November 15 marks another year of the annual election period for people with Medicare Advantage plans and Part D prescription drug plans.  This is the time of year when these plans can make changes within the same companies or move to another company which offers stronger benefits and or a better monthly premium.  If your company falls out of favor, this is definitely the time to look for better alternatives.

Medicare Advantage Plans

Because Medicare supplement (Medigap) plans generally have a higher monthly premium, the government created a program called Medicare Advantage to allow Medicare enrollees to receive their benefits through a private company.  Medicare Advantage plans have a much lower rate than a Medicare Supplement plan because for every Medicare Advantage member, the government pays a monthly premium to the insurance company that is based on the average amount Medicare spends per person in that member’s county.

Medicare Advantage plans are plans from private insurance companies that provide group and individual health insurance to millions of Americans.  The Advantage plans fall into three categories: HMO - Health Maintenance Organizations, PPO - Preferred Provider Organizations and PFFS - Private Fee for Service.  The HMO plans generally offer the most comprehensive benefits with a low monthly premium.  The PPO plans offer much more flexibility and access to many different network providers, with also a very low monthly premium.  The PFFS plans do not offer a network of providers, instead the member can visit any physician or hospital who accepts Medicare as long as the provider agrees to see the member, and bill the insurance company.  This sometimes may get a little tricky, because the medical professional can at anytime say they will not accept your PFFS plan.

Anthem Freedom Blue Plans

How do you qualify?

You must have Medicare Part A and Part B, and must continue to pay your Part B premium while on the Advantage plan.  You must also live in the county where the Medicare Advantage plan is offered.  Advantage plans are generally County sensitive.  Meaning they could offer great comprehensive plan on County A, and next door in County B, no coverage is offered.  So be sure to call so I can check to see if a particular company or plan in in your county.  Also to qualify you must not have End-Stage Renal Disease.

Part D Prescription Drug Plans:

Most seniors will choose to purchase a Medicare Part D plan, to provide prescription coverage for them.  There are hundreds of companies offering coverage, and they all have different prices, benefit options and services areas.  Below is a quick snapshot of Part D:

• Deductible - before benefits are paid, the member must pay a $310 deductible.  Many Part D plans waive this deductible.
• Coinsurance - After meeting the deductible, the member pays 25% and the insurance company pays 75%.
• Initial Coverage Limit - Once the total cost of drugs (member + insurance company) reaches $2,830, the coverage gap (donut hole) begins.
• Coverage Gap (donut hole) - During this coverage gap the member pays 100% of the cost of drugs.
• True Out of Pocket - Once the “True Out of Pocket cost (TROOP) reaches $4,550, the donut hole ends and catastrophic coverage starts.  TROOP  = deductible, coinsurance and payments during Coverage Gap.
• Catastrophic Coverage - Once the member reaches the catastrophic coverage level, the plan pays 95% of the cost for the rest of the year.
• Many plans will waive the deductible, and offer generic co-payments for generic during the donut hole.
• There are no medicare questions, and at least one Part D plan is offered in every county in the U.S. 
• Most plans are in the $30, $40 and $50 range.

For more information or questions regarding your area, please feel free to call anytime.

John Conner
www.JohnConner.com
John@JohnConner.com
800-700-1246