Tag Archives: Original Medicare

Making Sense of Medicare Advantage and Medicare Supplement

Vantage Point: Medicare Supplement or Medicare Advantage? What’s the Difference?

Have you ever had a conversation with a friend or family member where you were both thinking that you’re talking about the same thing, but then you realize (usually after much confusion and the conversation has drifted a bit), that you’re in fact not talking about the same thing?

The conversation comes to the point where you find that you’re talking about two different things, an “apples and oranges” conversation.

I think that there are a lot of “apples and oranges” conversations when it comes to what Medicare Supplement and  Medicare Advantage plans are. We’re talking about insurance with both, but they are different things.

Medicare Supplement plans, also known as Medigap plans, work with Original Medicare, which is Part A (hospital) and Part B (medical) coverage. They help pay for all or part of the 20% that Original Medicare doesn’t pay for, depending on what plan you choose. Medicare Supplement plans do not include prescription drug coverage, so if you want that, you’ll have to pick up a prescription drug plan separately.

Medicare Advantage, also known as Part C, are plans where a private insurance company replaces Original Medicare. Medicare Advantage plans have the same Part A hospital coverage and Part B medical coverage that you’d get with Original Medicare. (Remember, you’d still pay your Part B premium if you get a Medicare Advantage plan.) Plus, Part D prescription drug coverage is included in many Medicare Advantage plans. That means you’d have hospital, medical, and drug coverage together in one plan. Medicare Advantage plans may come with extras as well.

Now that the Annual Enrollment Period is here, you’ll be better equipped to have the “apples and oranges” conversations if they come up. If you still want more direction when it comes to your options, there’s a great local service available called SHIBA (Statewide Health Insurance Benefits Advisors). SHIBA is a free service of the Washington State Office of the Insurance Commissioner, Consumer Protection Division and can be reached at 509-902-1114 or 1-800-562-6900  It has great volunteers who can help you.

You can also come into our local office in Creekside Business Park, and we can go over anything you’re confused about in person, bit by bit.

We at Health Alliance Northwest in Yakima are here to help our community learn what the various parts of Medicare are to help each person make informed decisions that are the best for them. (The best choice might not be us, and we’re okay with that!)    

Breck Obermeyer is a community liaison with Health Alliance Northwest, serving Yakima County. She is a small-town girl from Naches and has a great husband who can fix anything and 2 kids who are her world.

HappyHappy, Healthy, Medicare New Year!

Long View & Vantage Point: Steps to a Happy Medicare New Year

Winter preparations are all done, and winter festivals and end-of-the-year holiday celebrations have ended. Just when you think you can sit back and relax, there is still one last item you may need to consider.

If you made any changes to your Medicare plan during the Annual Enrollment Period, here are some actions you can take to help you have a happy Medicare New Year:

  1. Make sure you’ve received your new plan’s member ID card.

If you joined a Medicare prescription drug plan (PDP) that works with Original Medicare, you’ll get a separate card to use when you fill your prescriptions, but you’ll still use your Medicare card for hospital and doctor services.

If you joined a Medicare Advantage plan, like a Health Alliance plan, you’ll get a new card to use when filling your prescriptions and for hospital and doctor visits.

If you need medical care or need to fill a prescription before you receive your ID card and your new coverage has already started, you may be able to use other documents as proof of coverage, like the welcome letter you got from the plan, or even your enrollment confirmation number and the plan’s name and phone number.

  1. Show your new member ID card to your doctor’s office and pharmacist on your first visit of the new year.

If you have stayed with the same insurance company, be sure to replace last year’s card with your new card. If you changed companies, be sure you’re always using your new card.

  1. If you chose to have your plan premium withheld from your Social Security check, don’t be alarmed if you don’t see it deducted right away. It can take up to 3 months from when you made this request to start seeing it withheld from your Social Security payment.
  1. Remember that your deductibles start over at the beginning of the year, so normal copayments won’t start until all applicable deductibles have been met for the year.
  1. Take advantage of your annual wellness visit. This free preventive benefit is designed to help you take charge of your health, learn about preventive services you might need in the future, and establish a baseline for personalized care.
  1. Take advantage of any gym membership benefits from your plan. Many plans offer gym memberships or access to fitness activities, at no cost to you. Our Be Fit benefit helps pay you back for your gym membership or fitness classes, so you can get fit at the gym of your choice.

Wishing you all a happy and healthy 2017!

Sherry Gordon-Harris is a community liaison at Health Alliance. She is a wife and mother of 2 boys and enjoys traveling, collecting dolls, and hosting princess parties and princess pageants.

