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Saturday, November 17, 2012

Medicare Open Enrollment Ends Dec 7: Which Plan is Better for You, Original Medicare or Medicare Advantage?

Forbes (10/12, Japsen) reported, HHS Secretary Kathleen Sebelius and CMS officials announced Friday that "Medicare Advantage Plans" are "scoring higher in a government-backed quality rating system designed to guide seniors to better medical care choices and service." For example, seniors "will in 2013 have access to 127 four- or five-star Medicare Advantage plans that provide benefits to 37 percent of the Advantage programs enrollees. This year, seniors had access to 106 four or five star plans, which serve 28 percent of seniors in Advantage plans." CMS' Jonathan Blum said: "We are seeing tremendous quality jumps." 

AHIP Praises Increase In High-Rated Medicare Advantage Plans. Modern Healthcare (10/12, Zigmond, Subscription Publication) in its "Window to Washington" blog reported that "America's Health Insurance Plans on Friday had reason to celebrate after HHS released the 2013 quality ratings for Medicare's health and drug plans." Karen Ignagni, president and CEO at AHIP, said in an email,"Currently, 37% of Medicare Advantage beneficiaries are enrolled in a plan with four or more stars, an increase from 24% in 2011. This increase is indicative of the commitment by Medicare Advantage plans to advance new and innovative strategies to improve healthcare quality and health outcomes." 

Source: ACPE Daily Digest

A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

Find out what factors contribute to how much you pay out-of-pocket when you have a Medicare health plan.

You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.

You can't have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you're in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.
Medigap policies can’t work with Medicare Advantage Plans.

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