The Annual Enrollment Period is quickly approaching and starting October 15, you will be able to switch Medicare Plans. Which do you favor in the battle of Medicare vs Medicare Advantage? If you’re not quite sure, we’re here to help! By understanding the basic principles of each, you will be better prepared to make that decision.
What is Medicare?
Medicare is operated under the federal government and covers a variety of health care expenses and provides benefits for seniors over 65 as well as those with Social Security benefits or certain health conditions. There are many parts, policies, and new standards associated with Medicare. We get it – it’s confusing! It’s important to understand the history of Medicare Part A B C D, because AEP is right around the corner!
Created in 1965, Original Medicare is a federally-regulated healthcare program designed largely for senior citizens. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage).
Part A covers inpatient and outpatient care at hospitals, nursing homes, hospice care, and home health services. Part B covers doctor visits and ambulance rides. Most beneficiaries receive Part A for free. Most people pay the same rate for Part B coverage, but a small number of beneficiaries may have income-adjusted premiums.
Original Medicare allows beneficiaries to go to any provider that accepts Medicare, which is over 900,000 physicians nationwide! This means that no matter which Medicare provider you visit, the costs will stay the same. This is ideal for beneficiaries who travel often or want doctors in different locations.
If you are enrolled in Original Medicare, you are able to enroll in a Medigap plan. Medigap plans provide financial benefits for an extra monthly premium. This can include help paying your copayments, coinsurance, and deductibles. Additionally, some of these Medigap plans cover prescription drugs. However, if your plan does cover prescription drugs, you cannot purchase a separate drug plan.
Time to get the coverage you need with Medicare!
History of Medicare
National health coverage wasn’t even discussed until President Roosevelt in 1912. He ran on a platform that included providing health coverage to anyone who needed it. Flash forward to 1945 when President Truman took office. Within seven months, he called for a national health fund that would be available to all Americans.
Truman fought hard, but it took another 25 years before anything went into effect. In 1965, Lyndon B Johnson signed legislation that provided benefits for seniors over 65. As of 2018, the Centers for Medicare and Medicaid Services (CMS) estimate that over 58.5 million people benefit from Medicare. As more policies and new standards go into effect and technology creates healthcare innovations in this industry, Medicare will continue to evolve.
Medicare Part A B C D
Medicare is broken into specific parts and each part is unique. Original Medicare consists of Parts A and B. Part A covers inpatient hospital fees, hospice care, and home health services. Part B covers doctor services, outpatient care, and physical therapy.
Most beneficiaries receive Part A for free and Part B is covered by a monthly Medicare premium. Beyond Original Medicare, there are Parts C and D. Part C is Medicare Advantage (MA).
MA plans combine Part A (hospital fees insurance) and Part B (medical insurance) and usually prescription drug coverage. Part D is a standalone plan that is purchased separately on top of Original Medicare. It can help cover the cost of prescription drugs.
What is Medigap?
If you are enrolled in Original Medicare, you are eligible to purchase a Medigap plan. What is Medigap? Medigap plans help pay some of the cost that Original Medicare does not cover. This can include copayments, coinsurance, and deductibles. Medigap plans generally don’t cover vision or dental care but may include prescription drug coverage. They are sold by private insurance companies. You cannot be enrolled in a Medicare Advantage plan and Medigap, so it’s important to compare and evaluate your budget and needs.
Pros and Cons of Medicare
Some people love Medicare, and others don’t care for it.
Why Medicare is Awesome
Premiums: If you worked for most of your life, you won’t have to pay any premium for Medicare Part A!
Healthcare Innovation: Medicare has increased healthcare innovations in the medical market tremendously. Thanks to Medicare, millions of Americans suddenly have access to health coverage they otherwise would be unable to afford. Millions of dollars have been invested in healthcare innovation and development!
Medicare “Rules:” CMS has steady Medicare rules that help prevent fraud, waste, and abuse. Without breaking the Medicare Rules, Medicare agents and plans can’t take advantage of you!
Why Some People Dislike Medicare
Hospital Fees: Even with the help of Medicare, hospital fees can still cost a pretty penny. Medicare beneficiaries typically pay 20% of the total fee. Additionally, Medicare typically does not have a cap. This means that if you have a series of health issues within a year, you may be spending more than you originally budgeted.
Prescription Drug Coverage: Medicare does not cover prescription drugs. If you are looking to purchase drug coverage, you will need to purchase separate prescription drug coverage through Medicare Advantage or Part D.
Limitations: Original Medicare provides the same health coverage for everyone. There is no personalization or choosing the exact benefits you want, unless you enroll in Medicare Advantage. If you are seeking more than basic health coverage, an MA plan could be perfect for you.
Enrolling in Medicare Advantage
What is Medicare Advantage?
The history of MA plans is relatively short compared to Original Medicare. Just like Medicare, MA plans have benefits for seniors over 65 and certain disabled persons. These plans are rising in popularity and may be the best option for you!
Medicare Advantage plans can allow you to have a monthly premium for all your additional benefits, like dental, vision, and prescription drugs. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors and other Medicare eligibles. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.
The History of the Medicare Advantage Program
Medicare Advantage plans were not offered until 2003. Since then, enrollment has tripled to 19 million beneficiaries according to the Henry J Kaiser Family Foundation. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even SilverSneakers®. These plans have a set network of providers you must choose from, but don’t worry! There are many different networks and plans available.
Medicare Advantage (Part C) Popularity
According to the Henry J Kaiser Family Foundation, enrollment has tripled to 19 million beneficiaries since 2003. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even fitness programs like SilverSneakers®. These plans have a set network of Medicare providers you must choose from, but don’t worry! There are many different networks and plans available.
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular plans among Medicare Advantage.
HMOs:
An HMO, or Health Maintenance Organization, has a closed provider network. You’ll have to select one primary provider for most of your healthcare needs. HMOs may require you to get a referral for more severe injuries or illnesses.
PPOs:
PPOs, or Preferred Provider Organizations, allow you to see any doctor, but staying in your network you will save you money. Additionally, they don’t require referrals and like HMOs, they often cover Part D supplements.
