Medicare Coverage Plans in Fort Wayne, IN
Congress, around 1997, was hunting for a way to harness the power of the private sector to improve quality of care and reduce costs in the Medicare program. Thus, Medicare Part C was born (Parts A and B being “Original Medicare”). At first, it was named Medicare+Choice and was renamed Medicare Advantage in 2003.
The idea was to have plans bid to provide all the services Medicare provided. If they had money left over, that could be taken as profit or used to offer extra benefits not included in Original Medicare, such as prescription drugs, hearing aids, eyeglasses, contact lenses, dental care, and more.
Over time, Medicare Advantage has become very profitable, and very popular for two main reasons: 1) due to the extra benefits it offers, and 2) convenience — it lets plan members access a provider network (hospitals, doctors, etc.) in their local area and some also have great travel benefits.
Medicare Star Rating System
Medicare Advantage plans vary in costs and coverage. Every January, plans may change their coverage and costs for the new year. So, it’s important to review your plan’s coverage each fall and compare it to other plans in your area.
Consider a plan’s costs, coverage, drug coverage, and the in-network pharmacies to see if it meets your current needs. Then, you can use the plan’s star rating system to aid you in your decision.
Medicare uses a Star Rating System to measure how Medicare Advantage plans perform, yearly, in five categories:
- Screening, tests, and vaccines
- Managing long-term conditions
- Plan responsiveness and care
- Member complaints and problems
- Customer service
The ratings range from one to five stars — one is the lowest and five is the highest. Plans are rated in each category, and Medicare gives one OVERALL star rating to recap the plan’s performance. You can use the overall star rating to compare how well many different plans perform to get the best coverage for you.
Note: If a 5-star Medicare plan is available in your area, you will have a one-time opportunity to change plans anytime during the year! This special enrollment period will begin on December 8 and run through November 30. The new coverage will start on the 1st of the following month.
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The Big Secret
But the biggest sweetener of all, for the Medicare beneficiary, is one seldom talked about. Medicare Advantage Plans have a maximum out-of-pocket limit. This means you can only be charged so much for co-payments and deductibles before all expenses are covered for the rest of the year.
Original Medicare and the Medicare add-ons such as Part D prescription drug plans do not have this feature. With Original Medicare, regardless of how generous it is, deductibles and co-payments can bankrupt you if you use enough medical services. Not so with Medicare Advantage Plans. Your costs are capped.
In 2021, the maximum out-of-pocket limits cannot exceed $7,550 for in-network medical services but maybe as low as $3,000. So, besides considering things such as making sure your doctors and drugs are covered — along with the extra benefits you want to be included — let the specialist at Medicare For Cheap find a plan with a low Maximum Out of Pocket!
We Tailor Plans Specifically for You
Medicare For Cheap can tailor plans to suit your needs. This means besides making sure that you can see your doctors, specialists, and hospitals, we also want you to pay the least for your prescriptions. Many Medicare Advantage Plans include prescription drug coverage, but not all of them will cover the prescriptions you take, nor will they charge the same amounts for those drugs. As part of your FREE service, we’ll find the best ways to cover your drugs because this can save you hundreds if not thousands of dollars each year.
Common types of plans
The right choice for you may depend on many factors, including where you live and what side of the spectrum you’re on — Medicare through disability, turning 65 or new to Medicare, or having Traditional Medicare with a Medicare Supplement that’s just getting too expensive. Everyone’s health and financial situation is different, so there’s no one-size-fits-all approach in the Medicare landscape.
Extra Benefits
The extra benefits, while often limited to, say one pair of eyeglasses or one set of dentures per year can be a lifesaver for expensive services like dental. Research is now showing that we’ve consistently underestimated the impact of vision and hearing loss on the life of the elderly and disabled. Having hearing and vision services available at low or no cost can make the difference between a fulfilling life and a tumultuous one. These “social determinants of health” are being recognized as more and more important. Another big thing that’s crucial to long-term health is physical fitness which is why most plans will include a gym membership!
When Can I Enroll in a Medicare Advantage Plan?
You can join, switch, or drop a Medicare Advantage plan, but only during the following enrollment periods:
- Initial Enrollment Period — When you’re first eligible for Medicare, you can join a plan during your IEP. It’s the 7-month period that starts 3 months before the month you turn 65, includes your birth month and ends the three months after.
- General Enrollment Period — If you have Part A and you get Part B for the first time during this period (between January 1 and March 31 every year), you may also join a Medicare Advantage plan. Your coverage may not begin until July 1.
- Medicare Annual Election Period (AEP) — Anyone with Medicare can join, switch, or drop an Advantage plan between October 15 and December 7. Your coverage will begin on January 1.
When Can I Change My Medicare Advantage Plan?
If you have a Medicare Advantage plan and it’s not working for you, you can change it during certain times of the year:
Medicare Advantage Open Enrollment Period (OEP) – January 1 through March 31
- Switch to a different plan with or without prescription drug coverage, or
- Go back to Original Medicare, if needed, and take out a Part D drug plan.
*** Note: Many people may make a mistake and pick the wrong plan during the annual election period so you can use this time to change plans. Your new coverage will take effect on the 1st of the month following the change.
Annual Enrollment / Election Period (AEP) – October 15 through Dec 7
- Switch to a different Advantage plan, or
- Go back to Original Medicare and add a Part D drug plan.
Any changes you make during AEP will go into effect on January 1 of the next year.
Special Enrollment Period (SEP)
- Make changes to your plan if you move or are leaving group coverage.
Other special situations may qualify you for a SEP. The rules about when you can change your plan and the type of change(s) you can make are different for every SEP.
