HEALTH SPOTLIGHT: Medicare Advantage Plans Also Cover Emergencies and Urgently Needed Care
By Space Coast Daily // January 9, 2017
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BREVARD COUNTY, FLORIDA – Retirement brings a delicious vista of days spent pursuing leisure passions, but as they say, with “great privileges come great responsibility.”
When you retire, you, and not your former employer, are responsible for obtaining healthcare coverage that will be critical if your supposedly rosy retirement years ever were to turn blue because of illness or accident.
Yes, traditional Medicare will be an integral part of your medical protection, but note that it is just a part and not the totality. Medicare is composed of Part A, which covers hospitalization expenses at no monthly premium for most Medicare beneficiaries.
Medicare Part B addresses outpatient medical expenses – the doctor’s visits, diagnostics and treatments – at a monthly premium that currently is $104.90 – $121.80, or more, depending on your income.
Don’t think that premium gets you off the hook for medical expenses, for with Part B, you will still be responsible for an annual deductible of $166, then 20 percent of Medicare-approved covered services. There is no ceiling to the maximum out-of-pockets costs you could incur in a year.
To the rescue comes Medicare Part C, also known as Medicare Advantage Plans, offered by insurance companies such as Health First, which has the approval of the Centers for Medicare and Medicaid Services (CMS). These plans offer the advantage of fixed co-pays – or no-copays at all in some instances – plus enhanced benefits and the option for prescription drug coverage.
There are some ground rules for these money-saving plans.
“To be eligible for Medicare Advantage Plans, the individual must be entitled to Part A and enrolled in Part B, and must live in the plan’s service area,” said Denitza Hernandez, Director of Medicare Sales for Health First Health Plans.
The scope of coverage is impressive. “Medicare Advantage Plans must cover all of the services original Medicare covers, except for hospice care, but hospice care is covered by original Medicare even if you’re in a Medicare Advantage Plan,” Hernandez added.
“All Medicare Advantage Plans also cover emergencies and urgently needed care.”
That’s when things get trickier. Some plans choose not to cover services not deemed medically necessary under Medicare.
“You need to check with your provider to see if a service you want or need is covered,” Hernandez said.
The ultimate beauty of Medicare Advantage Plans is their ability to control costs through managed care, just as health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs. For the consumer, that translates into lower premiums than traditional Medicare and supplementary insurance.
“Plans such as Health First also offer bonuses that include wellness services, gym memberships and coverage for prescription drugs and vision, hearing and dental benefits,” Hernandez added.
“They are truly a one-stop shop for medical coverage and can save you both money and worry. They cover everything at a cost you can afford.”
While the good news is that Medicare Advantage Plans can be your health’s – and your wallet’s – best friend, the bad news is there are literally thousands of these plans available. Selecting the one perfect for you will take time.
Not all Medicare Advantage Plans are created equal, so consumers need to do their due diligence before selecting one that best suits their needs. If you’re already on Medicare, you can change plans during the AEP, or Annual Enrollment Period, which runs from Oct. 15 through Dec. 7. Coverage becomes effective on Jan. 1 the following year, so choose wisely…or you’ll be stuck with the wrong plan for a year ahead.
Consumers nearing retirement age should explore Medicare and its options well ahead of that magic day when you clean up your desk and head out of the office for the last time. You will have a limited amount of time to select a plan after you retire, so it pays to be ready.
“We recommend they begin researching Medicare plans six months to a year before they’re eligible for Medicare,” Hernandez said.
Hernandez offers recommendations when comparing plans. You should compare how well the plans cover the services you know you will need. If you have other types of health or prescription drug coverage, make sure this coverage dovetails with Medicare.
“Cost is also an important consideration,” added Hernandez.
“Know the premiums, deductibles and other costs. How much will hospital stays and doctor visits cost you out of pocket? Is there a yearly limit to these expenses?”
While some consumers are not tied to any particular physician, others couldn’t think of leaving their favorite doctor. If you’re in the latter category, make very, very sure your doctor accepts the coverage you’re considering. If you want to switch to another physician, ascertain that he is accepting new patients with your coverage.
“You also want to check if you need to get referrals to see a particular physician,” said Hernandez.
You may also have hospitals you prefer over others. The plan you select should include your favorite health care facility as an option.
Plans that provide prescription coverage should encompass medications you routinely take. Convenience of locations for both pharmacies and physicians accepting the plan is also a consideration. If a plan permits you to fill your prescriptions by mail, even better.
Travel is often on the to-do list of many retirees, and if you’re one of these folks, consider a plan that covers your health while out of state or even out of country.
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Health First’s Medicare Advantage Plans, for example, offer everything original Medicare offers, plus additional benefits such as allowances for dental care, hearing and vision, as well as free membership at the health care system’s four Pro-Health and Fitness Centers, a nice bonus, since with retirement, you will have extra time to get in shape or take up a sport.
Health First’s Medicare Advantage Plans cover emergency care around the globe and offer no deductibles and preventive services at no cost to the patient. No referral is needed to see any of the plans’ 4,000 in-network physicians and providers.
Medicare Advantage Plans differ from Medicare supplements or Medigap plans because they handle all of your claims on your behalf.
To help in your decision-making, Medicare.gov, the official government site for all things Medicare, offers a star system that rates plans on customer service, wellness options, chronic disease management and approximately 50 other different quality signals.
CLICK HERE for information on original Medicare and Medicare Advantage Plans.