There have been rumors that health care reform would cause benefit cuts and/or premium increases for Medicare advantage Plans in 2016. Fortunately, for approximately one third of Californians on Medicare Advantage Plans, this will not happen, many counties will actually have plans that offer smaller deductibles and lower maximum out of pocket (moop) exposure. Open Enrollment begins October 15, 2015 and continues through December 7th for a January 1st 2016 start date. Whether you currently have a Medicare Advantage plan or a Supplement now would be the time to evaluate your carrier and plan options.
A Medicare Advantage Plan is not a Medicare Supplement.
Medicare Advantage Plans, AKA Part “C” are provided by private insurance carriers. Find your Medicare Advantage Plan! Carriers such as Humana, United Health Care through AARP, Anthem Blue Cross, Blue Shield of Ca, Aetna, and Health Net offer both Medicare Supplements and Medicare Advantage Plans. The monthly premium for a Supplement is always going to be more than an Advantage plan, even though they pay a smaller portion of your bills. With a Supplement the carrier pays the 20% not covered by original Medicare, and depending on your plan choice, it may also cover deductibles and excess charges. On the other hand, with an Advantage plan the carrier is responsible for all of your Medicare eligible bills; they are considered the primary payer. Around this time of year when you see commercials or other advertisements mentioning plans with zero premiums, zero primary care physician co-pays, and zero specialist co-pays, they’re referring to a Medicare Advantage Plan. The reason the carrier is able to provide this is because they get money from Medicare to take responsibility for your health care. Most Medicare Advantage Plans also include prescriptions and are called Medicare Advantage Prescription Drug Plans or MAPD. Many people like the convenience of having one card for all of their health care needs and a primary care doctor to help coordinate their healthcare.
Often people choose to stay with their carrier and plan simply because their doctor is a member, not realizing that their doctor may also be contracted with other carriers and plans that offer a smaller out of pocket exposure for them as the patient. Or perhaps they might choose one plan over another because the specialist copay is $5 less; only find that their most expensive prescription is not part of the plans formulary, forcing them to pay for the prescription out of pocket. That is why it’s important to do your due diligence and compare. When is Medicare Open Enrollment? At CAMedicare.com we represent all of the carries mentioned above and can give you a cost free report with objective advice. Call now 800-356-3615