Special Needs Plans
SNPs, like other Medicare Advantage plans, must offer the same coverage as Original Medicare. They also can provide additional coverage and are required to provide prescription drug coverage.
SNPs will require you to receive your care from within their plan networks, unless it is an emergency, or you need out-of-area dialysis. SNPs will also most likely require that you choose a primary care doctor and get a referral to see a specialist. This is because, as mentioned before, these plans tailor their benefits to their members and typically have specialists who specialize in your current condition.
The different SNPs are,
- Dual Eligible (D-SNP)
- Chronic Condition (C-SNP)
- Institutional (I-SNP)
How Are SNPs Different From One Another?
Each SNP has its own eligibility requirements. The one you qualify for depends on the definition you meet (one is set by the state you live in).
D-SNPs are for people who qualify for both Medicare and Medicaid. To qualify for this, you must meet your state’s standards for low income as determined by your Modified Adjusted Gross Income (MAGI). If you earn above a certain income level, you may have the ability to “spend down” by deducting your medical costs from your annual income, which will make you eligible for this plan. D-SNPs will also help pay your Part A and Part B premium costs in addition to giving you discounts for your treatments.
C-SNPs are for those with chronic disabling conditions. These are severe and life-threatening, and you must have at least one of the conditions listed to qualify for it. Dementia, HIV, End-Stage Renal Disease, and chronic heart failure are examples. With this plan, you will get the greatest coverage for treatments related to your chronic condition.
I-SNPs are for individuals who live in institutions such as nursing homes. The coverage here is also comprehensive and heavily discounted like other Medicare Advantage plans.
Hospital Indemnity Insurance
Hospital indemnity insurance is not a standalone insurance plan, so you cannot purchase it without first having an insurance plan of your own. It’s meant to be supplemental coverage.
This pays a benefit to you rather than sending the funds directly to your doctor. These are funds for you to do with as you see fit in regards to how you pay your bill. It can go toward coinsurance, copayments, or, it can use it to pay your deductible.
Now, if you have a Medicare Advantage plan, you can add on a hospital indemnity policy to help fill in some of the gaps that a Medicare Advantage plan won’t cover. For example, adding hospital indemnity through Medico or GTL will fill in the biggest gap you can face, which is the per day copayment when at a hospital.
With Medico, you can get supplemental cash benefits that you can use when needed. You also get great plan benefits, such as coverage for each day of confinement in a hospital, as well as coverage for services you receive in a hospital observation unit. GTL will also help provide coverage for hospitalization and ambulance copayments, as well as has a history of no rate increases since 2005.
With a Medico or GTL hospital indemnity policy, you can also add on a rider. A rider is a policy that you can add to your current insurance policy so you can get more coverage. With hospital indemnity insurance, you can add:
- Ambulance services benefit rider
- Cancer lump sum benefit rider
- Critical accident benefit rider
- Outpatient therapy/chiropractic services benefit rider
- Dental and vision benefit rider
- Skilled nursing facility rider
- Urgent care benefit rider
- Outpatient surgery benefits rider
What Does it Cover?
Plans range in the number of services they cover. This also has a direct impact on premium costs. If you want a plan that strictly covers a few items, such as time spent in the intensive or critical care unit and nothing more, you can pay as little as $7 per month.
More expensive plans can be anywhere from $19 per month up to a $463 monthly cost.
With more expensive plans, you can get extra coverage for such outpatient services as:
- X-rays and lab work
- Surgery
- Diagnostic imaging
- Continuous care
Another optional benefit is substance abuse counselling, which allows you to have a way to afford the treatment that will help you in maintaining a healthy lifestyle.
By doing this, you broaden the scope of your coverage. And to make your coverage even broader, you have the option to add any dependents onto your plan so that your children are covered just in case something happens to them.
When Does the Coverage Begin?
This depends on who you get your indemnity hospital insurance from. While some come with waiting periods, there are other plans that have zero waiting periods. Even when a plan has a waiting period, it will be considerably shorter than other types of insurance. For example, something like dental insurance would require you to pay premiums for two years before you’d even have effective coverage.
At most, indemnity hospital insurance will have a waiting period of 30 days (if there is one). However, even with a waiting period, you can get immediate coverage in case you incur a serious injury resulting from an accident.
PPO vs. HMO Plans
HMO plans are the standard for Medicare Advantage. With these plans, you will pay less out-of-pocket for your care as your coverage will be limited to the plan’s provider network. You’ll also be asked to choose a primary care doctor and get a referral when you need to see a specialist.
With PPO plans, you will have the choice to use in-network providers, but you can also get your care from outside these networks. You also won’t have to choose a primary care doctor or get a referral to see a specialist.
How do HMOs and PPOs approach out-of-network care?
The first difference comes from how these plans handle out-of-network treatment. Aside from emergencies, HMO plans will not cover you if you get treatment outside of your network. This means you’ll either pay full cost, or the out-of-network healthcare provider will refuse to treat you altogether (even if you’ve gotten services from them in the past).
PPOs are more relaxed. You can get non-emergency out-of-network treatment, but not for the same significant discount you’d have when getting care within your plan’s network. In other words, it will cost you more.
How Are They Similar?
HMOs and PPOs both provide the same coverage as Original Medicare, plus additional coverage, such as prescription drug coverage. However, do keep in mind that each plan varies in coverage.
Also, you cannot have a Medicare Supplement plan alongside an HMO or PPO plan.
We’d love to hear from you! Call our friendly team on 833-372-4327
Phone: 833-372-4327
Other: 260-376-0042
Email: medicareforcheap@gmail.com
Address: 4666 W Jefferson Blvd Ste.150, Fort Wayne In 46804
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