Author Archives: Felix Mcdonalid

Enrolling for Advantage Plans can be a wise decision

Medigap isn’t perfect for everyone, but if you qualify and can afford it, you probably won’t Medicare Advantageregret your decision. Some Medicare Advantage plans include rewards not present in the original Medicare, such as glasses, dental coverage, and membership in gyms. Some of the policies include prescription drug coverage. There are many kinds of Medicare Advantage policies; PPO, HMO, POS, and PFFS. Understanding the benefits on the one hand is not enough to make your decision. Advantage plans have many benefits in addition to their disadvantages; so keep comparing and contrasting until you are comfortable with your choice. For those who simply do not have the funds for a supplemental plan, there are health insurance plans available in most areas that now offer zero cost options. I’m not a big fan of health insurance plans, but if you just don’t have the funds, it could be the way to go. Just consider the limits of your health insurance plan and if you are allowed to leave your network of doctors and hospitals.

There were certain modifications from the present standardized Medicare supplemental policies by 2010. This was as a result of the Medigap Modernization Act of 2010, The act took effect on June 1st. These changes did not affect persons who were already signed up to the Medigap Plan before this date and apply only to people who enroll on or after June 1st. Medigap policy E, H, I, & J policies are being phased out by Medicare, meanwhile those currently enrolled in these policies may remain in them with no change. Two rewards that are also removed are the Preventive Care benefit as well as Home Recovery benefit, as Medicare determined that these were totally underutilized by the beneficiaries.

The final benefit of supplementary plans over Advantage plans is that the price is standardized and has been around since 1992. Advantage plans, on the other hand, change annually. Recently, this has always meant higher prices year after year. It is very important to remember that coverage in a Medicare Advantage Plan is the same coverage as Medicare Part A and Part B. It is not the same as Part A and Part B with a supplement. All Advantage Plans will have direct costs in the form of copayments for office visits, daily co-insurance for hospitalizations, etc. Adding a supplemental policy to your Advantage plan to cover these costs is not allowed. Regardless of the type of Advantage plan you choose, keep in mind that you will have to choose between suppliers who accept your specific plan or are ready to pay direct costs.

Insurance Companies and Medicare Part D insurance

Insurance companies assists millions of beneficiaries of Medicare achieve high quality rewards for their various Medicare insurance, Advantage plans, Medicare supplements, and Part D. Calculate the costs of your local pharmacy as if you did not have complementary insurance. When the total annual retail price goes beyond $2,250, the basic insurance you have will end and you will officially be in the “Donut Hole”. These government plans are confusing even for qualified professionals, so consulting with a Part D specialist is valuable. No matter which insurance company you choose, you want the Part D plan to best suit your specific needs. The lower-cost plans will reduce your overall costs and provide adequate coverage when the total retail expenses of prescriptions are less than $2,250 per year, as long as they cover the specific prescriptions you take.

Medicare Part D beneficiaries must understand how your plan formulary works and must also keep up with all modifications to your Medicare part D plans formulary. If they do not keep up, they may discover they are in a situation where they cannot get their medications the next time they enter the pharmacy. With the information above, a beneficiary of Medicare will be more equipped to select the policy that is appropriate for their situation. For example: if a person waits two years to submit an application, he will pay a fine of 24% of the national average premium per month thereafter, provided that the individual remains enrolled in Part D. Unless the beneficiary has any proof of other guarantees. With medications, such as employer group health insurance, to show why they chose not to enroll in Part D, they get caught paying this fine for the rest of their lives.

Because of the complicated forms of many Medicare Part D plans, it is important that Medicare Part D participants inform their doctor about the plan they signed up for. That way, the individual’s doctor can work within the limitations of the form to ensure that the recipient  receives the best and most appropriate therapy covered by their plan. Medicare has found some ways to fix the screw hole, but not all beneficiaries know it. Until their use reaches the limits of the Part D program and coverage is suspended, they will not seek remedy. If you are registering for new schemes in Part D, ask the representative what Thread Hole coverage is in Part D and also check the latest discounts and considerations offered. First, there is a late enrollment penalty. For each month in which a person is eligible but not enrolled, a fine of 1% of the national average drug plan premium applies.


 Medicare plans provided by the federal government of the United States covers part A as well as Part B of your medicare. In simpler words, it means that the Original Medicare would cover your hospital and medicare coverage. Whereas Medicare advantage plans not only cover your medicare as well as hospital coverage but also provides you with tons of extra benefits. You can enrol yourself in these advantage plans at a monthly premium as low as $0. Humana is one of the biggest healthcare providers in the United States and covers all the 50 states of the country. Humana Medicare Advantage plans in Austin are discussed below.


  1. Humana Gold Plus H0028-037 (HMO)

With an overall rating of 4.3, Humana Gold plus plan offers a monthly premium of $0. This Health Maintenance Organisation plan requires you to have a primary care provider, who would have the overall picture of your health at all given times. You can choose any doctor to be your primary care provider, provided he lies in the network of the plan. You do not have to pay any co-pay while visiting your primary provider. The plan provides an out of pocket maximum expense of $6700, which is quite affordable. It also provides prescription drug coverage, dental care, vision care, and over the counter benefits as well.


  1. HumanaChoice H5216-128 (PPO)

With an overall rating of 4, Humana Choice plan offers a monthly premium of $0. This preferred provider organisation plan gives you the flexibility of seeing any doctor of your choice, without any network restrictions. This plan also does not require any referral to be signed beforehand. The out of pocket expense is a bit more in this plan. You need to pay a $10 copay when you visit a doctor inside the plan’s network and a 30% coinsurance for doctors outside the network. The plan covers inpatient hospital stay at a $0 copay after day 5. Along with providing dental as well as vision services the plan also provides various fitness programs and skilled nursing facilities as well.


