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Does Advantage Plans of Medicare Help Senior Citizens With Prescriptions?

In spite of the cheering news that next year average premiums for Medicare Advantage will be lowered by 4 percent, there is still cause for concern for beneficiaries of Medicare. In 2012, co-payments for branded drugs will increase, according to a recent Avalere Health study.

Co-pay is a given figure that you may be required to pay for your health insurance plan for a specific medical service or supply. For example, your health insurance policy may require $ 35 for a branded drug or a copayment of $25 for an office visit, after which the insurance firm will pays the remainder of the fees.

Co-payment for preferred branded medicines will increase by up to 40%, while non-preferred branded medicines will increase by 30% on average. With a steady rise in obesity, which is shown to be a precursor to many of these health problems, the value of cancer and critical illness policies will become more evident with each passing year. In addition, people who may choose not to purchase any form of basic or extended complementary health coverage may still be receptive to a cancer or critical illness policy.

What does health reform mean to us? OPPORTUNITY! It then looks brilliant, especially for Medicare’s supplement life, workplace, and sales. But we need more talented agents in the coming months to deal with the growing workload. As a result of the imminent changes in commissions in major medical markets and Medicare Advantage, you will have access to a broader and more well-versed group of agents. Reap the benefits of it. Keep recruiting. Keep training. Make the most of the incredible potential that surrounds you when it comes to people and products!

With a PFFS plan, you can consult any doctor or hospital that accepts Medicare as long as they accept it. They can accept a plan on a case by case basis. Advantage plans are mandatory to cover what Medicare covers, but sometimes they cover things at different rates. Not all Medicare-accepting doctors or hospitals will accept an Advantage Plan, so you should check before signing up to receive something. If you go to a doctor or hospital that does not accept your plan, you will be responsible for the entire bill. Medicare will pay nothing.

The best idea would be to find a professional who specializes in these products and see which plan would be best for your own circumstances. Medicare supplements are also called Medi Gap or Medsups. They cover the “gaps” in coverage that Original Medicare cannot cover. They also come in different levels of A – L, which of course provide different amounts of supplemental coverage. The price also varies.

Guarantee yourself with a Medicare Part D Prescription Drug Plan

Even if you don’t use Medicare part D plans coverage often at first, it will be there when you really need it, and that means guaranteeing yourself.

In addition, all Part D drug plans have a catastrophic coverage phase that limits your annual spending after you disburse a certain amount in a calendar year; because protection is so cost-effective and comprehensive, why risk not signing up?

There are other special enrollment periods available to Medicare beneficiaries, such as when employer-sponsored plans are relocated or left.

Part D drug plan awards are reasonable. Since most states have multiple plans to choose from, routine market economic supply and demand laws keep monthly drug plan premiums at a reasonably low rate. For example, in 2011, we had access to a plan for only $14.80/month.

Generally speaking, a person can enroll in a Prescription Drug Plan during their initial open enrollment period when they first qualify for Medicare Part B. For a person who is 65, that would be the three months prior to month of his birthday, his birthday month and three months after the month of your birthday. After the initial application period (IEP), there is an annual open application period (AEP) when you can change plans. Historically, the annual open enrollment period begins on November 15 and ends on December 31 with effective registrations on January 1.

People on Medicare Part D should also keep in mind that buying drugs, which are not covered by your plan form, at an authorized pharmacy, is a great alternative to paying the price of the local pharmacy. Many people will also benefit greatly from ordering their medications from a pharmacy once they reach the coverage gap, called the “no coverage period”. This coverage gap occurs at the annual expense level of $2250 and beneficiaries are 100% responsible for their costs up to $5100 in drug costs. For a surprisingly large number of people, they can save more by buying all medicines rather than buying them through the Medicare program.

For half a century, Medicare beneficiaries have not had regular prescription retail coverage. As you can imagine, there was a lot of outrage about this, as older people have regular needs for prescription drugs, like everyone else. Finally, in 2003, the Medicare Modernization Act was passed, which created Medicare Part D as a program to give beneficiaries access to co-paid retail drugs if they enrolled in an approved drug plan. Although the program is technically voluntary, there are reasons why beneficiaries should seriously consider enrolling when they are initially eligible for Medicare.

Medicare Advantage Plans can take different forms

 Medicare AdvantageA Medicare Advantage plan can be a health plan, a PPO plan, or a particular service charge or a particular service charge. The HMO Medicare Advantage plan remains a popular option, especially for Medicare beneficiaries who want to pay only as little as possible from their pocket and low or no monthly premiums. However, Medicare HMO benefit plans are only offered in metropolitan areas with a large number of Medicare beneficiaries.

In contrast, a Medicare PFFS or Private Fee for Advantage Service plan allows the Medicare recipient to visit any doctor, any hospital of their choice. Not surprisingly, this type of Medicare benefit plan is enjoying great popularity among Medicare beneficiaries.

Advantage plans are now offered in 98% of the country’s municipalities. This is a long way since 1996, when only 15% of the municipalities offered them. According to the 2007 Medicare Advantage plan statistics, the average citizen pays $736 per month in premiums, although actual monthly payments between states range between $500 and $800 per month.

Holders of Medicare plans that do not have end-stage renal disease or kidney failure may qualify for a Medicare benefit plan, but in some municipalities there are offers especially for people with kidney failure.

