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How To Choose A Medicare Plan-Part 2

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In Part 1 of How To Choose A Medicare Plan we explored the pros and cons of Original Medicare and Medicare Supplement plans.  In Part 2 we explore the other path, Medicare Advantage plans.  If you are new to Medicare, you must choose one of these two paths.  With these two articles, our intent is to give you enough information to decide for yourself which path is right for you.

Medicare Advantage Plans

Medicare Advantage plans are health insurance plans that replace your Medicare Part A and Medicare Part B with a private insurance policy from a private, for-profit insurer.  They come in many different forms but are usually either HMO’s or PPO’s.  They often include a Medicare Part D prescription drug plan as part of the Medicare Advantage package.  Medicare Advantage Plans are also referred to as Medicare Part C.

If you choose a Medicare Advantage plan you must still pay your Medicare Part B premium that is automaticallyMedicare Enrollment Maze deducted from your Social Security check.  However, instead of those funds going to Medicare, they are redirected to your Medicare Advantage insurer. 

Medicare Advantage plans are required to be actuarially equivalent to Medicare Part A plus Medicare Part B.  What that means is that over large groups of people the medical expenses of the population in total should be approximately equivalent to the medical expenses of those people with Original Medicare Part A & B.  Simply put, “actuarially equivalent” means very little to the individual as individual experiences will vary greatly depending on the plan and their medical needs.  In addition, Medicare Advantage is not equivalent to Original Medicare plus a Medigap plan.  Original Medicare plus a supplement (any supplement) offers more coverage and freedom of choice but comes with a higher premium.

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Medicare and the Cost of Cancer Treatment

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This article is for both the person facing cancer today, wanting to know what to expect from their Medicare insurance as well as for the person turning 65 and weighing the pros and cons of staying with Original Medicare or moving to Medicare Advantage. Medicare and the cost of cancer treatment is written to help everyone on Medicare.  If you find this article helpful, please share.  We have also included a link to a printer friendly version so that you may save this article for your files.

For those who prefer video:  Medicare & the Cost of Cancer Treatment

I realise the article is a bit long, but the subject matter is critically important.  When first diagnosed with cancer, there is a lot going through your mind. One small part is the question of “What is this going to cost me?”  The battle with cancer can be emotionally draining without worrying or wondering about your health insurance and how it works.  This information on how Medicare handles the cost of cancer treatment is much more difficult to find and piece together than it should be.  I believe the information in this article can be a great relief, benefit, and resource for anyone about to embark on a very tough personal battle.  The information has been compiled from numerous sources including Medicare.gov and the National Cancer Society.

For those new to Medicare, this information will help you decide if you are more comfortable with Original Medicare or Medicare Advantage.  For the person who has cancer or a history of cancer, we hope the information will ease any financial uncertainty of not knowing what part of your treatment may or may not be covered by your current Medicare plan and how much out-of-pocket expense can be expected from you.

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Medicare Part B Explained

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What is Medicare Part B?

In general, your Medicare insurance is divided into three parts; Part A, Part B and Part D.  The simplest descriptions of Medicare refer to Part A as inpatient hospital coverage and Medicare Part B as outpatient coverage.  While technically correct, the details are where many Medicare beneficiaries get caught misunderstanding their coverage, resulting in surprise billings that could have been avoided.  Our recent article on Part A covered what to look out for and expect from that portion of coverage.  We hope to do the same with Medicare Part B in this article so that our readers are forewarned and forearmed.

To understand Medicare it may be best to first look at the contracts between healthcare providers and the Medicare insuranceCenter for Medicare and Medicaid Services (CMS) which is that portion of the Department of Health and Human Services (HHS) that manages Medicare.

All insurance organisations have negotiated rates for medical services.  Medicare has negotiated medical services down to between 15% and 18% of non-negotiated prices.  That means that if there were a medical procedure that would cost $1,000 before negotiation, the Medicare-participating doctor has agreed to accept Medicare’s rate of between $150 and $180 for that service.  More on this later in our next article on the difference between Participating and Nonparticipating providers.

Medicare Part B covers outpatient services, doctor services, lab work, home health care and Wellness care.  In everything it covers, Part B will either pay 80% or 100% of the approved negotiated rate after the annual deductible is paid. The exception to this is Wellness service which is covered 100% and does not require the deductible to be paid.