Medicare Advantage plans have one monthly premium. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.
Pros and Cons of Medicare Advantage
Why Medicare Advantage Plans are Awesome
Premiums:KFF reported that half of Medicare Advantage beneficiaries in 2019 pay no premium at all, and most others pay between $20 and $100.
Out-of-pocket Max: Although you pay a premium with both Original Medicare and Medicare Advantage, MA plans may offer a lower deductible in exchange for a higher monthly premium. Also, MA plans have a limit for your out-of-pocket costs, saving you even more in the long run!
Prescription Drugs: Prescription drug coverage is often included in Medicare Advantage plans. This allows you to bundle your health coverage – saving you money and creating more convenience for you!
Unexpected Benefits: Some Medicare Advantage plans even include cool benefits like gym memberships!
Flexibility: There is a broad range of Medicare Advantage plans out there, so you may be able to choose between a few options to get the one that’s right for you.
Why Some People Don’t Like Medicare Advantage Plans
Limited Networks: There is usually no nationwide coverage with Medicare Advantage plans. This can be an issue if you frequently travel within the US. Additionally, your network may require that you only see specialists that your doctor refers you to.
Price Fluctuation: The specifics of your Medicare Advantage plan varies per provider. You may still be required to pay copays and coinsurance fees. Additionally, your Medicare premiums and copayments may change each year.
Medicare Doctor
Medicare Advantage vs. Medigap
When comparing Medicare Advantage vs Medigap, it’s easy to get confused. Medigap can only be purchased alongside Original Medicare. You cannot have a Medicare Advantage and Medigap plan at the same time. Medigap plans cost an additional monthly Medicare premium, but they help fill the cost gaps in coverage – this means less out of pocket costs for you.
Medicare Advantage vs Medigap prices can vary. If this is something you’re interested in, it’s important to compare policies.
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Difference Between Medicare and Medicare Advantage
What is the difference between Medicare and Medicare Advantage? It is easy to confuse the two. The main difference is that while Original Medicare is the federal program, Medicare Advantage plans are privately owned. Medicare Advantage plans still have to follow all the rules determined by CMS (Centers for Medicare and Medicaid Services), but they are able to offer benefits that the federal program cannot. med
How to get Medicare Advantage
Does a Medicare Advantage plan look attractive to you? Did we grab your attention? AEP is coming soon!
From October 15 to December 7, anyone with Medicare can make changes to their plans. If you’re interested in purchasing a Medicare Advantage plan or hearing more about how to get covered, complete this form or call us at 844-431-1832 to arrange a free, no-obligation appointment with an agent and get covered today.
*This blog was originally published on September 20, 2018, and updated on July 28, 2019.
OTC Medicare Drug Coverage
According to the Consumer Healthcare Products Association, the average American makes 26 trips per year to buy over-the-counter (OTC) products. As you age, this number may increase. This means you may be spending more on these products each year.
Every penny counts and understanding the products, drugs, and the role of a Medicare Advantage OTC pre-paid card can help you save in the long run.
Contact Us | Medicare Plan Finder
What Are Over-the-Counter Medications?
These medications don’t require a doctor’s prescription to be purchased. They can help ease pains such as backaches, help prevent or treat illnesses such as athlete’s foot and allergic reactions, and help manage recurring issues such as migraines.
The most common over the counter medications are fever reducers, anti-inflammatories, allergy pills, and cold medicine.
OTC Medicare | Medicare Plan Finder
Does Medicare Cover Over-the-Counter Drugs?
Original Medicare (Part A and Part B) does not cover over-the-counter products and medications. Some stand-alone Part D plans may cover the costs, but generally, a Medicare Advantage plan is your best option if this type of drug coverage is important to you.
Your Medicare Advantage plan provider should give clear instructions on how to utilize your allowance towards medications and products.
Oftentimes, your insurance carrier will provide a website or downloadable document that lists the eligible products/medications, instructions to purchase, and the details of the benefit. If you have any issues, feel free to contact a licensed agent here.
Medicare Advantage | Medicare Plan Finder
What Is Medicare Advantage OTC Card Coverage?
Certain Medicare Advantage plans offer beneficiaries a unique way to buy over the counter products: a pre-paid card! These cards can be used to purchase most OTC products and medications.
Once you exceed your allowance (average of $50-$100/month for most providers), the card is no longer valid until it is reloaded by your insurance provider. Most plans reload the cards to the set amount on a monthly basis and any previous balance will be lost.
What Can I Buy With My OTC Card?
Before you ask yourself, “What can I buy with my OTC card,” you should first look at your plan’s OTC catalog. Eligible products and medications may vary through your plan provider, but common eligible items include:
Acne aids
Cough, cold, and flu medications
Antibiotic creams
Bandages
Denture products
Digestive aids
Ear care
First-aid kits
Orthopedic support
Pain relievers
Sleep aids
Wart removal
Generally, these items are not covered:
Chapstick
Deodorant
Dietary supplements
Mouthwash
Perfume
Soaps
Teeth whitening products
OTC Medicare | Medicare Plan Finder
Where Can I Use My Medicare Advantage OTC Card?
Stores and locations that accept your card will vary by provider. However, the following stores are included in most plans:
Along with an extensive inventory of over-the-counter products in the stores, many of the major pharmacies listed above also have a mail-order feature so you can have many of your favorite OTC and even prescription items shipped straight to your door! You may be able to use your OTC card at the following online pharmacies*:
*This is not an exhaustive list of online pharmacies.
Medicare OTC Card Activation
Your card should come with information about how to activate it. If you’re unsure how to activate your card, contact your plan’s customer service center and ask about OTC card activation.
How to Check Your OTC Card Balance
For information about how to check your OTC card balance, go to the website your plan gave you. If you’re not sure how to access it, call your plan’s customer service center for help.
How Do I Save on My Prescriptions?
While a Medicare Advantage OTC benefit can certainly be a great perk to have, you’re probably still wondering how you can cut down on your prescription costs.
