the Medicare Advantage Disenrollment Period. The dis-enrollment period began on January 1 and only ran until February 14.

So, what makes this period different? Well, this period only allowed beneficiaries to return to Medicare. The Medicare Advantage Open Enrollment Period allows a one-time switch between Advantage plans.

What is the Medicare Advantage Open Enrollment Period

The Open Enrollment Period allows you to switch from one Advantage plan to another. Although, you may not use this period to switch from one Part D drug plan to another.

Think of this as your chance to make any last-minute policy shifts.

Life happens at the most inconvenient times, Medicare understands. As of 2019, Advantage plan enrollees may make policy changes until the end of March.

New policies or any adjustments begin the 1st of the following month. Let’s say Katherine has a Medicare Advantage policy. She realizes her benefits don’t cover the care she needs in the upcoming months.

It’s February 1, so Katherine decides to find a more accommodating plan. She must wait until March 1 for her plan to start.

When to use the Medicare Advantage Open Enrollment Period

One big question is why beneficiaries would make another change? The reasons vary, but a common issue is that most people don’t understand how Advantage plans work.

Often Medicare enrollees attempt to make changes on their own without the help of an agent. There are many factors to consider when choosing an Advantage plan or a drug plan.

When deciding what option is best for you, it’s easy to overlook essential elements. That’s why working with an expert is beneficial; they make sure you don’t miss anything.

Unfortunately, beneficiaries forget to check the plan’s provider network before switching. Using an out-of-network doctor means paying out-of-pocket for services.

Recipients see the low premium cost and miss all the other costs associated with the plan. Yet, most programs have copayments and other expenses.

Medicare Enrollment Periods – The Breakdown

Learning the ins and outs of Medicare can be confusing, to say the least. One thing that seems to confuse many is the different Medicare enrollment periods.

The various election periods happen during certain times of the year. Election periods allow beneficiaries to make changes to their current coverage. Understanding each election period is essential for all.

The Annual Election Period

From October 15 through December 7 each year is the Medicare Annual Election Period. The AEP is the most common time for beneficiaries to change their Medicare Advantage or Part D plans.

Changes made during this time take effect on January 1. The Annual Election Period is for making changes to Medicare Advantage or Part D plans.

Each year, beneficiaries receive a Notice of Change letter in September. After reviewing this letter, you may decide you don’t like the upcoming changes. Use the AEP to switch to more comprehensive coverage.

The Special Election Period

Trying a Medicare Advantage plan for the first time can be nerve-wracking. You have twelve months to change back to Medicare if you try an Advantage plan for the first time.

During your first 12 months on the plan, you can switch without underwriting using the SEP. Advantage plans aren’t for everyone. The coverage may not meet your expectations or healthcare needs.

In such cases, the Special Election Period exists as a chance to go back to Medicare coverage. Beneficiaries may only use the Special Enrollment Period once in their lifetime.

Many circumstances qualify a person for a SEP. Moving out of state is a good reason, which means finding coverage in a new area. Beneficiaries may use a Special Enrollment Period to find a plan in the new service area.

Any major change can open the door for a SEP. If you get married, divorced, or are planning to move, expect eligibility for a plan change.

The Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period is different than the fall AEP. Often the Annual Election Period is mistaken for the Open Enrollment Period.

The Advantage OEP is from January 1 – March 31 for Medicare Advantage or Part D enrollees. During this time, you have options for policy changes.

Although, this period doesn’t guarantee a pass into a Supplement. Choosing to enroll in a Supplement to go with your Medicare may save on costs of care.

First, you must apply and answer any health questions. Following your request, Medigap companies underwrite your application to determine your health risk.

Companies may deny coverage based on your health. When this happens, you may have Medicare coverage without Supplement insurance.

Changes in plan benefits or coverage take effect on the 1st day of the month following the request. So, if you have any changes to make, be sure to get the ball rolling.