In 1965, the government created a social security program called Medicare. This program focuses on the health benefits of its citizens and taxpayers in retirement. To qualify, you must be over 65, have a citizen or have at least one permanent legal residence in the country for 5 years and they or their spouses have been able to pay their taxes or contributions for at least the last ten years. The Medicare program is divided into different plans to help determine the specific program for the beneficiary.

One of the biggest differences between the two types of plans has to do with the freedom to change your coverage. A supplement can be changed at any time of the year. Advantage plans have an annual enrollment period at the end of the current year for coverage beginning January 1 of the following year. If you enroll in a Medicare benefit plan and don’t like it, you only have until February 14 to return to the original Medicare. By February 15, if you have not changed yet, you will be trapped in the plan for the rest of the year.

When choosing between a Medicare supplement and a Medicare Advantage plan, for most people, the deciding factor is usually the cost of the monthly premium. If Advantage Plan has the providers you need and a suitable price for your budget, it may be the right option.

Humana Medicare Advantage plans offered in Las Cruces

Medicare Advantage plansAdvantage plans are extra beneficial plans which are offered by private institutions to the citizens of the United States who are eligible for the Original Medicare. These private organisations are credited and approved by medicare. More and more people are switching to advantage plans, because of the fact that they not only manage your original medicare but also provide extra benefits apart from medicare, at a very affordable cost. Humana Medicare Advantage plans offer an affordable monthly premium and tons of benefits. Many of the Humana Medicare Advantage plans offered in Las Cruces are discussed below.

 

 

 

 

  1. Humana Choice H5216-137 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $0. The annual deductible for the plan is $1000, along with a maximum out of pocket expense of $6700. While visiting your primary doctor you have to pay a copay of $20 for inside the network doctor, and a copay of $50 while visiting a specialist The plan also covers your prescription drugs, with a deductible of $435. The deductible is applicable to preferred brand, non preferred drug, and specialty tier. For generic and brand name you have to pay a coinsurance of 25%. The plan also provides cardiac and pulmonary rehabilitation services, occupational therapy services, as well as speech therapy services. The plan also covers up to 100 days of Skilled Nursing Facility.

 

  1. Humana Choice H5216-077 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $0. The plan has no annual in-network deductible and an out of pocket maximum expense of $4400. You have to pay a $0 copay for visiting your primary health care provider, and a $30 copay for an office visit to a specialist. The plan does not cover your prescription drug needs. The plan also provides extra benefits like home health care services, preventive care services, eye exams, eyewear, contact lenses, eyeglasses, glaucoma screening, routine hearing exams, fitness benefits, Silver sneakers program, outpatient mental health services, transportation services, as well as chiropractic coverage. The plan also provides alternative acupuncture services at a $0 copay, with 25 treatments per year.

 

  1. Humana Honor (PPO)

With an overall rating of 4, the Humana honor plan has a monthly premium of $0. It is a preferred provider organisation plan, which lets you choose a healthcare provider of your choice. In this plan, you don’t even have to get a referral to see any special doctor. The plan has no annual deductible, and an out of pocket maximum of $4400. Under this plan, you also have to pay a $20 copay for visiting your primary doctor, and a $50 copay for visiting a specialist. Humana Honor plan provides added services like dental coverage, oral exams, vision care, hearing services, and transportation services. You are also entitled to fitness, and over the counter benefits. However, the plan does not cover prescription drug services and you have to enrol in a Part D plan separately.

 

  1. Humana Choice H5216-196 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $0. The annual deductible for the plan is $1000, with an out of pocket maximum of $6700. While visiting your primary doctor who has to pay a copay of $0, and for a specialist a copay of $45. The plan covers prescription drug services as well, with a deductible of $195. The deductible is applicable to the non-preferred drug and specialty tier. For generic as well as brand name drugs you have to pay a 25% coinsurance. For the urgently needed services, you have to pay a maximum copay of $65. The plan also covers outpatient mental health, at $20 copay.

 

  1. Humana Value Plus H5216-199 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $16.80. This plan charges the medicare defined annual deductible amount of part B of your medicare. It also has a maximum out of pocket expense of $6700. Along with providing prescription drug coverage, it also covers in-hospital care for both acute as well as psychiatric services. The deductible for prescription drugs is $435, which is applicable to generic, preferred brand, non-preferred drugs, and specialty tier. You have to pay a 25% coinsurance for generic or brand name drugs. It also covers home health services and preventive care at a $0 copay. The plan has a network of nurses, pharmacies, doctors. Using the in-network services you would pay much less for the covered services. It also covers your transportation costs thus saving your out of pocket expense.

 

  1. Humana Gold Choice H8145-123 (PFFS)

With an overall rating of 3.4, the plan is offered at a monthly premium of $127. The plan has no annual deductible and an out of pocket maximum of $6700. While visiting your primary doctor you have to pay a copay of $15 and for a specialist, you have to pay a copay of $50. The plan includes prescription drug services as well with a deductible amount of $300. The deductible amount is applicable to preferred brand, non-preferred drug, and specialty tier. For generic as well as brand name drugs you have to pay a 25% coinsurance. The plan covers outpatient surgery and rehabilitation services. Along with this, the plan provides medicare approved dental services, eye exams, eyewear, glaucoma screening, hearing exams, over the counter benefits, as well as enrollment in the SilverSneakers program.