All posts by Caroline Lawrence

Prescription Drug Coverage and Medicare Advantage Plans

Under the original Medicare plan, prescription drugs are only covered by Part D. Now, some Part C suppliers now offer prescription drug coverage as part of Plan C. That’s why it’s so important to compare drug prices with similar coverage terms. Your Medicare Advantage plan awards can reach $40 or $240 or more. The difference is in the coverage provided, although there are also some differences between different areas of the country. Beginning in January 2011, companies offering Advantage PFFS (Private Service Charge) plans should allow these members access to a provider network if they choose to use it. A PFFS plan is not a network-based plan, but members can visit any provider that accepts Medicare attribution. The provider must accept the terms and conditions of payment of the plan and have the right to accept the visit of the plan per visit.

If a company decides not to renew its Medicare Advantage plans for 2011, this could be because there is no credible network for its municipality or service area. If an insurance company has only one plan available, and it is a PFFS plan, it may be an easier and more economical solution for them to simply withdraw from the market. Some plans are designed to provide predictable copays for doctor and specialist visits as well as hospital stays. In many cases, you may even consult specialists without indication. It is important to make the right decision before signing up for an Advantage plan when carefully analyzing and comparing the different benefits and costs. Health Advocates Insurance, Inc. has been your specialist in Medicare and Medicare Advantage supplement plans since 1970.

If you know someone who has been in the medical center for an extended period, ask them what their expense was. You can be informed of several incredible numbers that your insurance agency has solved and it could have been your duty if the insurance company did not resolve. Well, when you turn 65, your first insurance company will be the government through Medicare. If you believe Medicare will increase your bill alone, it is not true and should start looking for Advantage plans of Medicare this moment. ou should make some comparison shopping with different suppliers if you want to hire a Medicare Advantage policy. As with any other type of insurance run on private companies, rates can vary in hundreds of dollars from one company to another. The difference will be in what each policy really covers.

The Federal Government and Medicare Advantage plans

The federal government typically helps provide funding the benefit policy via the fees paid by the drug recipient, and also the fee paid to the company directly. In such instance, the insurer will probably end up earning revenue because it has the power to assign surcharges and deductibles to its clients and at the same invest these funds to specialists they have access to.Medicare Advantage plans are the third part of the original Medicare program, established by the government, to meet the medical and hospitalization needs of an individual, especially if they are 65 or older. A person would need to have parts A and B of the original Medicare plan to qualify for Medicare Advantage plans. To decide which kind of Part C policy will cover your needs, you should review the various kinds of currently available policies. There are many different plans, including the following:

MSA – Medical Savings Account Plan

HMO – Health Maintenance Organization Plan

POS – Service Point Plan

PFFS – Private Service Rate Plan

SNP – Special Needs Plans

PPO – Preferred Provider Organization Plan

Most benefit plans require you to use a network of providers, such as an HMO or PPO. Choosing a plan that requires you to find new providers is not very convenient. Find a plan that includes your doctor, specialists, auxiliary facilities and hospitals. You’ll be glad you did.When it has to do with Medicare, you will have to make a choice between the Medicare benefit plans and the original Medicare programs. One easy method to choose between the two types of programs is to determine if you want to offset the costs of prescription drugs. Sometimes, those in need of prescription medication will sign up for original Medicare since it will cover the fee for prescription medication in Part D of the policy. On the other hand, the benefit plan does not cover the cost of prescription drugs.

Most plans include drug coverage. The Part D formulary is a list of all the drugs covered in a plan and also has details about the layer placement. You should review these plan documents even before worrying about the monthly premium. Finding a plan that meets your needs is the first step. You can then compare the prizes from the short list of plans that seem your best options. The only way to make sure you have the best Medicare supplement and make the most of Medicare is to seriously examine all the Medicare Advantage and Medicare Supplement plans available in your area.

Quotation Systems Medicare Supplement Quotes

Online sites offer free use of their Medicare supplement plans quotation systems. But, using the Internet is not your only option. These sites generally also offer free personal assistance. Finding an agent that compares many plans or a website that allows you to compare purchases quickly and easily is the best option. A great ways to protect you and your funds is to make comparison of the fees from many leading insurance firms before submitting the application. It may take a while to talk to an agent who is a staff of all insurance companies that sell Medicare supplement plans where you live, but there is a shortcut.

Some pricing model may be the most popular because it is not based on age. The rates are the same for everyone in a designated area, regardless of age or sex, or even if they use tobacco. In general, rates start higher than other pricing models, but will differ in the coming years. These plans will not be the most expensive because their rates will not be increased to take into account their advanced age. It may not be clear which pricing model has been applied to the plans available in your area. Finding an agent willing to do some research can help.