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Medicare Plans

Medicare OEP 2020: How to Make Changes to Your Medicare Advantage Plan

by My Senior Health Plan
written by My Senior Health Plan

Medicare Open Enrollment Period (OEP) 2020 will begin on January 1st. If you are enrolled in a Medicare Advantage Plan (maybe you signed up for a new plan during AEP 2020?) and wish to adjust your coverage, you may qualify to make a one-time change to your existing policy.

Medicare OEP 2020. What is it?

OEP is the Medicare election period that runs from January 1st to March 31st each year. It allows Medicare beneficiaries enrolled in Medicare Advantage Plans to:

  • Switch from one Medicare Advantage plan to another Medicare Advantage plan
  • Disenroll from a Medicare Advantage plan and return to Original Medicare, with or without a Part D drug plan

 

Note: According to Medicare.gov, the following are changes that you cannot make during OEP.

You will not be able to:

  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Join a Medicare Prescription Drug Plan if you’re in Original Medicare.
  • Switch from one Medicare Prescription Drug Plan to another if you’re in Original Medicare.

 

Also, if you’re within the first three months of your Initial Enrollment Period, you have the option to

  1. Change to another Medicare Advantage Plan (with or without drug coverage) OR
  2. Go back to Original Medicare (again, with or without a drug plan)

Let’s look at an example.

During AEP, Sylvia enrolled in a Medicare Advantage Plan. The plan will activate January 1st. However, early in February, she decides she could benefit from Medicare Advantage Plan D.

Being in the OEP window and having had her existing plan since January, Sylvia can make the one-time change. Her new policy will go into effect on March 1st.

However, that’s not where Sylvia’s story ends. Her plan activates March 1st, but after a couple of weeks (and still within the OEP), she finds that the new plan isn’t a good fit for her needs.

Unfortunately, Sylvia will have to wait until October 15th when AEP begins again—unless, of course, she qualifies for Special Election Period (SEP).

What is SEP?

SEP allows seniors to make changes to their Medicare Advantage and Medicare prescription drug coverage under particular circumstances.

Examples of when you may qualify for SEP include the following.

You’re moving to a new address that affects your coverage (e.g., moving back to the States after living overseas or moving to a new address that isn’t in your existing plan’s service area).

You’re living in an area where a weather event has occurred—one that FEMA has determined as an emergency or major disaster. Due to the weather situation happening during another valid election period (e.g., AEP), you may qualify for SEP.

Additionally, the weather-related SEP is available to beneficiaries who depend on friends or family members living in the affected areas to manage their healthcare needs.

You will lose your other insurance coverage. For example, if you are no longer eligible for Medicaid, you may qualify for SEP and the opportunity to sign up for a Medicare Advantage Plan. Also, if you no longer have coverage from your employer (or union), SEP will allow you to apply for Medicare Advantage coverage.

Tapping into your Medicare resources

Medicare election periods from OEP to SEP can get complicated. However, you have access to resources—from your insurance specialist to online information (such as the Medicare.gov website). The key is to keep an eye on election period dates that apply to you, take action early and, if necessary, ask for help.

Need to adjust your Medicare Advantage coverage during OEP? The MySeniorHealthPlan.com team can answer all your questions and guide you through the process.

Call today toll free: 877.255.6273

 

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Medicare Plans

Difference between Medigap Plans and Medicare Advantage

by Jagger Esch
written by Jagger Esch

When it comes to insurance, it would be fair to say you either pay now or pay later. If you pay now, you are choosing to pay a higher premium with the expectation your insurance plan will pay more when you file a claim. The pay later option means a lower monthly premium and leaves the Medicare Beneficiary with a greater out of pocket expense when seeking medical treatment. Difference between Medigap Plans and Medicare Advantage
There are several reasons to choose a Medigap Plan over Medicare Advantage Plans. The comprehensive benefits provided by a Medigap, as known as Supplement Plans can limit or eliminate out of pocket costs. Individuals covered by a Medigap Plan avoid network restrictions and have coverage worldwide. Most importantly, Medicare Supplement Plans allow the insured to budget the cost of their coverage and reduce unexpected expenses.