You may want to start by finding out if you’re eligible for “Extra Help,” a Medicare savings program for prescription drugs. Then, look at your current coverage and make sure you have the right plans for your needs. A licensed agent can help you.
Then, download our free prescription drug savings card. It works in many major pharmacies and is sort of like a coupon. Just show the card when you pick up your prescriptions, and your pharmacist can tell you whether or not your prescriptions can be cheaper with the card. It’s worth a try!
How Do I Get Medicare Advantage OTC Coverage and Prescription Drug Coverage?
Are you interested in getting OTC Medicare coverage? Our licensed agents are contracted with most major carriers in your state. There are countless plans that can fit your personal needs and budget all while having the additional benefit of over-the-counter drug coverage.
Already enrolled in a Medicare Advantage plan? You may unknowingly have this benefit already, and we want to help you use it. Call us today at 844-431-1832 or fill out this form to get started.
Find Medicare Plans | Medicare Plan Finder
This post was originally published on January 17, 2019, by Kelsey Davis and updated on July 15, 2019, by Troy Frink, and November 12, 2020, by Anastasia Iliou.
Does Medicare Cover Urgent Care?
More than 89 million patients visit an urgent care facility each year. In fact, the number of facilities nationwide has increased from 6,400 to 8,100 since 2014 with roughly 600 more expected to open in 2019. Urgent care is a cost-effective way to get the care you need. If you’re wondering if Medicare covers urgent care, look no further, Medicare Plan Finder makes understanding your coverage easy.
Urgent Care Services Covered by Medicare
Urgent care is typically covered by Medicare Part B. It’s important to note that urgent care centers are not required to accept Medicare. While it’s rare for a facility to deny Medicare, it’s ultimately up to the centers and doctors. Part B covers lab tests, x-rays, emergency transportation, durable medical equipment, mental health, and partial outpatient hospitalization. Urgent care centers provide several services that fall under Part B including illness treatment, minor injury care, x-rays, lab tests, annual exams, and immunizations.
Does Medicare Part B pay for Urgent Care?
Yes, Medicare Part B would cover your urgent care costs if certain conditions apply:
You are already enrolled in Medicare Part B
Your Part B deductible ($185 in 2019) is met
You visit an urgent care facility that participates in Medicare
What is the Medicare Copay for Urgent Care?
Typically, after your deductible is met, Medicare Part B will cover 80% of your costs. You will be responsible for a 20% copay. This may be different if you are enrolled in some sort of savings program or plan that covers Part B copayments (like certain Medicare Supplement plans).
Without insurance, urgent care visits can cost over $100. Imagine having to pay only $20 instead of $100!
What Does Medicare pay for Emergency Room Visits?
Medicare will typically pay up 80% of most services, including emergency room visits. That means that you will likely owe 20% of your emergency room bill. This again can differ if you have a certain Medicare Supplement plan or are part of a savings program that covers your copayments and coinsurance.
It’s important to know where the closest urgent care facility that accepts Medicare is. Don’t abuse your local emergency room. Go to an urgent care facility if you are feeling sick and can’t get a doctor’s appointment.
Click on your city below to see urgent care facilities in your area that accept Medicare (we’re adding more cities weekly). If your city is not yet listed, visit medicare.gov to search for facilities near you that accept Medicare.
How Much Does Medicare Pay for Urgent Care Visits?
Urgent care visits cost less than the emergency room, but can still cost $100 on average before insurance. Since urgent care centers cover a wide array of illnesses and injuries, it’s hard to estimate how much your visit will be. However, Medicare will cover 80% of your costs in urgent care. You will be responsible for the remaining 20% and up to $20 copay unless you are enrolled in a Medicare Supplement plan.
Medicare Supplements and Urgent Care
Medicare Supplement (Medigap) plans are financial benefits that can work alongside Original Medicare. They help to cover costs that Original Medicare does not including deductibles, copays, and coinsurance. There are ten plans available (A, B, C, D, F, G, K, L, M, and N), and each letter represents different coverage at a different price point. Medigap plans can help pay for the remaining 20% of your urgent care costs. For example, if you visit an urgent care facility, and had not met your deductible yet, and were billed with a $20 copayment and 20% coinsurance, Medicare Supplements could help with those costs. Depending on which plan you enroll with, you could pay as low as nothing out of pocket.
Medicare Advantage and Urgent Care
Medicare Advantage plans (MA) are required to provide, at a minimum, the same coverage as Original Medicare. This means that urgent care is still covered. However, MA plans offer several benefits that Original Medicare does not including dental, vision, or hearing coverage, and even group fitness classes like SilverSneakers®. It’s important to keep in mind that Medicare Advantage plans have networks so you will need to make sure the urgent care facilities you visit are covered. At Medicare Plan Finder, our licensed agents can help you enroll in a plan that offers the additional benefits you want with the network you need. Why wait? FIll out this form or give us a call at 844-431-1832. Appointments are no cost to you and there’s never an obligation to enroll.
Urgent Care vs. Emergency Room
Urgent care centers and emergency rooms both address your issues quickly and provide same-day relief. They are both covered under Medicare, but trips to the emergency room can leave you with higher out-of-pocket costs and can take longer to get the medical attention you need. It’s important to understand the difference between these facilities so you better understand where to go in the future.
Urgent care centers are intended for injuries or illnesses that are not life-threatening and cannot wait to be treated by your primary care physician. This includes injuries or illnesses like:
Allergic reactions
Muscle sprains
Rashes, cuts, or scrapes
Swelling or irritation
Mild fever
Cold or allergies
Nausea, vomiting or diarrhea
Sore throat
Flu
Emergency rooms are for serious or life-threatening injuries and illnesses that need immediate attention. This includes injuries or illnesses like:
Heart attack
Stroke
Chest pain
Coughing up blood
High fever
Loss of consciousness
Severe wound
Major fracture
Serious burn
Enroll Today
If you’re interested in enrolling in a Medicare Advantage or Medicare Supplement plan, fill out this form or give us a call at 844-431-1832. Our agents are happy to answer any questions regarding plans in your area, eligibility requirements, coverage, costs, and so much more.