In general, your age, gender, if you use tobacco and your zip code, determines what you pay for the Medicare supplement plan. This is only the tip of the iceberg when it comes to pricing schemes for Medicare supplements. In fact, some people have paid hundreds of dollars more than others for the same coverage. Do not depend on the integrity of a seller. Instead, learn how the industry works to find the best available value. Because Medicare supplemental insurance or Medigap policies are standardized to offer the same rewards, it is logical to anticipate that prices will be standardized as well. Nothing could be further from the truth.

An example of how a Medicare Advantage plan can insure a person might be as follows: a cheaper copayment for doctor’s visit which can compensate for lower insurance for specialized health facilities. A general perception which an Advantage plan of Medicare produces for her target audience is that they seem unimaginable because they are. One thing you want to clarify about exactly what each specific type of Medigap insurance covers. Plan A has the lowest benefits and Plan F has the most complete coverage. Other plans offer a variety of options and combine benefits in many ways. Some plans reimburse 50, 75 or 100% of the largest Medicare deductible. This is the deductible for part A in hospitalization. It’s $1,132 and Congress declares how much it will be each year.

Ensure Your Plan Covers Medications

Medicare AdvantageMake sure that the medications you take regularly are covered, as many older people are unpleasantly surprised to find that the plan they apply for does not cover the prescriptions they need. Although not all Medicare Advantage plans include Part D prescription drug coverage, most are likely to offer them. Are you taking advantage of a great opportunity that exists in the coming months of 2019 and beyond with active members of Medicare Advantage (MA)? You will notice that thousands of seniors across the country continue to enroll to become members of Medicare Advantage as the New Year approaches, but they may want to change their status. Are you ready to help them?

MA members are in their annual ‘Open Enrollment Period’ from January 1 to March 31. This period applies to those who are currently members of Medicare Advantage or persons who wish to become members of MA. They will have the ability to switch into or out of a Medicare Advantage plan, but cannot enroll in Part D-controlled drug insurance for the first time, exit Part D, or replace a Part D independent prescription plan with other. Medicare Part C is Medicare Advantage. Since 1997, seniors have the option of enrolling in Medicare private insurance. The provider of the plan gets their premium for Part B and an extra Medicare value for each member. These plans shall insure at least what is covered by parts A and B. It’s worth taking a few more minutes to make sure you’re covered in a way that keeps you comfortable.

Parts A and B are known as original Medicare. The first benefits were paid in 1966 while it was developed in 1965 to assist the elderly with medical fees. It is a health policy of the government which insures most of your medical expenses. Coverage gaps exist and a lot of senior citizens use Medicare supplement insurance plan to insure all or some of the gaps. This creates a situation whereby their medical expenses can be forecasted and tracked from one month to the other and from one year to another. Always check your provider’s directory to ensure that not only your specialists are in the plan, but also that local hospitals are included. It is hospital coverage that could cause a big dent on your finances should your stays not be totally covered. With some simple tips, you will find that choosing the right Medicare Advantage plan will not be the arduous task you might expect. Remember that the right choice will help you find peace of mind next year.

What you need to know about health insurance in Georgia

Individual health insurance, family health insurance, group health insurance, student health insurance, affordable health insurance, child-only health insurance and temporary health insurance are some of the cheap health insurance plans available in Georgia. Georgia health insurance offers medical benefits that cover the cost of treatment incurred in a hospital. The coverage provided is comprehensive, including medical appointments, hospitalizations, emergencies, prescriptions, dental care and mental health services. It serves families, students, children, employees, workers, freelancers, small and large companies and retirees. For the citizens of Georgia, there is a wide range of health insurance plans available to choose from. Each varies significantly according to the size of the deductible and the benefits covered.

Since the 1985 Omnibus Consolidated Budget Reconciliation Act (COBRA) was established, people who have been recently laid off or who have lost their job for one reason or another can retain their previous employer’s insurance for up to 36 months. Of course, it depends on the circumstances. However, most of the time, people who are unemployed will be able to use COBRA to protect themselves until a new employer plan is initiated. Although COBRA seems an attractive option, it is generally the least favorite for those who currently do not have health insurance. This is due to the extremely high cost of the premium.

To get started, buying free health insurance quotes online is the easiest and best way to find low-cost health insurance coverage. If you have permanent health problems, such as diabetes, or have had cancer at some point in your family history, your monthly cost can easily be more than paying for your home and car together, but there are many good insurance plans available nowadays in the United States. The most important thing is that you want a provider of health insurance that has a trust worthy payment history without fighting with you in every little detail. Now, your local agents can only offer what is available at this time and not offer the best for your pocket and your health.

