What will it be for 2010, Original Medicare or an Advantage plan? Typically, the average person turning 65 and about to be enrolled into Medicare is unclear on just how to receive his or her benefits. Do you choose Original Medicare or one of the many private, Medicare Advantage plans? 2010 is a year of great financial change for many Medicare insurance companies due to the recent health insurance reform of the Obama administration. However, this will not affect the actual working of either traditional Medicare or the privately managed Advantage plans.
Medicare Advantage plans in 2010
The essential working of the plans, whether they are Medicare Advantage PPO plans, HMO plans, or private fee for service plans, remains largely the same as the Advantage plans in 2009. One significant difference for 2010 is that the costs premium and out-of-pocket costs appear to have generally increased from 2009, and that there are far few plans offering zero premium options, and more plans whose cost sharing more closely mirrors that of Original Medicare.
What are you getting when you join a 2010 Medicare Advantage plan? The Medicare program requires that the Advantage plans offer you the same core services that you receive in Original Medicare. However, the Advantage plans deliver your benefits according to their own policies and procedures. When you join an Advantage plan, that plan takes over management of all of your Medicare health benefits and become the only and single payer on your medical expenses. You are still in the Medicare program, but instead of the Federal government managing your benefits, the private, Advantage insurance takes over. The Advantage plans are not supplemental insurance and will never pay after Medicare. They pay instead of Medicare, and Original Medicare will never pay on charges while you are enrolled in a private plan.
Medicare Advantage PPO Plans and HMOs
Medicare Advantage PPO and HMO plans are in charge of all of your benefits. As mentioned above, that remains true for as long as you remain enrolled in such a plan. The health maintenance organization (HMO) is made up of a network of health care providers, and when you become a member, you are generally required to receive all of your care from within the network. Normally, if you go out of the network, you would pay the charges out of your own pocket. The only exception to that rule is if you need emergency or urgent care services. A PPO, or preferred provider organization, also includes a network of providers. However, the PPO allows you to receive services out-of-network from providers of your choosing as long as they agree to submit claims to the insurance company.
If you join a Medicare Advantage plan, can you still get drug coverage? The answer to that is a solid yes. In fact, most advantage plans include drug coverage, also generally known as Medicare Part D. In 2010, just as in 2009, if you need drug coverage and want to join an HMO or PPO, you must accept the drug coverage offered by the plan. However, if you join a private fee for service plan that does not include Part D, then you would be allowed to join a separate, stand-along prescription drug plan.
How do you know which kind of plan is best for you? That is tough question. In large part that depends on your understanding of your medical needs and knowing what would make you feel secure. Those able to afford the more expensive, private coverage may prefer to join the Advantage program. Generally speaking, Medicare beneficiaries requiring light to moderate health care are likely to have a better experience in an Advantage plan than those whose health care needs are more extreme. If you are thinking of joining a private plan, we advise giving careful consideration to your health care needs, your cost expectations, and then speaking with plan representatives to determine what is best for you.
Is a Medicare Advantage PPO plan the right choice? Find out today. Learn more about how health insurance works today!
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