Essential Medicare Benefits for All Medicare Plans
Prior to 1965 when Medicare was created, people over the age of 65 found it almost impossible to be covered by private health insurance companies after retirement. Original Medicare is the program the government created to cover essential medical needs like hospital stays and doctor visits. There are two parts: A and B.
The term Medicare has expanded since the 1960s to include other important services and programs in order to help people be as healthy as possible. Now, private health insurance companies can sell “Medicare Advantage” plans, often known as Part C. “Extra” Services such as vision insurance, hearing coverage and physical fitness programs typically fall under Part C.
Does Medicare Count for Minimum Essential Benefits?
The Affordable Care Act originally required that everyone have a health plan with the minimum essential benefits, which included:
Ambulatory outpatient services
Emergency services
Hospitalization
Pregnancy/maternity/newborn care
Mental health and substance abuse services
Prescription drugs
Rehabilitative services/devices
Lab services
Preventive/wellness services
Pediatrics (including dental and vision for kids)
If you had Medicare, you would have met the minimum essential benefits requirement. The federal government dropped the requirement that you have a minimum coverage level under the Affordable Care Act (also known as ACA or Obamacare) in 2019. However, certain states still impose penalties.
You meet minimum coverage requirements if you have coverage under Part A, Parts A and B together, or a Medicare Advantage plan (Part C). If you’re covered by any one of those plans, you will not have to pay the penalty for not having health insurance. If you were only enrolled in Part B, you would not meet the government-mandated minimum requirements.
When people talk about Medicare benefits, they are referring to Original Medicare plans. However, specific plans cover different things, and not all plans have the same coverage. Here’s what Original Medicare plans cover:
Preventive care
Annual wellness appointments
Doctor visits
Telehealth
Mental health
Ambulance transportation
Home health (limited)
Original Medicare plans do not cover prescription drugs – except in limited cases, such as for oral cancer medications. Most prescription drugs require a Medicare Part D coverage or certain Medicare Advantage plans.
Difference Between Part A and Part B
Medicare Parts A and B fall under Original Medicare. Part A is Medicare hospital insurance, and it covers hospital visits and stays. It does not cover ambulance transportation. (That’s included in Part B.) Part B covers doctor’s appointments, telehealth, mental health, preventive care, annual wellness visits, ambulance transportation, and limited home health.
Medicare Health Benefits
If you need more coverage than what Part A and Part B provide, you’ll want to look towards a Medicare Supplement plan or Medicare Part C. Part C plans can include:
Dental
Vision
Hearing
Fitness classes and gym memberships
Non-emergency transportation, such as trips to the doctor’s office
Meal delivery
And more!
Many people will find that Original Medicare benefits cover most of their needs as they age, but it’s important to consider the quality of life that can be obtained when you have access to a gym or have taxi fare to get to the doctor. We can’t think of anything more important than your health and well-being, and a Part C plan can provide the additional benefits you need to be healthy and happy.
Meeting with a licensed agent for Medicare
Medicare Advantage
While you aren’t required to enroll in Medicare Part C, it is a valuable asset for most people. Medicare Parts A and B cover only the most basic needs for health care. There are thousands of Medicare Advantage plans to choose from, and a qualified professional can help you sort through them and find one that suits your needs.
Medicare Advantage plans are private health insurance plans that cover every service Original Medicare covers. Advantage plans are often used along with government-run plans to ensure the patient has coverage for what he or she needs, which can include dental, vision, and even meal delivery.
Medigap
Medigap policies cannot be used in conjunction with Medicare Advantage. Medicare supplements pick up where Original Medicare falls off. Medigap plans can help with coinsurance, co-payments, and deductibles. These plans are strictly for financial coverage, and not health coverage.
How to Get More Benefits
If you need coverage for things that don’t fall under the Original Medicare umbrella, you need to know a few things before you enroll. Medicare Advantage (Part C) and Medicare Supplements (also called Medigap) can serve different needs, and either can be beneficial depending on your circumstances.
The Initial Enrollment Period (IEP) consists of the six months surrounding your 65th birthday and your birthday month. This is important to know because you must select a policy in that timeframe in order to be covered. If you do not enroll in Medicare Advantage during that time, the only other time you can do that is during the Annual Enrollment Period (AEP), which is every year from October 15 through December 7.
While most people who wish to make changes to their health insurance or get new coverage must enroll during the AEP, the Special Enrollment Period (SEP) allows people – even those younger than 65 – to enroll if they are diagnosed with specific, chronic health conditions. If you qualify for the SEP, you can add or change coverage once per quarter during the first three quarters of the year. Some people may have limited special enrollment periods that surround qualifying events. For example, if you move to a new service area where different plans are available, you may be granted a temporary (typically 60 day) special enrollment period.
Get Essential Medicare Health Benefits
A comprehensive Medicare plan can help you live your best life. If you’re ready to enroll in Medicare benefits and need assistance in selecting the right plan for you, we can help you find a plan that fits your budget and lifestyle. Call us at 844-431-1832 or contact us here today.
A Guide to 5 Star Medicare Plans
There are 2,734 Medicare Advantage (MA) plans on the market nationwide in 2019. This is an increase of 417 plans since 2018! Based on location and eligibility, the average enrollee has 24 plan options, but only 10 percent of beneficiaries are enrolled in 5 star Medicare plans. These star ratings can help you understand the quality of services and care within the plan.
What is a Medicare 5 star rating?
Doctor and Patient | Medicare Plan Finder
Medicare has four main parts (A, B, C, and D), but not every part is rated. The Centers for Medicare and Medicaid Services (CMS) uses a rating system to rate Medicare Advantage and Part D plans. The rating system is as follows:
Five stars: Excellent
Four stars: Above average
Three stars: Average
Two stars: Below Average
One star: Poor
Medicare Advantage and Part D may have the same star system, but they have different factors that are weighted in the rating process. This is because they have primarily different purposes.
MA plans can provide additional benefits beyond Original Medicare like hearing, vision, or dental coverage. On the other hand, Part D plans provide prescription drug coverage.