While increasing your risk, one way to reduce your insurance costs is to set a higher deductible. If you are in good health, you will enjoy moving forward, avoiding an unforeseen event such as an accident, etc. Maintaining better health will help you have fewer health insurance claims. All insurance companies must be very competitive because it is very fast and easy to compare them with other competing online companies. Uninsured children are less likely to receive adequate medical care for serious injuries, recurrent ear infections or asthma, for example, and want to avoid having to face open-heart surgery of $100,000 without insurance.

Insurance for Prescription Drugs

There is also something called hiatus coverage that you should understand, because once your coverage begins, at zero or $310, when the total cost of prescription drugs reaches $2,700 a calendar year, the major insurance companies actually stop to pay until the total cost of drugs reaches $4,350. Again, these numbers are based on the 2010 plans at the time of this writing, so they are subject to change. My insurance agent informed me that this will be perfectly clear if you think of the coverage gap as a period without coverage, as it is sometimes called. Medicare Advantage plans, the second broad category of prescription drug plans, cover not only medications but also Medicare-approved medical services. These plans are available through private insurers and include PPO, HMO, and private service fee programs. In the case of Medicare Advantage plans, the Medicare beneficiary has “altered” her traditional Medicare benefits to a Medicare Advantage program. Medicare Advantage plans sometimes offer members who want additional benefits. However, there are often restrictions on doctors and hospitals that can be used for covered medical services.

Older people have survived two years of major Medicare changes with Part D drug plans and Advantage plans that have the greatest impact on Medicare beneficiaries. Although seniors who are new to plans still have some confusion, it seems that most people understand at least how drug plans work. Advantage plans are a different story, and unscrupulous agents keep pulling people out of Med Supplements with the promise of over-coverage. Remember, you really get nothing for free. Advantage plans quickly become expensive if you really need to use them. Every company has levels, every company has certain drugs where Medicare has changed the requirements, and every company is stuck in the infamous donut. Switching companies out of the donut hole achieves nothing. The donut hole goes wherever you go. However, it starts over every year. So if you came in last year and had to pay a lot for your drugs by the end of the year, you will do so this year too, and you may come in earlier due to rising drug prices.

Leading private insurance companies offer several Medicare part D plans to choose from. The difference here from one plan to another is in the amount of the deductible, which can range from any deductible up to $310. Your deductible, of course, is the total amount you must spend on medications before your coverage takes effect. The lower your deductible, the higher the monthly premium you pay. Then, with zero deduction, you will pay the highest monthly premium.


Medicare Advantage plansMedicare Advantage plans have boomed in the last decade. Not only have they taken a step further in providing extra benefits and services to its clients but also reducing the cost of the monthly premiums. With more and more people wanting to choose a health care provider of their choice, there is no guarantee that he would lie within a medicare advantage plan network or not.


With the Private Fee for Service (PFFS) plans, your medicare insurance company decides how much it will pay to the providers and the hospitals, and how much would you need to pay. Humana provides one of the best PFFS plans along with various benefits attached to it. There is basically no plan network in Humana’s medicare advantage plans. You would have the freedom to choose almost any health care provider, as long as he agrees to the terms and services of Humanas PFFS plans. It not only provides flexibility to its clients but also ensures less coinsurance as well as copayments as compared to PPO plans.


With a Private Fee for Service plan, you do not have to choose a primary care provider and do not have to worry about taking referrals to see a doctor of your choice. Most of the Humana PFFS plans also include prescription drug coverage, which is better than the standard coverage of Medicare. These plans also provide full coverage on preventive screenings once a year, which covers almost all of your basic tests. Along with all these, it also covers your hospital expenses.


With PFFS plans no matter where you are, there is a good chance that you have a health care provider in that area, which would agree to your plans terms of service. However, in case of emergencies, all the hospitals and doctors are entitled to treat you, no matter if they accept your insurance plan or not. It is really easy to use a PFFS plan. Just show your PFFS card to any hospital or health care provider you want. If they do accept the terms of service they would accept your medicare insurance plan as well. In case of emergencies, Humana’s private fee for service plans provides coverage out of the United States as well.


These plans are mostly suitable for citizens who would like to select health care providers of their choice. They are not as suited for people who have a special medical need and can get very costly for them. Before choosing to opt for a PFFS plan you should first analyse and study whether your preferred health care providers agree to the terms of your plan or not. You must also see if it covers prescription drug coverage or not. If not, you can enrol in a stand-alone prescription drug plan as well.


