Medicare Advantage Plan and Medicare Contract

An Advantage plan is a contract Medicare has with a private insurance company to manage its benefits. You don’t pay after Medicare, you pay instead of Medicare. Premiums associated with Medicare Advantage plans are generally lower than premiums; however, when you go to a doctor or hospital, you get paid. There are different types of Advantage plans. There are PPO, HMO, and PFFS (i.e. private service charge) plans. With HMOs, you are restricted to “networked” doctors and will need “referrals” to consult a specialist. When you have a supplement, you can consult any doctor or hospital that accepts Medicare. According to the Medicare employees, the overall average prices charged for prescription drug plans do not determine what an individual beneficiary will eventually pay. Jon Blum, deputy administrator of Medicare, said a general conclusion cannot be reached because each person’s medication needs are individualized. You must consider the specific plan and medications that the individual takes.

The health care review law is helping high-cost drug recipients save money. For those who fall into Medicare’s “overdraft period” coverage gap, beneficiaries can get a 50% discount on branded drugs. Approximately 47 million people with disabilities benefit from Medicare and approximately nine out of 10 beneficiaries have a prescription drug plan. Medicare Part D plans have different coverage levels. The policy which is most common has 5 levels: non-preferred generics, preferred generics, non-preferred brands, preferred brands, and special drugs. Voluntary profit sales should continue to expand and not just for small businesses. Employers continue to reduce worker-sponsored insurance coverage at an alarming rate. Many large companies and corporations have experienced a steady increase in insurance premiums over the past ten years as medical costs have risen. As part of health reform, employers with fifty or more workers will be fined by the government when they do not provide their employees with insurance coverage.

After months of debate, health reform is finally a reality! What does this mean for insurance companies? This is a good thing? Is it a bad thing? Is it a mixed bag? From my perspective, health reform is a big thing. Health care reform focuses on primary health insurance, not life insurance, voluntary benefits, or Medicare supplements. No plan is suitable for everyone. Many people are very happy with Medicare Advantage PPO or HMO policies because they like network providers and health benefits. Others like the flexibility of a Medigap or Any Doc MA plan. A person’s budget will also affect their choice. Medisupps come with a premium, but some MA plans do not have an additional price.