With a Traditional Supplement your patient can choose any doctor or hospital they prefer with no referral for specialists. They will have a monthy premium. Medicare will pay 80% of doctor and hospital costs and the supplement will pay the other 20%. There are no hidden costs, co-pays, pre-approvals or hoops to jump through. In addition to a doctor and hospital Part B Traditional Supplement, your patient will need a stand-alone Part D drug plan to cover prescriptions. These are the only two policies they will need when joining Medicare Part A or Part B.
Traditional Medicare Supplements V.S. Medicare Advantage Plans
At My Part D USA we want to keep you informed about all aspects of Medicare Benefits. The “great controversy” in 2007/2008 for Medicare coverage is the aggressive advertising of the new Medicare Advantage Plans or Private Fee for Service Plans. Many Medicare beneficiaries and POA’s are confused about the differences between Original Medicare with a Traditional Supplement, and Medicare Advantage Plans, and do not know which type of plan would be best for their doctor and hospital coverage. When Trying to save money on premiums, patients or their POA's unknowingly join plans that will not cover their medical expenses.
Please do not confuse Medicare Advantage Plans with Original Medicare Benefits and Medicare Supplements! Medicare Advantage Plans fail to make clear the critical factor that your patient's doctor & hospitals may not be willing to accept the terms and conditions of these Medicare Advantage Plans. Also, unlike Original Medicare combined with a Traditional Supplement, they DO NOT cover durable medical equipment.
IMPORTANT FACT: If your patient has joined a Medicare Advantage Plan and is not happy with it for any reason, they have 12 months to get back on a Traditional Medicare Supplement policy with NO UNDERWRITING, no health questions. They cannot be turned down for coverage with that 12 month period. The Medicare Advantage Plans do not tell you this!
At www.MyPartDusa.org we can consult with your patient to find out how they can get back on a Traditional Supplement. This will insure that your facility does not lose resources and may have to absorb costs that are not necessary!
Since 2006, the state Office of the Insurance commissioner has received over 500 consumer complaints about the Medicare Advantage Plans, sometimes know as Part C. Some consumers said agents misled them or misrepresented themselves as government workers. Others complained about high-pressure sales in homes or group settings or that they were enrolled in plans without their consent. If you think your patient was misled call 800-633-4227 for the Centers for Medicare.
In the summer of 2007, the marketing and sales of Medicare Advantage Plans was suspended due to the many misunderstandings and outright unlawful sales tactics used by companies and salespersons pushing Medicare Advantage Plans over the Traditional Medicare Supplement policies. They have recently been placed back on the market, after Medicare has imposed new language that all companies and salespersons must use when giving their presentations. The new language is as follows:
“A Medicare Advantage Private Fee-For-Service plan works differently than a Traditional Medicare Supplement policy. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies. Doctors, hospital and all providers may make this decision on a patient-by-patient basis.”
This means that a doctor could accept a Medicare Advantage Plan at one visit and refuse it at the net visit if they so choose. If your patient has been going to a doctor they prefer and do not wish to change doctors or hospitals to one that accepts these terms, they will have much more security of coverage with a Traditional Medicare Supplement.
“Medicare Advantage Plans are offered by private insurance companies. Medicare Advantage Plans are NOT the same as Original Medicare that is offered by the Federal Govt. Medicare Advantage Plans do NOT work like a Traditional Medicare Supplement, Medigap, Medicare Select or stand-alone PDP plans. A Medicare Advantage Plan does not pay after Medicare pays its share. CMS/Medicare is not involved in individual transactions.”
In other words, when patients elect to join a Private-Fee-For-Service plan they do not cover the 20% that Medicare does not cover. Even though they will pay the $96.40 per month for Part B Medicare, their coverage is NOT with Medicare, but only by the Medicare Advantage Plan they joined. They must have Part B Medicare to join the Advantage plan. However, Medicare pays the private insurance plan a fixed rate per beneficiary, regardless of how many or how few services the beneficiary actually requires. HELP FOR LOW INCOME: There are government assistance plans available for people who qualify so they don’t have to pay the Medicare Part B fee of $96.40. If their monthly income is below $1,561 (single) and resources are below $4,000 (single) you may qualify. The limits are higher for a married couple. In our evaluation of your patients benefits we will uncover every avenue for savings and do all the required paperwork for submitting applications for “extra help” programs.
With a Medicare Advantage Plan they may have a built in Prescription Drug Plan that must be used. My Part D USA compares that drug plan against other choices for stand alone drug plans. If we find bettter coverage with a stand alone drug plan they may need to reconsider enrolling in that particular Advantage Plan. They may be able to choose the drug plan that is best for them if the Advantage Plan they are considering allows them to have a stand-alone.
The Medicare Advantage Plans can lure them in with either no premium or very low cost premiums. However, a Medicare Advantage Plan can be the only choice for persons on disability and those that cannot afford to pay the premiums on a Traditional Medicare Supplement. The only exception for joining is end stage renal disease.
My Part D USA weighs all these options carefully when prescribing health coverage for each individual. We make sure that they continue to keep coverage that is accepted by their doctors, hospitals or group facility.
At My Part D USA our Senior Consultants are standing by to hep answer these questions for each patient’s individual needs, even though we work with the whole group. We will coordinate benefits with your facility, organize and submit all forms and applications, effectively managing your patients and POA’s communication directly with the Centers for Medicare.
