FAQs

What is Medicare Advantage...

               and how does it affect me?

·         Medicare Advantage plans offer coverage with little or no monthly premiums.  In some instances the client can actually receive money back every month! 

·      When a client enrolls in a Medicare Advantage plan they are still part of the Medicare Program and retain all of their Medicare rights and protections.

·      When joining a Medicare Advantage plan a client will continue to receive all their regular Medicare-covered services.  With a Medicare Advantage the client will also have access to additional services that neither Medicare Supplements nor Original Medicare can provide. 

·      Medicare Advantage plans can offer prescription drug coverage whereas Medicare Supplements do not. 

·      Medicare Supplement premiums continue to rise while the commissions continue to shrink.  At the same time most Medicare Advantage premiums are at or near $0 and both commissions and renewals continue to grow!

·      With a Medicare Supplement the client must pay to have the privilege to have health care access whether they use it or not!  With a Medicare Advantage plan the client only makes a small co-pay when they use the services.

·      A client can enjoy having the peace of mind knowing that with a Medicare Advantage plan that they are guaranteed that even in a time of poor health they won’t have to pay out more than $3000 in any calendar year.  With a Supplement the client is guaranteed to have to pay out $1500 to $1800 a year before they receive any kind of service. 

·      The days of getting a referral from your primary Doctor to see a specialist have long since passed.  Current Medicare Advantage plans, such as a PFFS, allow the client to go to any doctor, any hospital, anytime and anywhere without referrals!

·      With a Medicare Advantage plan the client only has to answer ONE health question; Do you have End-Stage Renal Disease (Kidney Failure)? 

• Note: We even offer plans for folks that answer "Yes" to this question.

What is the difference between Managed Care and Private Fee For Service (PFFS) plans?

Managed Care

Also referred to as Medicare+Choice, there are several types of Medicare managed care plans. You may be most familiar with Medicare health maintenance organizations (HMOs). In January 2003, a new type of Medicare managed care plan was introduced to the marketplace - a Medicare Preferred Provider Organization (PPO).

Medicare HMOs

Medicare+Choice HMOs must provide all Medicare covered services and may provide benefits not covered by original Medicare. For care to be covered, the participant must receive all of their healthcare either from the HMO or from a provider the HMO refers you to. The only exceptions are an emergency or an urgently needed care situation. Neither Medicare nor the HMO will pay for non-emergency services received from providers outside the HMO.

HMOs with Point of Service (POS) Option

HMOs can offer a Point of Service (POS) option. Under the POS option, beneficiaries can go out of the network to receive services, but normally with higher out-of-pocket co-payment requirements.

Medicare Cost HMOs

Some HMOs have "cost" contracts with Medicare. If a person is in a "cost" plan, they can receive covered services either through or outside the HMO. If the participant goes outside the HMO's network for non-emergency covered services, they will pay the same co-insurance and deductibles as in the original fee-for-service Medicare. If services are received within the HMO network, the beneficiary will only be responsible for applicable co-payments. Most HMOs with cost contracts offer open enrollment throughout the year.

Private Fee For Service

PFFS plans differ from managed care plans, such as Medicare HMOs in several important ways.

• PFFS members may go to any doctor, hospital, or other provider that agrees to accept the private fee-for-service plan´s terms of payment.

• Members don´t have a primary care physician to oversee their care, so they don´t need a referral to go to a specialist.

• Although members must live in the plan´s service area to be eligible, they can receive treatment anywhere in the United States, as long as the provider is willing to treat them.

As with Medicare HMOs, PFFS members must have both Medicare Part A and Part B and not have end-stage renal disease. The PFFS plans contract with Medicare for one year. Each year, the PFFS plan decides whether to stay in or leave Medicare. If the plan leaves Medicare, members must either return to original Medicare or join another Medicare+Choice plan.

How can I help my clients plan for their future?

The savings your clients will realize through enrolling in a Medicare Advantage plan will not only provide some financial 'breathing room", but will also allow them to make better decisions regarding Life insurance spending.

Prior to the modernization of the Medicare program in 2003, many Seniors were financially unable to adequately plan for the high costs of their final expenses.

Now that they are saving substantially on their healthcare costs, take time to help them review their existing Life insurance coverage to ensure it will provide enough funding for funeral and related expenses as well as any legacy gifting. This is the perfect time to present new options for their consideration.

Visit PremierAgentCenter.com for the best in Senior market life products. The logical way for your clients to invest their savings, and plan for the future.