Medicare AdvantageMedicare Advantage plans are offered by private health insurance companies and differ from region to region. More and more people are switching to Medicare Advantage plans from Original Medicare, because of the fact that they provide much more benefits than the original medicare. Humana provides multiple advantage plans and they all cater to different sections of the society. Humana Medicare Advantage plans in Illinois are discussed below.



  1. Humana Gold Plus H1468-013 (HMO)

With an overall rating of 4.3, the plan is offered at a monthly premium of $0. The plan has no annual deductible and an out of pocket maximum of $2750. While visiting your primary doctor you have to pay a copay of $0 and for a specialist, you have to pay a copay of $25. The plan includes prescription drug services with no deductible amount. For generic as well as brand name drugs you have to pay a 25% coinsurance. The plan also covers emergency services at a copay of $120. The plan covers outpatient radiology services, lab services, as well as therapeutic services. Preventive as well as home health care services are also covered at a $0 copay. The plan also provides transportation services at a $0 copay.


  1. Humana Choice R5361-001 (Regional PPO)

With an overall rating of 3.4, the plan is offered at a monthly premium of $0. The plan has an annual deductible of $100 and an out of pocket maximum of $6700. While visiting your primary doctor you have to pay a copay of $20 and for a specialist, you have to pay a copay of $50. The plan does not include prescription drug services. The plan also provides therapeutic services and radiology services, like a CT scan and MRI scan. You can also avail urgently needed services at a maximum copay of $65. The plan has a network of hospitals, doctors, nurses, and pharmacies. You would pay much less if you use in-network pharmacies and healthcare providers.


  1. Humana Choice H5216-013 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $88. The plan has no annual deductible and an out of pocket maximum of $6700. While visiting your primary doctor you have to pay a copay of $5 and for a specialist, you have to pay a copay of $40. The plan has prescription drug coverage as well. The plan covers an in-hospital stay for both acute as well psychiatric stay, at a $0 copay after the sixth day. You can also avail any urgently needed service as coinsurance of 20%. The plan covers oral exams, dental x-rays, prophylaxis, extractions, restorative services, eyewear, eye exams, glaucoma screening, routine hearing exams, hearing aids, fitness benefits, over the counter benefits, SilverSneakers program, meals, as well as chiropractic services.


  1. Humana Choice H5361-002 (Regional PPO)

With an overall rating of 3.4, the plan is offered at a monthly premium of $139. The plan charges medicare defined part B annual deductible and an out of pocket maximum of $6700. While visiting your primary doctor or specialist you have to pay a coinsurance of 20%. The plan covers prescription drug coverage with a deductible of $420. The deductible amount is applicable to generic, preferred brand, non preferred drug and specialty tier. For generic as well as brand name drugs you have to pay a 25% coinsurance. The emergency services are also covered in this plan at a copay of $90. The plan also provides skilled nursing facility for up to 100 days, with a $0 copay for the first twenty days. The plan covers preventive care and home health care services as well. The plan also covers fitness benefits as well as over the counter benefits without paying any copay or coinsurance. Transportation costs are also covered under this plan.


  1. Humana Gold Choice H8145-008 (PFFS)

With an overall rating of 3.4, the plan is offered at a monthly premium of $166. The plan has an in and out of the network annual deductible of $200 and an out of pocket maximum of $6700. While visiting your primary doctor you have to pay a copay of $15 and for a specialist, you have to pay a copay of $45. The plan includes prescription drug services as well with a deductible amount of $380. The deductible amount is applicable to preferred brand, non-preferred drug, and specialty tier. For generic as well as brand name drugs you have to pay a 25% coinsurance. The plan covers outpatient surgery and rehabilitation services. Along with this, the plan provides medicare approved dental services, eye exams, eyewear, glaucoma screening, hearing exams, fitness benefits, as well as enrollment in the SilverSneakers program.


  1. Humana Choice H5216-178 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $0. The plan has no annual deductible and an out of pocket maximum of $6700. While visiting your primary doctor you have to pay a copay of $5 and for a specialist, you have to pay a copay of $40. The plan includes prescription drug services as well with no deductible amount. For generic as well as brand name drugs you have to pay a 25% coinsurance. The plan covers in-patient hospital stay for both acute as well as psychiatric services at a copay of $0 after the sixth day. It also covers emergency room services at a copay of $90 and services regarding outpatient surgery. Chiropractic services and outpatient mental health services including both individual as well as group sessions are a part of this plan.