Understanding and Comparing Medicare Part D

On December 8th 2003, as part of Congressional legislation called the Medicare Modernization Act of 2003 or (MMA), Medicare Part D came into being. For the first time in American history seniors could count on Medicare to assist them with their prescription drug costs. Though the MMA has been around for the past five years many of my new clients continue to ask me to explain how their prescription drug benefits work, which I always gladly do.

All the insurance companies offering these plans must adhere to a minimum standard of policy design. From this base plan they all enrich their plans and premiums differently. It is this base policy that I will discuss, so it is important to check your actual policy for the details that apply to you.

There are four phases of coverage:

• Annual Deductible
• Initial coverage
• The Gap
• Catastrophic Coverage

As of 2008, all insurance companies are required to offer a base plan that has a maximum deductible of $275 in addition to their other plans. It is important to remember that deductibles will change over time. When looking at plans it is important to weigh premium cost against benefit. As of right now there are many generous and affordable plans available that do not have any deductible at all. For those on a MAPD: Most Arizona Medicare Advantage plans do not have any deductible at all.

Initially the plan coverage your drug purchases up to $2510. During this period all you are required to do is pay the co-pays as described in your outline of benefits. Though you are only paying co-pays your insurance company is calculating their true cost for each of your medicines. The true cost being calculated is the insurance carriers pre-negotiated discounted retail price. When you have purchased drugs totaling $2510.00 (true cost) your insurance company will notify you that you have reached the Gap.

During the “Gap” your insurance company will continue to extend to you their pre-negotiated discounted price (the true cost) but you will pay that cost with your own funds, no co-pays. Some insurance companies will cover generics in the gap but many do not.

Once you have spent $4050 you have entered into the catastrophic phase. During this period or until the end of the calendar year all you will pay is $2.25 for generics and $5.60 for all other drugs.

These plans are annual renewable contracts. Stand alone plans can be purchased or replaced for 11/15 through 12/31 each year for a start date of January 1 of the New Year. For those on a MAPD you can switch again from 01/01 through 03/31 of each year as well.

Because these are annual renewable contracts the best way to decide which one is the right one for you, is to actually Compare Medicare Part D Plans side by side you could save hundreds by making an informed decision!
Click to compare & save

Understanding Arizona Medicare Supplemental Insurance

Medicare is a federal health insurance program for people 65 years of age or older. It pays for much of a participant’s health care, but not all of it. Some costs not covered are, prescription drugs, deductibles, and the 20% coinsurance. Medicare Supplements and Medicare Advantage plans are health insurance policies sold by private heath insurance companies that are designed to fill in the gaps in Medicare coverage. The key to understanding Arizona Medicare supplement insurance coverage is to realize that there are only two basic choices, select either a Medicare Supplement policy or a Medicare Advantage plan. Both accomplish filling in the gabs differently.

There was a time not too many years ago, when Medicare supplements were the only choice for Medicare recipients. A good Medicare supplement gives a policy holder the most access to health care nationwide. With a Medicare supplement you can go to any doctor or health care facility in the nation that is willing to accept Medicare billing. This is very helpful to snowbirds and those who travel extensively for months at a time. These insurance policies are guaranteed renewable for life. During a Medicare participant’s open enrollment period they can elect to participate in any Medicare Supplement policy with any insurance carrier without having to provide proof of insurability. The open enrollment period is the three months before and the three months after their Medicare Part B start date. After this time period switching carriers often requires proof of insurability. If a Medicare participant elects to go with a Medicare supplement policy they will be required to buy a Medicare Part D policy to cover their prescription drug cost. There are fourteen different standardized Medicare Supplement plans to choose from. Each provider’s plans are identical so unlike the MA plans shopping for these are much easier. Medicare supplement policies all come with a monthly premium. Costs will vary from company to company. However, each company’s plans are all exactly the same. With all that parody in these insurance plans what should a Medicare recipient be looking for?

Seniors should be looking for companies with:

• A track record of verifiable financial stability
• Excellent customer and bill paying services
• A history of consistent premium costs free of huge increases

This important information is not readily available to consumers.

Of the 14 standardized Medicare supplement plans only two should be considered by most Medicare recipients – plan F and plan G. Plan is F is the most popular because it guaranties to cover a person up to the maximum allowed by Medicare for any Medicare approved service. This leaves little to chance and a policy holder will know that they should never receive a bill unless they have had a non-Medicare approved service or procedure. An example would be a face lift. Plan G is a little different in that it will not pay for any excess charges allowed by Medicare. A person with plan G must be vigilant that their providers will accept Medicare assignment. That is why consulting with an independent agent is a good starting point in finding the best Arizona Medicare supplement policy.

Over the past few years Medicare Advantage (also called MA) plans have become very popular in Arizona because the premiums are very low or nothing at all. There are three distinct types of MA plans; HMO, PPO and PFFS. Arizona Medicare Advantage Plans are annually renewable contracts between you and the insurance company. Unlike Medicare Supplements, your enrollment can never be turned down for coverage due to any preexisting health conditions. Many companies that offer these MA plans even have special need plans for those with chronic conditions, to further help them with their medical costs. Another nice feature of the MA plan is that they are available with a prescription drug plan at no additional cost. These types of plans are often referred to as MAPD plans.