  1. HumanaChoice R4182-001 (Regional PPO)

With an overall rating of 3.5, Humana choice plan is a regional preferred provider organisation plan, which serves within the region of Austin. This plan has a monthly premium of $0. It provides an out-of-pocket maximum of $5700 for in-network services. You also have to pay a $15 copay for visiting an in-network general doctor, and 30% coinsurance for visiting a doctor outside the network. The plan covers both in-hospital acute as well as psychiatric stay, with a $0 copay after the fifth day. It provides hearing services, vision care, dental care, and fitness programs as well. It also provides preventive services and home health care services as well, at a copay of $0.


  1. HumanaChoice H0473-003 (PPO)

With an overall rating of 4.5, this Humana choice plan is a fairly new plan added to the city of Austin. With a monthly premium of $38, this preferred provider organisation plan gives you the flexibility of choosing your doctor anywhere around the city, without the restriction of a region or network. With no annual deductible, this plan has a $0 copay for visiting your primary doctor, inside the network. However, you would not need any referral to visit any special doctor. The plan also has the benefit of prescription drug coverage. It covers Tier 4, that is non-preferred drugs, and Tier 5, special drugs as well. It provided added benefits of dental services, vision, hearing services, chiropractic care, fitness benefits, and enrollment to SilverSneakers program as well.


  1. HumanaChoice R4182-004 (Regional PPO)

With an overall rating of 3.8, this is another PPO plan offered by Humana. It has a monthly premium of $54, along with an annual in and out of network deductible of $750. The plan does cover prescription drugs as well. Along with covering Tier 4 and Tier 5 of prescription drugs, the plan covers Tier 3, that is preferred brand drugs as well. It has a 25% copay on generic and brand name drugs. This plan covers the emergency ambulance and air ambulance services as well, with a very affordable copay and coinsurances, along with 100 days in Special Nursing Facility. The plan also covers basic benefits like hearing services, dental care, and vision care as well.


  1. HumanaChoice R4182-003 (Regional PPO)

With an overall rating of 3.4, this regional PPO plan has a monthly premium of $95, along with an annual deductible of $750, in as well as out of the network. The plan provides a minimal copay of $15 for visiting your primary doctor inside the network, and a coinsurance of 40% for a doctor outside the network. It has prescription drug deductible of $175 and covers Tier 3, 4, and 5 of prescription drugs, which is not covered in the Original Medicare. The plan also covers lab services and therapeutic radiology services as well. The plan also covers oral exams, dental x-rays, eye exams, eyewear, glaucoma-screening, hearing exams, and hearing aids as well at $0 copay.


  1. Humana Gold Plus SNP-DE H0028-044 (HMO D-SNP)

With an overall rating of 4.4, this special needs plan has a monthly premium of $0. Special needs plans are extra beneficial plans for individuals who are suffering from a particular chronic disease. These plans are specially designed to fit your medical needs according to the particular health condition you suffer from. With no annual deductible, the plan offers a $0 copay for visiting your primary doctor. It also has a $0 copay for inpatient hospital coverage and no prescription drug deductible. It covers all of the prescription drugs from Tier 1 to Tier 5. The plan not only specialises services according to your requirements but also focuses on your overall health. It provides routine dental services, medicare covered vision services, diabetic eye exam, routine hearing services, and transportation services as well.


Medicare AdvantageAdvantage plans are extra beneficial plans which are offered by private institutions to the citizens of the United States who are eligible for the Original Medicare. These private organisations are credited and approved by medicare. More and more people are switching to medicare advantage plans, because of the fact that they not only manage your original medicare but also provide extra benefits apart from medicare, at a very affordable cost. Humana Medicare Advantage plans offer an affordable monthly premium and tons of benefits. Humana Medicare Advantage plans offered in Indiana are discussed below.


  1. Humana Gold Plus H5619-021 (HMO)

With an overall rating of 4, this plan is offered at a monthly premium of $0. The plan has no annual deductible and a maximum out of pocket expense of $990. For visiting your primary care provider or specialist you have to pay a $0 copay. The plan also covers prescription drug services, with no deductible amount. For generic and brand name drugs you have to pay a coinsurance of 5%. Along with this it also provides vision services, dental services, over the counter benefits, fitness benefits, hearing services, as well as SilverSneakers program, also providing the skilled nursing facility at a $0 copay for the first twenty days.


  1. Humana Honor (HMO)

With an overall rating of 4, the Humana honor plan has a monthly premium of $0. The plan has no annual deductible, and an out of pocket maximum of $6700. Under this plan, you also have to pay a $20 copay for visiting your primary doctor, and a copay of $50 for a specialist. Humana Honor plan provides added services like dental coverage, oral exams, vision care, and hearing services. The plan covers lab services, radiology services, rehabilitation services, language and speech therapy as well. However, the plan does not cover prescription drug services and you have to enrol in a Part D plan separately.


  1. Humana Value Plus H5619-037 (HMO)

With an overall rating of 4, the plan is offered at a monthly premium of $16.80. The plan has a monthly deductible equal to the Part B deductible amount mentioned in medicare, and an out of pocket maximum of $6700 for in-network providers. You do not have to pay any copay while visiting your primary health care provider or any specialist. The plan covers prescription drug coverage with a deductible of $435. The deductible amount is applicable to generic, preferred brand, non preferred drug and specialty tier. For generic and brand name drugs you have to pay a maximum copay of $3.60. The plan also covers cardiac and pulmonary rehabilitation services, occupational therapy services, physical therapy services as well as speech therapy services at 20% coinsurance. Along with covering up to 40 meals over a span of 20 days, acupuncture services are also included in the plan, along with transportation services.