Medicare Advantage plans are rated on the following factors:
Level of access to preventive services (including annual physical exams and screenings)
Care coordination
How often members receive treatment for long-term conditions
Current member satisfaction
Plan performance in comparison to the previous year
Customer service quality
Part D plans are rated on the following:
Number of member issues with the plan
How many people left over one year
Patient safety while using prescriptions in the plan
Accuracy of pricing
Quality of care
Customer service quality
Part D Checklist | Medicare Plan Finder
What is a 5 star Medicare plan?
A 5 star plan is a plan with a 5 star rating! Rating information is released annually in October. You can review the ratings and compare plans here.
If a plan receives a rating below three stars for three consecutive years, it will be flagged by CMS. If the plan continues to rate poorly, it may be removed entirely from the marketplace.
This ensures that you are given the best plan options when you are enrolling. In 2019, most beneficiaries can enroll in a Medicare Advantage or Part D plan with four or more stars.
HMO: With a HMO, you will need to select a primary care provider (PCP). Your PCP will need to make a referral in order for you to see a specialist.
PPO: You will not need to select a PCP with a PPO, nor do you need a referral to see a specialist in most cases.
The key difference that may help many people choose an option is cost. HMOs typically have lower monthly premiums than PPOs.
A licensed agent with Medicare Plan Finder can help you determine which type of plan is best for you. Our agents are highly trained and they can discuss the benefits of the plans in your area so you can make an informed decision.
Medicare Advantage | Medicare Plan Finder
5 Star Medicare Advantage and Part D Plan Carriers
5 Star Medicare Advantage plan (and Part D plan) carriers include:
Anthem
Cigna
Humana
Please note, ratings change annually, and each specific plan can have a different rating. We can not guarantee placement in a top-rated Medicare plan and this list is subject to change.
When can you enroll in a 5 star plan?
Several enrollment periods allow you to enroll in a Medicare Advantage plan, but did you know there is an enrollment period specific for 5 star plans?
5 Star Medicare Plans Special Enrollment
If you do not currently have top-rated Medicare Advantage plans available in your zip code, and a new plan becomes available, you can switch from your current plan to a 5 star plan even if it is not the Annual Enrollment Period. This means that you have a Special Enrollment Period. This enrollment period lasts from December 8 to November 20 of the following year. During this time you can:
Switch from Original Medicare to a 5 star plan
Change from a lower-rated plan to a 5 star plan
Switch between different 5 star plans
How to Find5 Star Medicare Advantage Plans Near You
Are you looking for top-rated Medicare plans near you? Our licensed agents can answer any questions about how to enroll, when you can switch, and plans that are available to you.
Interested in arranging an appointment? There is no cost to you and never an obligation to enroll. Fill out this form or call us at 844-431-1832.
Contact Us | Medicare Plan Finder
Medicare Advantage Supplemental Benefits
Did you know Medicare Advantage plans have tripled in enrollment since 2003? This means more than one-third of beneficiaries are enrolled in an MA plan in 2019! The increase in enrollment has lead to new benefits like telehealth, non-emergency transportation, and gym memberships like SilverSneakers®. Research shows that the top three Medicare Advantage supplemental benefits that cause beneficiaries to switch to an MA plan are vision coverage, OTC allowances, and healthy behavior rewards.
Medicare Vision Coverage
Nearly 90% of people over the age of 65 wear glasses. Plus, one in three older adults suffers from some form of vision-reducting eye disease like glaucoma, macular degeneration, cataracts, or diabetic retinopathy. Fortunately, Medicare Advantage plans may include vision coverage and help you cut back on out-of-pocket costs.
What eye care does Medicare cover?
Generally, Medicare does not cover eye exams or glasses. This means that if you are only enrolled in Original Medicare (Part A and B) you will have to pay 100% of your costs, including the fees to have your frames fitted. However, if you had cataract surgery to insert an intraocular lens, Medicare Part B may pay for corrective lenses. This can include a pair of glasses or contacts, but you must get them through a Medicare supplier.
Medicare will cover the corrective lenses even if you had the cataract surgery before enrolling in Medicare. Plus, both lenses may be covered if you only had cataract surgery on one eye. If your situation applies, you will pay 20% of the Medicare-approved costs after reaching your Part B deductible. If you want upgraded frames, you will be required to cover the additional cost.
Are you looking for more coverage? Medicare Advantage plans can add additional benefits like routine eye checkups, eye exams, glasses, and contacts. To learn more about how to get vision coverage through a Medicare Advantage plan, click here.
The average American makes 26 trips per year to buy over-the-counter (OTC) products. What if we told you that some of the expenses from these trips could be covered? Well, great news! Some Medicare Advantage plans offer a monthly OTC pharmacy allowance.
What is a Medicare Advantage OTC card?
A Medicare Advantage OTC card can be used to purchase most OTC products and medications. The average allowance is $50-$100/month for most providers. Once you exceed this balance, your card is no longer valid until it is reloaded the next month. If you do not spend the monthly balance in its entirety, you may lose any remaining allowance.
Eligible products and medications may vary through your plan provider, but common eligible items include acne aids, cough, cold, and flu medications, antibiotic creams, denture products, bandages, digestive aids, ear care, first-aid kits, orthopedic support, sleep aids, and wart removal. However, chapstick, soaps, deodorant, dietary supplements, mouthwash, perfume, and teeth whitening products are generally not covered.
To learn more about how to get OTC pharmacy allowance through a Medicare Advantage plan, click here.
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Healthy Behavior Rewards
Original Medicare does not incentivize healthy behavior, but some Medicare Advantage plans will! Research shows that 93% of people will change their behavior if they are rewarded. This is a win-win for everyone involved.
Healthy behaviors can include utilizing your annual wellness visit, losing weight, and smoking cessation. Incentives can include sweepstakes or direct rewards like gift cards and discount coupons. Some plans may utilize a “point” system that can be claimed at a later date for rewards.
