Health Care For Senior Citizens – The Medicare Advantage Plan

Senior citizens face the important decision of choosing a healthcare insurance plan as they advance in years. Many are concerned about life after retirement and the increasing costs of healthcare and health maintenance. They are often unsure which plan best suits their needs at the lowest possible cost.

Upon reaching the age of 65, most seniors will become eligible for Medicare Insurance. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). People who become eligible have been paying Medicare taxes while employed for at least 10 years. These people will automatically be enrolled in Original Medicare (Part A and B), covering hospital and medical expenses.But this Plan does not cover everything that might be required. For instance, Original Medicare does not cover costs of prescription medication, making the purchase of an additional insurance on top of Medicare essential.

These additional Plans include Advantage Plans, offering additional benefits such as vision, hearing and medical care; Prescription Drug Plans offering prescription drug coverage; and Medicare Supplement Plans that offer supplementary benefits to Original Medicare.

Choosing among the various Plans can cause a high amount of anxiety among seniors. But the primary concern of choosing a Plan that provides the highest value along with the desired coverage remains important. Thus, researching the various Plans before enrolling in one is definitely beneficial.

Medicare Advantage is offered by private companies in contract with Medicare. This gives Medicare a chance to offer a larger variety of Advantage Plans presenting multiple coverage options and costs. Although this may be welcome news, seniors will still have to sift through a lot of information to understand which Plan suits them best.Unfortunately, there is no escaping that. In fact, the better the research and understanding, the more cost-efficient the choice.

For 2016, Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), HMO Point Of Service (HMOPOS), and Medical Savings Account Plans (MSA). Here is a brief description of each one of them:

• Health Maintenance Organization (HMO): allows beneficiaries to visit any physicians and hospitals in the HMO network.

• Preferred Provider Organizations (PPO): allows beneficiaries to seek treatments from practitioners within the PPO network. Others can be consulted for an additional fee.

• Private Fee for Service (PFFS): allows beneficiaries to use any doctor as long as the practitioner agrees to the terms of the PFFS. The terms can be decided while choosing the Plan.

• Special Needs Plan (SNP): assists people with disabilities, and certain medical conditions for which customized plans are required. This Plan includes Medicare Part D prescription drug coverage.

• HMO Point of Service (HMOPOS): allow beneficiaries to seek care outside of the traditional HMO network under certain situations or for certain treatment. Additional fees for using the POS (out-of-network) options may be applied.

• Medicare Savings Account (MSA): lets beneficiaries escape the cost of the monthly premium after the deductible is met. This is done by maintaining a health care costs savings account for the user.

Going through these options early on, at the time of enrollment, can save some costs and stress. Fortunately, Medicare realizes the complication and offers many tools to make things easier for seniors. Online mediums, support centers and year-around events help seniors understand the various options they have. To get started they advise:

1. Going to the Plan Finder on the Medicare website: https://www.medicare.gov/find-a-plan/questions/home.aspx
2. Going to the Plan’s website and exploring the Plan in detail
3. Contacting the Plan to resolve ambiguities and concerns: https://www.medicare.gov/forms-help-and-resources/contact/contact-medicare.html
4. Contacting a service provider, like e-TeleQuote, for advice on Plans and matching them to specific needs: https://www.etelequote.com/contact-us/

Seniors also have to be careful about when to enroll in Plans. Missing enrollment periods can entail additional costs!

For Original Medicare, if not enrolled automatically, seniors must enroll in the 7-month Initial Enrollment Period during which they become eligible for Medicare. The period starts 3 months before the month in which a senior turns 65, and lasts until 3 months after it. To enroll with Medicare Advantage Plans, enrollment in Original Medicare is mandatory, because Advantage Plans supplement, (not replace) Original Medicare. Following that, seniors can enroll:

• During the Initial Enrollment Period (IEP) for Part B: the 7-month period during which one becomes eligible for Medicare.
• During the Special Enrollment Period (SEP) for Part B, if seniors qualify for it. Beneficiaries can be eligible for SEP if they are still working when they become eligible for Medicare, or if their employer covers them at the time they become eligible. The SEP gives beneficiaries 8 months to enroll in Part B after they lose their employment or employer coverage, whichever comes first. If they qualify for SEP they can enroll in Part C during the 3 months before their Part A and B coverage begins. The time to enroll ends when beneficiaries have both Parts A and B.
• During the General Enrollment Period (GEP). This lasts from January through March every year. If beneficiaries sign up for Part A and/or Part B during this time, coverage would begin on July 1. They can join Part C from April through June of the same year.
• During Fall Open Enrollment Period (FOE) starting from October 15 and lasting until December 7 every year. During this time,beneficiaries can switch Part C Plans, or enroll for the first time. Coverage will begin on January 1 of the following year.

In addition to the above, seniors should explore the additional resources to research Plans for costs and benefits, before enrolling with them. Some of these are:

• The official Social Security details eligibility and benefits of Medicare: www.ssa.gov

• The American Association of Retired Persons provides information on healthcare and insurance plans: http://www.aarp.org

• Medigap provides comprehensive information on the various kinds of Medicare Insurance Plans, and offers advice through free customer support: www.medigap.org

• Center for Medicare Advocacy offers legal assistance, education, and advocacy services to seniors and disabled individuals in need of healthcare: www.medicareadvocacy.org

• Public events by Medicare like information and consultation sessions, extravaganzas, and orientation weeks. Stay up to dates by visiting www.medicare.gov or following them or Twitter: https://twitter.com/MedicareGov?lang=en