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Medicare Part A

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With over 70% of seniors in the United States participating, original Medicare remains the top healthcareMedicare Part A Part B program in the country.  Because seniors can choose any doctor that takes Medicare without having to consider networks or referrals, Original Medicare offers seniors more freedom of choice than any alternative Advantage program. In addition, because virtually every medically necessary medical procedure is covered by either Medicare Part A or Medicare Part B, seniors using Original Medicare do not have to worry about their insurance program denying coverage.  As long as you and your doctor believe it is necessary, the odds are your Original Medicare will cover it. In this article, we answer the question; what is Medicare Part A?

Original Medicare has three basic parts; Part A, Part B and Part D.  In general, Part A covers inpatient hospital care, Part B covers outpatient care and Part D covers prescription drugs.  This article focuses on Medicare Part A which seems the simplest, but is in fact the most misunderstood part of Original Medicare.

Medicare Part A covers:

  • inpatient hospital care,
  • skilled nursing,
  • nursing home care,
  • hospice and home health services.

Part A MedicareMost insurance agents simply explain that Medicare Part A is your inpatient hospital coverage and Medicare Part B is outpatient coverage.  While that is technically true, it ignores the potential pitfalls and surprises are in the details of the plans.   Part A operates very differently that Part B.  It’s in these details that Part A is misunderstood and can lead to surprises and significant unexpected health costs for the Medicare beneficiary.

Medicare Part A offers health insurance coverage in time units called “Benefit Periods”.  A benefit period begins the day you are admitted as an inpatient in a hospital.  The benefit period ends when you have not been an inpatient in either a hospital or skilled nursing facility for 60 consecutive days. You can have an unlimited number of benefits periods.  Note: your skilled nursing benefits only take effect after you have a qualifying hospital stay (i.e. an admitted inpatient for 3-days)

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Medicare Supplement Plan N Review

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Whether you are just turning 65 and enrolling in Medicare, or are over 70 and looking to keep your health insurance cost down, seniors in Florida and across the country continue to search for the best value in Medicare Supplement coverage.  Medicare Supplement Plan N should be among the top three Medigap Plans to consider.  This Medicare  Supplement Plan N review explains why.

Watch a 12-minute video on Plan-N now

or continue reading….

In a previous blog we wrote of Medicare Plan F High Deductible as often the best value for seniors in Florida who are in generally good health. While Plan F-HD makes sense for most from a pure numbers perspective, many seniors prefer to have greater coverage, but balk at the high cost of a Plan F or realize that with Plans F and C being discontinued as of 2020, they do not want to be stuck in those specific Medicare Plans when no new younger seniors are allowed entry and the rising medical cost per aging beneficiary push premiums to prohibitive levels.

Enter Plan N, one of the most popular Medicare Supplement plans in the country because it covers all the most significant potential medical expenses, but at a cost much lower than a Plan F.  In fact, the premiums for Plan N are often 30% to 35% less than Plan F.   Plan N is one of the most popular Medicare Supplement plans in the state of Florida, as well as many other states across the country because of the cost to benefit features that make it one of the best values in Medicare Supplement plans.

Here is how to compare a Plan N to other Medicare Supplement Plans —

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Medigap Plan F-HD for Florida Seniors

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Which Medicare Supplement Plan?Whether you are just turning 65 and looking at your Medicare options for the first time, or you have been on Medicare for some time and want to lower your cost while keeping the service and benefits you are used to, seniors in Florida face the same tough decisions as seniors anywhere in this country.  However, the way Medicare Supplement plans are priced, the Medigap Plan F High Deductible makes sense for Florida Seniors.

A survey of insurance professionals in Florida revealed Medigap Plan F-High Deductible (Plan F-HD) as the plan they will or are using for their Medicare.  Shockingly, they admitted to not showing this plan to clients because the commission is too low. And yet, the annual maximum out-of-pocket limit on Medigap Plan F-HD is LESS than the required annual premium of Medigap Plan F or Plan for most Florida seniors.

With a Plan F-HD you can lower your monthly premiums to just $50-$70 and have an annual maximum out-of-pocket limit that is $2,180; less than the annual premium for most Medigap Plan F coverage!

Watch a 10-minute Video on Plan F-HD:  Watch Video Now

or continue reading…


Here is an example to illustrate the value of Plan F-high deductible:

A Medicare Plan F may cost a 65-year old in Florida $2,705 per year in annual premium.  It covers 100% of Medicare expenses not covered by Original Medicare Parts A & B. It has no deductible.

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