Get Medicare Advantage Supplemental Benefits
Vision coverage, OTC allowances, and healthy behavior rewards are just a few of several Medicare Advantage supplemental benefits. Are you interested in joining the 20.4 million beneficiaries who are enrolled in MA? Our agents can contract with nearly every carrier in your state! This means that you can enroll in the MA plan that best fits your needs and budget. Call us at 844-431-1832 or fill out this form to arrange a no-cost, no-obligation appointment with an agent in your area.
What are Medicare MSA Plans (Medicare Medical Savings Accounts)
A Medicare Medical Savings Account, or MSA, is one of six different types of Medicare Advantage plans. Medicare Advantage plans are private Medicare plans that cover everything Original Medicare covers but can add in additional benefits like dental, vision, hearing, physical fitness, non-emergency medical transportation, and more. The MSA plan type creates a non-taxable financial account for your healthcare costs.
How do Medicare MSA Plans Work?
If you’ve previously had a healthcare plan through an employer or the individual marketplace, you may have heard of an HSA, or Health Savings Account. Medicare MSA plans are similar to HSA plans. The plan you choose will include a bank account with a set amount of money in it. You can use that money to pay for your healthcare costs. If you use all of the money in your account and need more, don’t worry: once you meet your plan’s deductible (a set limit on what you can spend), you will be fully covered. If you don’t use all of the money in your MSA, it will carry over to the following year. This way, you can continue to build on your account. The money in your MSA is not taxable.
MSAs are also different from other Medicare Advantage plan types, like HMO (Health Maintenance Organizations) and PPOs (Preferred Provider Organization) in that you do not have to select a primary physician. Depending on your plan, you may still have a network, but it wouldn’t be nearly as strict as another plan model.
The Cost of an MSA
You will not have to pay a monthly premium specifically for your Medical Savings Account, but you will have to pay a premium if your plan includes additional Medicare Advantage benefits. Regardless, you will still pay your Part B premium.
Your plan determines the amount of money that goes into your account each year – this depends on the plan you choose. Once that is settled, you cannot go in and deposit additional monies. You will have a card that functions somewhat like a debit card for your medical expenses. When you use the card, the money will be taken from your account and given to the doctor. You will receive a statement each month that tells you what money has been taken out of your account and for what purpose. You can ONLY use this card for medical expenses. If you use the card for non-medical expenses, you will then have to pay a 50% tax penalty.
What do Medicare Advantage MSA Plans Cover?
Medicare MSA plans and other types of Medicare Advantage plans start by covering everything that Medicare Part A and Medicare Part B cover. Then, individual Medicare Advantage MSA plans often add benefits like dental, vision, long-term care, additional home health, and more. MSAs are different from other types of Medicare Advantage plans in that they typically do not cover prescription drugs.
In 2017, the Kaiser Family Foundation released data that only 3% of people enrolled in a Medicare Advantage plan selected an MSA option. The MSA plan type is typically better for those who are healthy, not taking expensive prescriptions, and more worried about cost savings than additional benefits.
Medicare Medical Savings Account Eligibility
Most people who are eligible for Medicare can enroll in a Medicare Advantage MSA plan. There are a few exceptions:
Those who have another form of health insurance coverage (employer or group coverage, individual health plan, TRICARE, etc.)
Anyone eligible for Medicaid
Those with ESRD (End-Stage Renal Disease) and those who are in hospice
Non-citizens and those who live outside of the United States for more than half of the year.
If you aren’t sure whether or not you can enroll in an MSA, or if you would like to talk to a professional about your various plan options, send us a message now or give us a call at 844-431-1832.
What is a Medicare PPO (Preferred Provider Organization)?
A Medicare PPO, or Medicare Preferred Provider Organization, is a type of Medicare Advantage plan. It’s different from other Medicare Advantage plans because while you will select one Medicare preferred provider (doctor), you will have the freedom to use other doctors. Your costs will be cheaper if you use doctors, hospitals, and specialists that are within your PPO network, but you do have the freedom to see several different doctors.
What is Medicare Advantage (MA)?
Medicare Advantage plans are owned and operated by private companies instead of the federal government. This means that though they cover everything that Original Medicare covers, they are allowed to add additional benefits like dental, vision, non-emergency transportation, and even physical fitness.
MA is great for people who are looking for ways to save money on healthcare and have coverage for specialty healthcare services.
Medicare PPO plans are just one type of Medicare Advantage. They are called Medicare “Preferred Provider Organization” plans because even though you will select one provider that is “preferred,” you do have the freedom to see other doctors. This is a huge “pro,” especially for people who see multiple specialists for different healthcare concerns.
It is also a convenient option for people who are not comfortable with the idea of having a strict plan network. If you want to get a second opinion on a health concern, or if you decide you want to switch doctors, it will be easier to do so with a PPO than if you had an HMO plan model.
The downside to having a PPO plan is that PPO options are typically more expensive than other plan types. PPOs usually have higher co-payments; this is the cost of flexibility. A Medicare PPO will usually have a co-payment averaging between $10 and $15 per office visit.
Medicare HMO vs PPO
As mentioned, HMO (Health Maintenance Organization) plans are generally cheaper than PPOs. They are different because HMOs require you to select one primary physician that you visit for all of your healthcare needs; you won’t be able to visit another doctor without a referral.
In most cases, HMOs do not require co-payments when you visit your primary physician. Ultimately, your HMO vs PPO decision will come down to whether costs or flexibility are more important to you.
There are very few eligibility limits for Medicare PPO plans. As long as you are eligible for Medicare and reside in an area where a Medicare Advantage PPO plan is available, you probably qualify.
This means that you can qualify for a PPO if you are age 65 or older, have ALS (Lou Gehrig’s Disease), or have been receiving SSDI (Social Security Disability Insurance) for at least 25 months. The only exception to this is for some people who have ESRD (End-Stage Renal Disease). ESRD is the only pre-existing condition that Medicare Advantage PPO plans do not typically cover.
Most PPO plans will charge a monthly premium (in addition to your Part B premium). Costs will vary significantly based on the amount of coverage your plan includes.