Medicare Advantage plans are heavily advertised by the insurance companies during the two open enrollment periods AEP and OEP. AEP is the annual enrolment period currently starting from November 15th and runs through December 31st each year. During this time period Medicare recipients can freely switch from one MA and or PD plan to another with a policy start date of January 1st. OEP is the open enrollment period and runs from January 1st through March 31st of each year. During this time period Medicare recipients can once again change plans and providers with one limitation they can not add a drug plan if they do not already have one.

HMO's are health maintenance organizations. Like many health plans in Arizona you are limited to the contracted health care providers and facilities the company has in their directory. These plans provide for limited or no coverage outside of the company directory unless you have an emergency that requires immediate hospitalization. These types of plans require that you designate a primary care physician or (PCP) who is contracted with the company. They are your single source for health care with a few exceptions, such as urgent care and emergency care. If you need a specialist or surgery they will be the ones to refer you to other providers within the organization. One of the reasons many people who choose this type of plan enjoy it (besides the good service they receive) is the cost. Currently, the monthly premium for an MAPD in Maricopa County Arizona is zero.

PPO's are preferred provider organizations. They are similar to the HMO style plan except that you have the freedom to choose any health care provider, service or facility within the directory without a referral from a PCP. Many insurance companies offer both HMO and PPO style plans to their Medicare Advantage members. Though the freedom of a PPO comes with the extra expense of a monthly premium, it is an excellent choice for those who want the freedom to pick and choose without having to be referred by a PCP. These plans will also save you on your monthly premium compared to a traditional Medicare Supplement. Like the HMO plan Part D is included for no additional expense. The PPO plan is a very good fit for Arizonans who live in multiple covered counties at different times of the year.

PFF's are Private Fee for Service Plans. This type of MA plan has only one major limitation. The provider you use for services must be willing to accept the insurance companies’ payment for services performed. If your provider is willing to accept the terms and conditions of the PFFS insurance carrier you are only responsible to pay the co- pays as described in the plan’s summary of benefits.

In 2005 Medicare Part D was introduced to help Medicare recipients with the cost of their prescription drugs. Like the MA plans Part D is an annually renewable contract and all plans are not created equal. So it is important to have your plan tailored to your prescription needs so that you get the maximum saving on an annual basis.
Medicare is constantly changing from year to year and keeping up with those changes is often a daunting task. I highly recommend the use of an experienced insurance agent when looking to buy or change plans.

As an independent agent I represent my clients so I offer many different Medicare plan options from many different providers. With thorough explanations of your choices, rights and options I allow my clients to choose the one that will best help them meet their individual needs and budget. To contact me you can call me at (602) 502-3113 or go to (AzHealthNow)and fill out a confidential quote form.

The Best Arizona Medicare Supplement Part Two

For many Arizona seniors, the best Arizona Medicare Supplement may not be a Medicare Supplement at all. Many Arizonans are opting for Medicare Advantage plans to help reduce their total health care costs. Even the very best Medicare Supplements come with the added expense of a monthly premium. This cost savings allow Arizona seniors to reallocate those unspent health care dollars on other pressing insurance needs like long term care insurance.

Long term care insurance is the single most pressing insurance need for many Arizona seniors. Sixty nine percent of the people turning 65 will need some kind of long term care in their life time. The average annual long term care premium for individuals under 65 is about $1,337 annually. The very best Arizona Medicare supplements cost about $150 a month or $1800 annually. The concept of cost shifting of premiums from traditional Medicare Supplement policies to long term care insurance policies is a strategy every Arizona senior should start considering.

More and more Arizonans are going the Medicare Advantage route. Some are doing it because that is all they can afford but many are going that way because of the positive word of mouth these plans are receiving from their fellow Arizona seniors. In Maricopa County a Medicare Advantage HMO has a zero monthly premium. That is a huge savings over an Arizona Medicare supplement. Unfortunately, many who should be considering using these health care dollars for Arizona long term insurance are simply saving money on their health premium costs and not considering the hole they have failed to fill in their retirement health care plan.

Everyone should have a family discussion about how they plan to finance and who is going to do what in a probable chronic care situation or long term care illness. Meeting with a licensed independent insurance agent to see what a long term care policy might cost is a good starting place. My clients have all been surprised at how affordable long term care insurance really is.

If you would like to explore your Medicare healthcare options or look into a long term care insurance policy feel free to call me at (602) 502-3113 or follow this link and fill out a confidential quote request form.

