Medicare and Medicare Advantage Update 2010

Q. What are the changes to Medicare in 2010?take Medicare Advantage Blue Cross. What does
A. Medicare is made up of three parts: Hospitalthat mean?
Insurance (Part A), Medical Insurance (Part B), andA. Medicare Advantage plans are a hybrid of
Drug (RX) Insurance (Part D). Part A Deductiblecoverage offered from an insurance company.
for 2010 is $1,100 for a hospital stay of 1 - 60When you are eligible for Medicare at age 65, you
days, $275 per day for 61-90 days, and $550 dayselect Part C--Medical Insurance offered by a
for 91-150 days of a hospital stay (lifetimecompany. You still pay your premiums out of
reserve days). After 150 days, you pay all costsyour social security check for Part B but the
for the hospital. Part A also includes Skilled nursinggovernment pays the insurance company to
facility and some home health care but not longadministrate the benefits. These Medicare
term care. Skilled nursing facilities is subject to aAdvantage Plans appear to have many benefits
$137.50 per day co-insurance for days 21-100.and include Drug coverage (Part D). Medicare
Part B covers Medicare eligible physician services,Advantage plans are the best of both worlds but
outpatient hospital services and certain homethey have some drawbacks. If your doctor is not
health services and durable medical equipment.a Medicare Advantage plan doctor, you will pay
You pay 20% of the Medicare-approved amountadditional costs to see him/her but with most
after you meet the $155 deductible.plans you can see another doctor (usually not
Part D coverage is for both short and long-termavailable with HMO plan). You will be subject to
prescription needs not given in the hospital,separate deductibles and separate co-payments
coverage for both brand name and generic drugsand often need a referral for approval before you
and can differ dramatically from one company tocan get care from the specialist. If you do not
the other. Part D is not deducted from yourget a referral, the plan may not pay for your
Social Security check.care.
Q. Can you explain the difference between aQ. Since Medicare Advantage provides all Medicare
Deductible, co-pay(ment) and out of pocket.health care through that plan, what if I don't like
A. The deductible is the amount you must payit? I have heard Doctors payments will be cut and
for health care before Medicare begins to pay.the company I sign up with may stop insuring
These amounts can change every year. Athem. What protection do I have?
co-payment is a partial cost you will spend to seeA. Since Medicare is a government provided plan
the doctor. These can be zero or more. Thesefor those 65 and older, you have many options
are out of pocket which are costs that you mustfor coverage. Every November 15 through
pay on your own because they are not coveredDecember 31 you can switch from one Medicare
by Medicare.Option to another--you can enroll in any Medicare
Q. What are the differences in HMO, PPO, PFFS,Advantage or Part D at this time. This is called
SNP and MSA plans?the Annual Enrollment Period. (AEP) Your new
A. Health Maintenance Organizations (HMO)- Justcoverage would begin on January 1. From January
like the private sector, HMO is a group of doctors,1 to March 31 Medicare members can make ONE
hospitals and other care providers that agree toplan change to a like kind. For example, you can
give health care to Medicare beneficiaries for achange to another MA plan. The member
set amount of money from Medicare everyCANNOT change Part D coverage during this time
month. You get your care from the provider inunless they have it with the plan they are leaving.
the plan.This is called Open Enrollment Period (OEP). During
Preferred Provider Organization (PPO)- Doctors,Special Enrollment Period (SEP), members must
hospitals and providers that belong to theenroll within 63 days of a special event. This is if
network and with most PPO plans, you can useyou move outside the service area, move into or
doctors, hospitals and providers outside theout of a long term care facility, loose credible
network for an additional cost.prescription drug coverage, return to the US from
Private Fee for Service (PFFS)- These areanother country or get assistance from the state
sometimes referred to as regional PFFS since thein which you live, loose coverage under an
doctor or hospital accepts payments from theemployer or union either voluntarily or involuntarily.
insurance plan rather than Medicare. The InsuranceQ. What other benefits do I get with a Medicare
plan decides how much it will pay and what youAdvantage Plan?
pay for the services you get. You may pay moreA. You may get extra benefits by selecting a
or less for Medicare covered benefits.Medicare Advantage Plan. These may include
Special Needs Plan (SNP) - A type of plan forvision, hearing, dental and/or health and wellness
people with chronic illnesses or conditions withprogram including membership to a specific gym.
special needs.Because you do not need to buy a Medigap or
Medical Savings Plans (MSA) - A type of savingsMedicare Supplement policy, the premium are
plan for those people who do not go to thesupplemented by the government and are less
doctor often but need a savings plan to payexpensive than a traditional supplemental plan.
some of the costs of the deductibles andQ. I hear there are many gaps in the Part D
co-payments.(Drug) coverage and I take 5 prescriptions a day.
Q. My Doctor takes Blue Cross but he does notHow do I get most of my drugs covered?