For example, a plan that includes prescription drug coverage will have a much higher premium than a plan that does not. You will then have co-payments for most medical services which can range from as little as $10 for a doctors appointment or prescription and up to hundreds for hospital services and procedures. However, there are usually limits on how much you will be asked to pay out of pocket with your PPO plan. This can easily range from $1,000 per year to $4,000 per year or more. Once you hit your out-of-pocket limit, you will be fully covered.
Medicare Advantage PPO Plans Near You
Ready to find a Medicare Advantage PPO (or HMO) plan available in your area? Plans vary by county, city, and even zip code. We can help you look at the options available in your area. To get started, send us a message or give us a call at 844-431-1832.
Pneumonia in the Elderly: Causes, Treatment, and Prevention
According to the Centers for Disease Control and Prevention, more than three million Americans develop pneumonia each year. As you age, your risk of developing this infection increases.
Pneumonia can cause serious complications in older adults and can even be fatal. Take this time to educate yourself on the causes, symptoms, treatment, and prevention of pneumonia in the elderly.
What Is Pneumonia?
Doctor Reviewing Lung X-Ray With Patient | Medicare Plan Finder
Pneumonia is an infection that results in the inflammation of air sacs in one or both of your lungs. The tiny sacs fill with fluid and disrupt the process your lungs use to create oxygen. As a result, you may have difficulty breathing. If left untreated, vital organs may not receive enough oxygen, bacteria can enter your bloodstream, and fluid can surround your lungs.
There are two main types of pneumonia – bacterial and viral. Bacterial pneumonia occurs when your immune system is weak from illness, poor nutrition, or age, and bacteria infiltrates your lungs.
If you smoke, abuse alcohol, have a respiratory disease, or have recently had surgery, you have a higher risk because your immune system is weakened. Viral pneumonia is caused by a virus, most commonly the influenza (flu) virus, and is responsible for roughly one-third of all pneumonia cases. Both types can range from mild to life-threatening.
What Causes Pneumonia in Elderly Patients?
According to the American Lung Association, there are more than 30 different bacterias, viruses, and fungi that lead to pneumonia. When pneumonia starts to spread through your lungs, your white blood cells will attack the germs. The area will become inflamed.
What Are the Symptoms of Pneumonia in Elderly Patients?
Bacterial and viral pneumonia have different symptoms, and can often be confused with bronchitis or the flu. Bacterial pneumonia can make your temperature rise as high as 105 degrees and cause excessive sweating, a high heart rate, and heavy breathing. Your lips and nails may develop a blue tint from the lack of oxygen. Other bacterial symptoms include:
Green, yellow, or bloody mucus
Fever
Loss of appetite
Low energy
Chills
Chest pain when breathing or coughing
Shortness of breath
On the other hand, the initial symptoms of viral pneumonia have the same symptoms of the flu. Within 36 hours, you may see a small amount of mucus and you may also see a blue tint on your lips. Other viral symptoms include:
Headaches
Muscle pain
Weakness
Worsening cough
Shortness of breath
Pneumonia in Elderly Recovery Time
The average healthy person can recover from pneumonia in one to three weeks, but depending on your immune system, recovery can last weeks or even months.
Coughing is the primary way to get the infection out of your body, and it takes a lot of your energy. Once you clear the infection, it can still take several more weeks to regain your strength.
Pneumonia in Elderly Survival Rate
Pneumonia can form very quickly and can rapidly spread to other parts of your body. The disease puts your immune system into overdrive and your body cannot create enough oxygen for your vital organs. Pneumonia can also worsen the symptoms of your other ailments, like heart disease.
Pneumonia in Elderly With Dementia
Dementia usually refers to a decline in mental ability that seriously impacts a person’s everyday life. Short-term memory loss and confusion and are most common when dementia results from an injury or an infection such as pneumonia.
According to the Alzheimer’s Association, the symptoms of dementia can be different in every person. However, a person may have dementia if two or more of the following functions are impaired significantly:
Memory
Ability to communicate
Ability to focus and pay attention
Reasoning and judgment
Visual perception
Pneumonia in Elderly With COPD
People with chronic lung disease may be more susceptible to pneumonia. The combination of COPD (chronic obstructive pulmonary disease) and pneumonia is particularly dangerous because it presents an increased risk of respiratory failure, which means that your body can’t get enough oxygen or can’t successfully remove carbon dioxide.
If you have COPD and think you might have symptoms of pneumonia, be sure to call your doctor right away.
Pneumonia Treatment
Doctor’s Appointment | Medicare Plan Finder
A doctor can determine if you have pneumonia through physical exams, chest x-rays, blood tests, CT scans, and other tests. Depending on the severity and type of infection there are several treatment options. Most cases can be treated at home with a combination of antibiotics, hydration, fever control, and rest.
However, some cases may require hospitalization. If hospitalized, you will likely receive fluids and antibiotics through an IV as well as breathing treatments and oxygen therapy.
Your risk of being admitted increases if you have another serious medical problem, more severe symptoms, or if you have been taking antibiotics at home and are not recovering.
Can Pneumonia Heal on Its Own?
Pneumonia cannot heal on its own. It’s important to start treating your symptoms as soon as possible. You can treat your symptoms at home, but visiting a doctor and getting antibiotics is highly recommended, especially for older adults and children.
Pneumonia Prevention
Pneumonia in the elderly along with pneumonia in other adults and children can oftentimes be prevented by practicing healthy habits including:
Washing your hands regularly — especially after blowing your nose, using the restroom, or eating.
Since the flu is a common cause of pneumonia, get your flu shot! Did you know Medicare pays for your annual flu shot? Read more about preventing the flu here.
Pneumonia Vaccine
Another form of pneumonia prevention is the pneumococcal vaccine. This can help protect you from bacterial pneumonia and is recommended for anyone over the age of 65.
There are two vaccine types, PCV13, and PPSV23. You and your doctor can work together to help determine which type is best for you. However, please note, the vaccination is not guaranteed to prevent the infection entirely, but it can drastically lower your risk. Your Medicare plan can cover the cost.
Pneumonia and Your Medicare Plan
Practicing a healthy lifestyle is one of the best ways to keep your immune system strong. Medicare Advantage plans can make sure you’re living the healthiest life possible. These plans may offer additional benefits beyond Original Medicare like routine physical exams and a monthly allowance for over the counter products and medications!
