Medicare Advantage Plan Review

An alternative to traditional Medicare is Medicare advantage plan. Private health insurance is paid by the federal government to provide insurance services that are at least as good as the payment models offered under the traditional Medicare offering.

The “benefits” for these plans include value added services which are not part of the traditional Medicare offering.

Medicare Advantage plan is a managed care plan that has low monthly premiums in return for relatively tight local area networks, prior approval / recommendations, and back payments that come out of your pocket every time you use a medical service and you will still have to pay your monthly Medicare part B premium. Many of these plans include the coverage of prescription drugs.

What’s the better deal – Medicare Advantage or supplement?

When deciding on your health insurance, a cheap premium should not be the only factor to consider. Whether Medicare Advantage is a better offer than the original Medicare or Medicare Supplemental plan depends on a variety of individual factors, for example, your comfort as regards managed care and your willingness to trade lower premiums while you are healthy may increase your out-of-pocket expenses if you become seriously ill.

The best protection that can be offered to Medicare Advantage customers is enlightenment. The biggest problems faced with these plans have to do with qualified nursing homes/nursing facilities.

Medicare Advantage plans are designed to help reduce unnecessary medical expenses and also fraud through review and more extensive oversight than original Medicare. Unfortunately, this creates a system of paperwork, checks, and balances that many administrators of hospitals and nursing homes do not like.

Here are some current scenarios in which our clients and local care facilities have been included:

  1. First authorizations for admission to a nursing home are sometimes rejected. Normally the rejection can be resolved by a call from the attending physician. If you receive a refusal, ensure the referring hospital/physician is doing the footwork necessary to fix the problem for you.
  2. The Nursing Home advises that Medicare Advantage 2019 member to drop their plan to use traditional Medicare and buy a supplement. For many reasons this is not good advice! While the paperwork for the nursing home is simpler under traditional Medicare; clients typically find that spending on Medicare alone is much higher.

Do not forget that Medicare supplements have medical underwriting. If you too sick and need skilled nursing care, probably you are too ill to qualify for Medigap plan. This lack of nurse knowledge has cost thousands of dollars for clients.

  1. Networks also hold water for skilled nursing centers, and often the nursing home that is closest to your home may not be the one with your plan on the network. The extra mileage causes additional stress for caretakers, who drive several times a day to visit their loved ones. If you desire to choose a nursing home freely, there are available nursing home plans of short term nature that you can purchase to make sure you could travel wherever you want.