Finding Best Medicare Supplements in Arizona

Many Arizona seniors, as they approach their 65th birthday and go on Medicare, are searching for the best Medicare supplement in Arizona. In today’s crowded Arizona Medicare market seniors have many choices. The correct choice will be different for each person, depending upon their health care objectives and economic realities. Looking at the big picture, seniors have two basic options: choose one of 14 standardized Medicare supplement policies or find a good Medicare Advantage plan. Either choice can be sound, depending upon your personal health care tastes. For now let’s look at some important factors to consider when shopping for the best Arizona Medicare supplement.

There was a time not too many years ago when Medicare supplements were the only choice for Medicare recipients. A good Medicare supplement gives a policy holder the most access to health care nationwide. With a Medicare supplement you can go to any doctor or health care facility in the nation that is willing to accept Medicare billing. This is very helpful to snowbirds and those who travel extensively for months at a time.

Unlike some Medicare Advantage Plans, Medicare supplement policies all come with a monthly premium. Many insurance companies offer a teaser premium for the first few years to attract new clients turning 65. Costs will vary from company to company. However, each company’s plans are all exactly the same. With all that parody in these insurance plans what should a Medicare recipient be looking for? Seniors should be looking for companies with:

• A track record of verifiable financial stability
• Excellent customer and bill paying services
• A history of consistent premium costs free of huge increases

This important information is not readily available to consumers. That is why consulting with an independent agent is a good starting point in finding the best Arizona Medicare supplement policy.

Of the 14 standardized Medicare supplement plans only two should be considered by most Medicare recipients – plan F and plan G. Plan is F is the most popular because it guaranties to cover a person up to the maximum allowed by Medicare for any Medicare approved service. This leaves little to chance and a policy holder will know that they should never receive a bill unless they have had a non-Medicare approved service or procedure. An example would be a face lift. Plan G is a little different in that it will not pay for any excess charges allowed by Medicare. A person with plan G must be vigilant that their providers will accept Medicare assignment.

Finding the best Arizona Medicare supplement is as easy as finding a dependable independent insurance agent to get real insight into the insurance companies you are considering. A good independent insurance agent will lay out the facts and enable you to make an educated decision.

If you need some additional information or help with your Medicare decisions feel free to call me at (602) 502-3113 or click here and email me and I will get right back to you.

Arizona Medicare Advantage Plan Simplified

Over the past few years Medicare Advantage (also called MA) plans have become very popular in Arizona because the premiums are very low or nothing at all. There are three distinct types of MA plans; HMO, PPO and PFFS. Arizona Medicare Advantage Plans are annually renewable contracts between you and the insurance company. Unlike Medicare Supplements, your enrollment can never be turned down for coverage due to any preexisting health conditions. Many companies that offer these MA plans even have special need plans for those with chronic conditions, to further help them with their medical costs. Another nice feature of the MA plan is that they are available with a prescription drug plan at no additional cost. These types of plans are often referred to as MAPD plans.

Medicare Advantage plans are heavily advertised by the insurance companies during the two open enrollment periods AEP and OEP. AEP is the annual enrolment period currently starting from November 15th and runs through December 31st each year. During this time period Medicare recipients can freely switch from one MA and or PD plan to another with a policy start date of January 1st. OEP is the open enrollment period and runs from January 1st through March 31st of each year. During this time period Medicare recipients can once again change plans and providers with one limitation they can not add a drug plan if they do not already have one.

HMO's are health maintenance organizations. Like many health plans in Arizona you are limited to the contracted health care providers and facilities the company has in their directory. These plans provide for limited or no coverage outside of the company directory unless you have an emergency that requires immediate hospitalization. These types of plans require that you designate a primary care physician or (PCP) who is contracted with the company. They are your single source for health care with a few exceptions, such as urgent care and emergency care. If you need a specialist or surgery they will be the ones to refer you to other providers within the organization. One of the reasons many people who choose this type of plan enjoy it (besides the good service they receive) is the cost. Currently, the monthly premium for an MAPD in Maricopa County Arizona is zero.

PPO's are preferred provider organizations. They are similar to the HMO style plan except that you have the freedom to choose any health care provider, service or facility within the directory without a referral from a PCP. Many insurance companies offer both HMO and PPO style plans to their Medicare Advantage members. Though the freedom of a PPO comes with the extra expense of a monthly premium, it is an excellent choice for those who want the freedom to pick and choose without having to be referred by a PCP. These plans will also save you on your monthly premium compared to a traditional Medicare Supplement. Like the HMO plan Part D is included for no additional expense. The PPO plan is a very good fit for Arizonans who live in multiple covered counties at different times of the year.

PFF's are Private Fee for Service Plans. This type of MA plan has only one major limitation. The provider you use for services must be willing to accept the insurance companies’ payment for services performed. If your provider is willing to accept the terms and conditions of the PFFS insurance carrier you are only responsible to pay the co- pays as described in the plan’s summary of benefits.

If you’re considering a Medicare Advantage plan it is important to know that they are all not the same. Comparing plans and benefits from two or three different providers is always in your best interest. You should consult with an independent insurance agent so you can choose the plan that fits your needs and your budget.

If you would like some help with your Medicare plan you can call me at (602) 502-3113 or fill out this confidential information form and I will call you.