We have licensed agents across 38 states who are contracted with all the major carriers! This means they can answer your questions and enroll you in a plan with an honest and unbiased approach. If you have any questions or are interested in arranging a no-cost, no-obligation appointment, call us at 844-431-1832 or fill out this form.
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Original Medicare vs Medicare Advantage
The Annual Enrollment Period is quickly approaching and starting October 15, you are able to switch your Medicare coverage. Which do you favor in the battle of Original Medicare vs Medicare Advantage? If you’re not quite sure, we’re here to help! By understanding the basic principles of each option you will be better prepared to make that decision.
What is Original Medicare?
Created in 1965, Original Medicare is a federally-regulated healthcare program designed largely for senior citizens. Original Medicare includes Part A (hospital coverage) and Part B (medical coverage). Part A covers inpatient and outpatient care at hospitals, nursing homes, hospice care, and home health services. Part B covers doctor visits and ambulance rides. Most beneficiaries receive Part A for free. Most people pay the same rate for Part B coverage, but a small number of beneficiaries may have income-adjusted premiums.
Original Medicare allows beneficiaries to go to any provider that accepts Medicare, which is over 900,000 physicians nationwide! This means that no matter which Medicare provider you visit, the costs will stay the same. This is ideal for beneficiaries who travel often or want doctors in different locations.
If you are enrolled in Original Medicare, you are able to enroll in a Medigap plan. Medigap plans provide financial benefits for an extra monthly premium. This can include help paying your copayments, coinsurance, and deductibles. Additionally, some of these Medigap plans cover prescriptions drugs. However, if your plan does cover prescription drugs, you cannot purchase a separate drug plan.
What is Medicare Advantage?
Medicare Advantage plans were not offered until 2003. Since then, enrollment has tripled to 19 million beneficiaries according to the Henry J Kaiser Family Foundation. Medicare Advantage plans are available through private insurance companies and must cover the same benefits as Original Medicare. However, many MA plans offer extra benefits like vision and dental coverage and even SilverSneakers®. These plans have a set network of providers you must choose from, but don’t worry! There are many different networks and plans available.
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular plans among Medicare Advantage.
HMOs:
An HMO is a closed provider network. Your primary care provider must fall into this network. Additionally, you must use this network in the event of an emergency. HMOs may require you to get a referral for more severe injuries or illnesses.
PPOs:
PPOs allow you to see any doctor, but staying in your network you will save you money. Additionally, they don’t require referrals and like HMOs, they often cover Part D supplements.
Medicare Advantage plans have one monthly premium. There is no hassle with sending payments for multiple plans. Some MA plans may offer a lower deductible in exchange for a higher monthly premium. This is a great option for healthy seniors. With MA plans, you only pay for the services you use rather than paying a higher upfront cost.
Differences between Original Medicare and Medicare Advantage
It is easy to confuse Original Medicare and Medicare Advantage. By understanding a few key differences you will be able to better evaluate which option is best for you.
Out of Pocket Costs
Original Medicare has no set limit for how much you will spend out-of-pocket. This means that if you need more medical attention for any given reason, you may exceed what you budgeted. However, Medicare Advantage plans have a maximum out-of-pocket limit. Once you reach this limit on out-of-pocket costs for covered services, your costs will be covered for the remaining calendar year. It is important to note that some Medicare Advantage offers lower limits- that means more money saved for you!
Health Questions
Original Medicare plans require you to answer numerous health questions. However, Medicare Advantage plans do not require any health questions. The only question they can ask you is if you have end-stage renal disease. Medicare Advantage plans will not cover this disease because the Center for Medicare and Medicaid Services (CMS) defines end-stage renal disease as “permanent kidney failure that requires a regular course of dialysis or a kidney transplant.”
Supplemental Insurance
You can not purchase a Medigap plan and a Medicare Advantage plan. You must choose one or the other. Medigap coverage helps fill in the gaps that Original Medicare doesn’t fill. However, Medicare Advantage plans allow you to get a more customized plan that gives you the benefits you need for your budget.
Extra Services
With Original Medicare, you get what you get. With Medicare Advantage plans, you get what you want. Original Medicare does not cover extra services, however, MA plans may allow you to get additional vision and dental coverage and group fitness classes.
Providers
As previously mentioned, there are over 900,000 physicians nationwide that accept Medicare coverage. Medicare Advantage plans require you to stay within the plan’s network. If you go out of your network there may be a significant price increase. If you traveling and are rarely in the same area, this may not be the best option for you.
Part D Coverage
Original Medicare is only Part A and B. If you want prescription drug coverage, you must purchase Plan D through a private provider or a Medicare Advantage plan.
Pros of Medicare Advantage
Throughout this article, there may have been a few pros of Medicare Advantage plans that caught your attention. In case you missed anything, we’ve compiled a list of the top reasons you should consider purchasing a Medicare Advantage plan.
Potential Lower Costs
Although you pay a premium with both Original Medicare and Medicare Advantage, MA plans may offer a lower deductible in exchange for a higher monthly premium. Also, MA plans have the maximum-out-of-pocket limit, saving you even more in the long run!
Prescription Drugs
Drug coverage is often included in Medicare Advantage plans. This allows you to bundle your coverage – saving you money and creating more convenience for you!
Additional Coverage
Medicare Advantage plans offer extra coverage that Original Medicare cannot. If you’re looking for vision, hearing, or dental coverage – an MA plan may be right for you!
Maximum Flexibility
Medicare Advantage plans include the benefits you want and need. The plans are flexible and ensure you get the coverage and the cost that fits your budget.
Get covered today!
Does a Medicare Advantage plan look attractive to you? Did we grab your attention? AEP is coming soon! From October 15 to December 7 you are able to make changes to your Medicare coverage. If you’re interested in purchasing a Medicare Advantage plan or hearing more about coverage options available to you, complete this form or call us at 844-431-1832 to arrange a no-obligation appointment with an agent.