Breck Obermeyer is a community liaison with Health Alliance, serving Yakima County. She is a homegrown girl from Naches and has a great husband who can fix anything and 2 kids who are her world. When not attending community events or providing Medicare education throughout the Valley, she can be found indulging in her hobbies of homesteading, pioneer cooking, and learning new survival techniques. She also has a strong love for all things Halloween.

Medicare Basics Without an App

Vantage Point: There’s Not an App for That – But We Can Help!

Personal fitness trackers—like the Fitbit® or Jawbone®—are popular devices to help you keep your New Year’s resolutions and stay fit all year long. The fitness tracker collects data and sends it to a phone app that tracks physical activity, calorie intake, and sleep quality. Wouldn’t it be cool if the device included an insurance tab to help people navigate their Medicare benefits, too?

Could you imagine how you’d feel slipping on the device if it said,
• “You have adequate coverage for your current health.”
• “Your doctor is in-network, and the out-of-pocket cost for your upcoming appointment is $10.”
• “Warning, you are nearing the prescription coverage gap.”

Until that technology comes along, Health Alliance Medicare can help explain Medicare basics. Most people paid for Medicare Part A through their payroll taxes while they were working, so they don’t pay a premium now. Part A covers inpatient hospital procedures, but not the doctor who does the procedure.

Medicare Part B covers the doctor and requires a monthly premium. Both A and B have deductibles (what you pay before your coverage kicks in) and coinsurance (a percentage of total cost that you pay). Figuring out coinsurance is tricky because it’s hard to plan what the overall doctor visit or hospital cost will be.

Medicare Part D is for prescription drug coverage. If you don’t choose Part D when you become eligible for Medicare, you could pay a penalty, called the Late Enrollment Penalty, if you add it later. If you pay a lot for your medicine, it’s important to read your monthly Explanation of Benefits to see if and when you’ll fall into the coverage gap.

Medicare Advantage plans, like Health Alliance Medicare, are called Part C and cover every benefit of Original Medicare and more, plus you can add prescription drug coverage. Medicare Advantage plans can be an easy transition for those turning 65 because they look a lot like employer insurance plans.

Until someone invents a Medicare app, consider Health Alliance Medicare your source for information. Helping people get started with the right information to avoid common and costly pitfalls later is the best part of our jobs.

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.

AEP Autumn

Vantage Point: It’s That Time of Year

Days are warm and evenings crisp. Orchards bustle during the pear and apple harvest. It is my favorite time of year, but for seniors it can be stressful because of Medicare’s Annual Enrollment Period (AEP), which runs from October 15 through December 7. This is the time of year when most Medicare beneficiaries can choose or change their Medicare coverage.

Better-than-ever health care coupled with healthier lifestyles means people are living longer. With that, living on a fixed income means many seniors worry about having affordable health care for years to come.

One of the most common questions we hear in our Wenatchee office is, “What is the difference between a Medicare Supplement and Medicare Advantage plan (also known as Part C)?” Learning about each product can help people understand what best fits their lifestyles, pocket books, and health care needs.

Whether choosing a Supplement or Advantage plan, you must continue to pay your part B premium.

Medicare Supplements work much like a secondary insurance. They pick up their share of the covered health care cost after Medicare pays, depending on what plan you purchase. For example, it may pick up 10 percent of the 20 percent coinsurance (meaning you would still pay 10 percent). Supplements will not cover any cost Medicare denies, and some Supplements require medical underwriting to gauge the health of the individual. Premiums, or the cost you pay for the coverage each month, are generally more expensive. Like with Original Medicare, you can see any doctor who accepts Medicare.

Medicare Advantage plans replace Original Medicare, which means hospital and doctor visits are paid directly by the plan. Many Advantage plans also include prescription coverage making for one tidy package. To be clear, you still keep all your Medicare benefits. There is no medical underwriting, and premiums are generally lower. Advantage plans also cover extras that Medicare does not, like dental and fitness programs. They also work closely with provider offices to help coordinate care. This helps many members stay healthier. Advantage plans have contracts with provider offices so a member normally must chose a doctor within the plan’s network.

Health Alliance takes Medicare seriously, and our Wenatchee office and helpful customer service representatives are a resource you can count on to help make a great decision for you during AEP and beyond.

Visit us at 316 S. Fifth St. in Wenatchee from 8 a.m. to 5 p.m., weekdays. Or call 1-877-561-1463, TTY 711, from 8 a.m. to 8 p.m. daily. That looks like a toll-free number, but our local representatives are on the other end waiting to help.