Medicare Part A

For 2018, the Medicare Part A deductible is $1340, then the plan pays 100% of hospital expenses for that benefit period. The benefit period lasts 60 days from the start of the hospital visit. If your hospital stay lasts longer than 60 days, you will incur a per day coinsurance.
The Medicare Beneficiary is responsible for that daily coinsurance. After 60 days, or in the event of an unrelated condition, if the Medicare Beneficiary is admitted to the hospital, a new benefit period starts, and the $1340 deductible is applicable, again. This can continue throughout the policy year.

Medicare Part B

Medicare Part B covers preventive services and medically necessary services such as doctor visits, durable medical equipment, diabetic supplies, and drugs administered in a doctor’s office.
The Medicare Part B deductible is $183 for the 2018 year, after the deductible is satisfied, Medicare pays 80%.

Gaps in Coverage

As you can tell, Original Medicare leaves gaps in coverage. There are gaps in Part A and gaps in Part B. Original Medicare does not have any out of pocket maximums or provide any caps to minimize the loss incurred by the Medicare Beneficiary. Your exposure to loss is undefined; there is nothing to protect the Insured person from financial losses.

Take into account that it cost about $5,000 to go to the emergency room. That’s without being admitted and without a gamut of tests. The gaps in coverage left by Original Medicare can be filled quickly and affordably by enrolling in a plan offered by any reputable insurance provider.

Medigap Plans Protect

Medigap plans do have a premium that is in addition to your Medicare Part A and Part B. The premium amount for your Medigap Plan is paid by the Medicare Beneficiary directly to the Insurance Company.

With a Medigap plan, you choose the amount of risk you are willing to take, the premium is reflected in the amount of benefits you elect. Regardless of the underwriting company (the name on the card you carry), the benefits are the same and are differentiated by letters.

Most people choose Plan G. Medigap Plan G, covers everything not covered by Medicare except for the $183 Part B deductible. The Plan F, provides the most protection to the Medicare Beneficiary, and minimizes the medical costs that could be incurred.

Of course, you can save on premium dollars if you are willing to consider some of the other plans. This is where your licensed insurance agent can help, by shedding some light on the various options that will provide the most coverage and still keep the premium within your budget.

Medigap Offers Freedom

You’re free to choose your doctors and hospitals. These plans allow Medicare Beneficiaries to select doctor’s based on their personal preference, in addition to choosing the hospitals they utilize. The only requirement, is that the provider accept Medicare.

The freedom offered by being insured can be liberating. Just ask someone who has been limited to a list of doctor’s or had a claim from a specialty hospital denied. Treatment of medical conditions/ diseases can be determined by the patient and doctor.

The Disadvantages of a Medicare Advantage Plan

Medicare Advantage Plans require the Medicare Beneficiary to use network doctors and hospitals. With most advantage plans, going out of network isn’t an option as there are no out of network benefits. Most have network restrictions and seeing a specialist will require a visit to your primary doctor to obtain a referral.

There are only specific periods during the year when you can enroll or switch to another Medicare Advantage Plan. Otherwise, you can’t change your Plans during the year.
The premium on a Medicare Advantage Plan can be low or even zero. However, the Medicare Beneficiary will incur expenses over the course of the policy year, including deductibles, copayments and coinsurance. Typically, Medicare Advantage Plans have an out of pocket maximum of at least $6,000.

You Get What You Pay For

Medigap Policies are the best choice for securing the most comprehensive coverage. You keep your Original Medicare Parts A and B. Then choose the Medigap Plan that best fits your needs and fills the gaps in coverage left by Medicare. A qualified licensed insurance agent can help you compare the costs and benefits of your options. When comparing your choices, it will become apparent which option will best suit your needs and budget.

Medicare Beneficiaries choose supplement plans for several reasons. Most people buy a Supplement Plan because they want to protect their assets. After more than 40 years in the workforce, it’s prudent to protect that which you have worked so hard to earn.
Others select a Medigap Plan for the freedom to choose their caregivers, hospital and doctors.

