Tag Archives: health plan

Medicare Advantage Mythbusting

Long View: Medicare Advantage Truths Might Just Change Your Mind

As I travel around the Illinois countryside, I hear the same misinformation about Medicare Advantage over and over. To tackle some of that, here’s a Q and A.

Question: When I join a Medicare Advantage plan do I lose my Medicare coverage?

Answer: No. If you have a Medicare Advantage HMO or PPO plan, a private health insurance company that has a contract with Medicare, like Health Alliance Medicare, provides the services instead of Original Medicare. People who disenroll from Medicare Advantage plans revert to Original Medicare. In either case, no one loses Medicare coverage.

 

Question: Will I be able to stay with my current doctors?

Answer: Probably, especially with Health Alliance Medicare. That’s why it’s important to check any plan’s provider directory to confirm your doctors work with the plan. People who select a Preferred Provider Organization (PPO) plan can use out-of-network providers, but they typically pay more when they receive services.

 

Question: We travel and might need to use the emergency room. Will Medicare Advantage plans only cover me for emergency care when I’m close to home?

Answer: No. Medicare Advantage plans cover out-of-area emergency and urgently needed care.

 

Question: If something serious happens and we need lots of services, could we predict how much we would pay for care?

Answer: Yes. Medicare Advantage plans have an annual Out-of-Pocket Maximum (OOPM), also called a Yearly Limit. When a Medicare Advantage member reaches that limit, the health plan pays 100 percent for Medicare-approved services. This amount doesn’t include the premium and other limited expenses. You can estimate what your expenses would have been last year on the Medicare Advantage plan you are considering.

 

Question: Medicare Advantage sounds good for me, but wouldn’t the premium be too costly for my 88-year-old mom?

Answer: Not at all. One of the best things about Medicare Advantage plans is the premium is the same no matter the member’s age. You and your mom would pay the same monthly premium if you had the same plan, unless either of you could get extra help paying for coverage based on your income.

 

Question: Would I have to deal with all the paperwork I get when I receive services from Original Medicare plus a Medicare Supplement plan?

Answer: No. You would have much less paperwork with a Medicare Advantage plan. In fact, that’s one reason Medicare Advantage plans exist, and I’m all for less paperwork.

 

Remember, the Medicare Annual Enrollment Period, or AEP, runs from October 15 to December 7. That’s the only time most people can change their coverage for the following year.

If you are thinking about a change for yourself or a loved one, you will have to do a bit of research. Trusted resources like Area Agencies on Aging and your local senior center can help.

Please consider Health Alliance Medicare a resource, too.

We all want to make well-informed choices that don’t depend on myths and misinformation.

Baby Feet

Before the Burp Cloths, Learn These Baby Basics

If you or someone you love has had a baby, you know the joys that come with being pregnant. Soon-to-be moms and dads might also be nervous about what their health plan covers.

Heather Miller knows. Her team in our call center gets lots of questions from soon-to-be parents.

And she just gave birth to her son Kolton.

If she didn’t know the ins and outs from working at a health plan, Heather says she would have questions, too.

“My first questions would be, ‘Are my visits covered? What about my sonograms?’” she said.

Here’s what Heather says members need to know.

Before the baby is born, we cover:

  • Doctor’s office visits
  • Lab work
  • Sonograms

After the baby is born, we cover:

  • Being in the hospital (48 hours, or 96 hours after a C-section)
  • Most lab work
  • Follow-up visits

New parents typically have 31 days to add their newborn to their plan. Once they have, the baby is covered beginning on the date of birth.

Heather says to review your policy or log in at YourHealthAlliance.org for more details. If you still have questions, call the number on the back of your ID card.

“You’ll feel a little less nervous when you know what your plan covers before you start setting up those pre-baby visits,” she said.