How Medicare Insurance Plan Is Changing Health Coverage


This Sarasota Herald-Tribune article by Maggie Clark & Barbara Peters Smith explains that changes to Medicare insurance plans can effect your health coverage.

Sometimes due to negotiations between insurance companies and providers such as hospitals, medical groups, or even individual doctors, patients can get caught in between while the insurance companies and providers either work out their differences or worse. (The insurance companies decide to drop those providers and not to accept patients in-network from them going forward.)

There aren’t any rules that stop insurance companies from dropping providers (doctors, medical groups, and hospitals) at any time during the year. So even though you may sign up during the annual enrollment period, your doctors, medical groups, or hospitals can be dropped at any time afterwards! The insured customers need to realize that their providers are not guaranteed to be in-network all year long in a Medicare Advantage Plan.

A Medicare Advantage plan receives a lump sum amount from the government for each enrollee, and reimburses providers in its network at pre-negotiated rates. Insurance companies make profit on any remaining balance after enrollee’s bill are paid.

As a more expensive, but yet a lot more flexible, alternative to an Medicare Advantage plan is to instead purchase both a Medicare Supplement and a Part D (Prescription Drug Plan). Generally most Medicare Supplement plans do not require you to stay in-network and as long as your provider accepts original Medicare then you are also covered with your Medicare Supplement plan. As with anything else, generally to get more flexibility you will pay a higher price. Many Medicare Supplement plans (such as Plan F), don’t have virtually any copays or deductibles. (That is unless you go out of the United States.) You are basically paying a predetermined upfront premium each month. However with Medicare advantage you are basically taking a chance. Even though there are either no premium at all or possibly a very low premium, you may still have copays, coinsurance, deductibles, etc. all which can add up more than a Medicare Supplement total yearly premiums if you become very ill. I kind of relate a Medicare Advantage plan, to a pay as you go type plan.

To read the full article, click on the link below.

http://www.heraldtribune.com/article/20141126/ARTICLE/141129787?Title=How-Medicare-insurance-plan-is-changing-health-coverage


Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.

By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.

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