Medigap Policies provide coverage at any doctor or facility that accepts Medicare. In addition, these Supplement Plans provide coverage when you travel outside the United States.

When choosing a plan to fill the gaps left by Medicare, Medicare Beneficiaries are electing to purchase one of the Medigap Plan options. These plans offer a set monthly premium amount that Medicare Beneficiaries can work into their fixed income.

A set monthly premium works best for Medicare Beneficiaries as the unexpected out of pocket costs associated with a Medicare Advantage Plans leaves the insured person financially vulnerable.

There are several options available and the best way to shop around for the plan that meets your needs is to contact a qualified licensed agent. Your agent will ask you some questions to better understand your concerns and budget.

Once your agent understands your specific needs, he/ she will be able to check with the carriers in your region to advise which companies offer the best premium amounts for the coverage you’ve elected.

Enrollment into a supplement plan is best when you are first eligible for Medicare Part B. However, if you have delayed enrolling in Part B, because of coverage through your (or your spouse’s) group health insurance plan with an employer, you may be able to enroll in Part B and your Medigap Plan when that coverage ends. You will want to take action prior to the group plans termination day. It’s a good idea to contact your insurance agent as soon as you suspect any changes to your coverage.

Difference between Medigap Plans and Medicare Advantage

Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage Difference between Medigap Plans and Medicare Advantage

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Medicare Plans

How New Value-Based Insurance Impacts Medicare Beneficiaries

by Jagger Esch
written by Jagger Esch

The new Value-Based Insurance Design will impact Medicare beneficiaries exponentially. Discover how quality of care in 2020 will be pushed to the forefront of doctor priority.

Medicare beneficiaries are going to see a positive shift in benefit options as early as next year. Patients can expect to see a higher quality of care in 2020 due to new provisions introduced by the Center for Medicare and Medicaid Services (CMS).

One of these incredible provisions is the expansion of Value-Based Insurance Design or VBID for short. A change made in the Chronic Care Act expanded testing of the Medicare Advantage Value-Based Insurance Design Model nationwide.

This is great news! The VIBD model gives plans the ability to create customized benefits for a certain enrollee population. The benefits offered are determined by specific conditions and/or socioeconomic status.

Value-Based Insurance Design (VBID): How it Started

The Centers for Medicare and Medicaid Services (CMS) designed a voluntary VBID model in 2015. This model was created for insurance carriers offering Medicare Advantage plans.

The purpose of this VBID model? To test the impact of offering Medicare Advantage organizations (MAOs) more flexibility in the design of benefits. Things like reduced cost sharing or extra supplemental benefits to patients with certain chronic conditions.

CMS stated in the VBID model 2020 – this model was created to lessen Medicare expenses while improving the quality and coordination of health care for Medicare beneficiaries.

Before the VBID model, Medicare Advantage organizations were unable to offer VBID due to federal requirements (they wanted benefits to remain consistent).

Particularly, MAOs needed to abide by the requirement that:“All plans must be offered at a uniform premium, with uniform benefits and cost-sharing throughout the plan’s service area…to all Medicare beneficiaries with Parts A and B of Medicare.”

Now, CMS has lifted the uniformity requirement for qualified Medicare Advantage organizations in half of the U.S.

25 States included: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, Alabama, Michigan, Texas, Tennessee, California, Colorado, Florida, Georgia, Hawaii, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, North and South Dakoda, Virginia, and West Virginia.

VBID testing in these states allowed for the following diseases: chronic obstructive pulmonary disease (COPD), diabetes, congestive heart failure, history of strokes, coronary artery disease, hypertension, mood disorders, and variations of the different categories.

Since the initial model release, nearly 60,000 beneficiaries were affected. Alabama, Michigan, and Texas will allow testing for dementia and rheumatoid arthritis.

