FAQ - Medicare Advantage Plans & Medicare Part D Prescription Drug Plans
1. What are Medicare Advantage Plans? ANSWER: They are Privatized Medicare health insurance Programs funded by Medicare. Medicare pays the private company (usually an insurance company in the case of PFFS plans) a set amount of money each month.
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2. Do Medicare Advantage Plans cover all of the services covered by original Medicare? ANSWER: Yes, some plans even cover additional services. See each plan for details.
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3. How long have Medicare Advantage plans been available? ANSWER: Unicare, Wellpoint Blue Cross Organizations and Humana have been offering Medicare Advantage Plans since about 2003. Most others started in late 2005 and 2006. Coventry and Pyramid Life (in most areas) are new for 2007.
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4. If I join a Medicare Advantage Plan, am I still in the Medicare Program? ANSWER: Yes, refer to page 35 in your 2007 "Medicare and you" book.
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5. Should I enroll in a Medicare Advantage-Prescription Drug Plan covering both Medical and Prescription Drug expenses? ANSWER: Generally, it is best to choose stand alone plans because open enrollment periods are different for Medicare Advantage Plans and Prescription Drug Plans. If you want to change one plan, you will lose the other plan. Choosing a MAPDP plan also limits your choices.
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6. Do I need a Medicare Supplement, or if I have one, can I keep it if I join a Medicare Advantage plan? ANSWER: You can have one, or if you already have one, you can keep it. However, you will have to continue paying your premiums and you may get little or no benefit from it while you are in a Medicare Advantage Plan.
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7. Can I enroll in a Medicare Advantage Plan with one company and a Prescription Drug Plan with a different company? ANSWER: Yes, this would allow you to choose the best plans.
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8. What are some important factors concerning co-pays on Medicare Advantage Plans? ANSWER: Look for co-pays with specified dollar amounts. Some plans have co-pays like 20% for expensive things like helicopter ambulance which often costs $5,000 to $10,000, or radiation and chemotherapy costing $8,000 or more, and outpatient surgery costing $2,000 to more than $10,000.
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9. Is a Medicare Advantage Plan better for me than original Medicare and a Medicare supplement? ANSWER: For most people, Yes. However, if you are using oxygen a Medicare Supplement may be better, especially if you are under 70 years of age and can purchase a supplement for less than $1,500/year. Oxygen is considered durable medical equipment and co-pays are usually 20% to 30% on Medicare Advantage Plans.
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10. Are there different kinds of Medicare Advantage Plans? ANSWER: Yes. There are five kinds of MA plans. Private Fee For Service Plans (PFFS), Medical Savings Accounts (MSA's), Health Maintenance Organization Plans (HMO's), Preferred Provider Organization Plans (PPO's), and Special Needs Plans (for specific groups of people). In most cases only the Private Fee For Service Plans allow you to choose your own doctor and hospital.
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11. Can I change from one Medicare Advantage Plan to another or back to original Medicare? ANSWER: Yes, you can change once each year during the open enrollment period, open enrollment for beneficiaries with both Part A and Part B of medicare, has been extended through 2008. However, if you have a Medicare Supplement that company is only required to re-enroll you during the first twelve months.
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12. When is the open enrollment period for Medicare Part D drug plans? ANSWER: The annual open enrollment period (AEP) is November 15th through December 31st.
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13. Are there any advantages of enrolling in any of the high deductible Medicare Advantage Plans with medical savings accounts that are available in 2007? ANSWER: These plans may be good for people with low claims or for people living in areas where Medicare Supplements are expensive and other plans are not available. Significant amounts of money will be added to your medical savings accounts each year which can be used for most medically related expenses including dental and long-term care insurance premiums.
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14. Am I required to enroll in a Medicare Part D Prescription Drug Plan? ANSWER: This is a voluntary program but it is probably a good idea to enroll when you are first eligible. If you delay enrollment until a later date, you will have to pay a penalty which will be added on to the cost of your PDP plan forever. If you are not enrolled in a plan and suddenly you need an expensive drug, you must wait for the Annual Open Enrollment Period (AEP) before you can enroll. You have three months after your Medicare Part B effective date to enroll without a penalty. If you are not taking any drugs and want to save three months premium, you can use this open enrollment time.
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15. What does it mean when a Medicare Advantage Plan has a negative premium? ANSWER: That amount of money is paid by the insurance company each month toward your Medicare Part B premium. This reduces the amount of money that Medicare deducts from your social security check each month.
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