Mid-January 2019 the CMS announced the upcoming changes to the VBID model for the following year (2020). Changes include allowing plans in ALL 50 states and U.S. territories to apply.

This includes plan types that weren’t initially part of the VBID model.

For instance, plan types such as Regional Preferred Provider Organizations (RPPO) and all Special Needs Plan (SNP) types – Chronic Condition SNPs (C-SNP), Dual Eligible SNPs (D-SNP) and Institutional SNPs (I-SNP) will be included in the VBID model for the calendar year 2020.

The updated VBID model for 2020, gives an opportunity to new MAOs that might want to apply. Thus, MAOs should look over the current VBID model for Medicare Advantage to see what it has to offer.

One example of how the value-based insurance design will impact Medicare patients in 2020 has already begun. Since the Medicare Advantage program started broadening benefits, beneficiaries are continuously enrolling in them over Original Medicare plans.

Enrollment for MA plans is expected to reach an all-time high in 2019. According to CMS, 22.6 million Medicare beneficiaries are signed up for this program.

VBID Benefits in 2020

Come January 2020, Medicare Advantage (MA) plans can offer reduced cost-sharing and extra supplemental benefits. Benefits for enrollees will be more customized to their situation than ever before.

The same is true for benefits that aren’t directly related to health care. Benefits such as transportation for home health and home care providers can be a huge help for many beneficiaries.

According to a recent nationwide poll, (conducted by the National Aging and Disability Transportation Center) about 1 in every 5 older adults will give up driving privileges after their 65thbirthday.

Access to covered transportation services can assist home health-care agencies, by helping clients get to and from important health-related appointments.

About 3.6 million people (mostly older patients) will miss health-related appointments every year. Benefits of transportation services should lower this number greatly.

This updated VBID includes more benefits specific to managing chronic conditions, telehealth services, for those who qualify for a low-income subsidy, and (or) are dual-eligible.

Participating MA plans can offer telehealth services as a substitute for in-person health care visits. If the MA plan will cover face-to-face visits for a health issue – then the MA plan will also cover telehealth services.

CMS is testing out another new program, hoping to effectively influence members to create healthy behaviors by offering more meaningful rewards and incentives.

Rewards and Incentives programs

These RI programs have allowed costs that better reflect expected benefits for health-care, up to the annual limit. Reflections should promote a healthier lifestyle, prevent injuries and illness, and aid in using health care resources efficiently.

Medicare Advantage plans offering a Prescription Drug Plan (MA-PDs) can offer RI programs too. Likewise, RI programs are provided to patients who take Medicare-covered Part D prescription drugs.

RI programs are also for those participating in the following: disease state management programs, medication therapy management with health-care providers (or pharmacists), and preventative health services.

Lastly, enrollees are required to stay updated with prescribed medications – including the understanding of any generic alternatives that may be more cost-friendly.

VBID Hospice Benefits
Although it’s not in place just yet – come 2021, the VBID model testing will allow MA plans to offer benefits for Medicare’s hospice coverage.

Recent updates were created to give more access to hospice-related services and provide better coordination between hospice providers – ultimately providing better hospice care for members.

The highly anticipated 2021 CMS update to VBID, allowing hospice benefits is expected to have the largest impact. Hospice care is not currently a covered benefit in Medicare Advantage plans, so for beneficiaries, this is BIG NEWS.

Value-Based Insurance Design has Cost Reduction in Mind

The current versions of Medicare Part D and Medicare Advantage haven’t been updated in over a decade. The CMS debates were well over-due for an upgrade.

As times are changing, so are the advances in health care. What worked for benefit options a decade ago – isn’t quite good enough for recent years. One example is, the technological options available today, like telehealth services.

The idea behind VBID is to provide Medicare patients with optimal coverage options, lessening the costs for beneficiaries, and making the entire Medicare program more efficient.

Aiming to promote a healthier lifestyle at a more affordable rate – VBID is still proposing Medicare Advantage expansion plans. Expect more updates and changes to be launched over the next few years.

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