Though a wonderful alternative to expensive private insurance coverage policies, Medicare can create a financial burden for those who make false presumptions. Often, participants in the traditional Medicare plans presume incorrectly that the program will cover them 100%. Unfortunately, this is incorrect. In order to remain viable as a wide sweeping coverage program for lower income members, Medicare needs to find areas where it can cut corners and costs. This prompts competitors in the insurance coverage field to offer Medicare replacement plans. When looking at a comparison of original Medicare vs Medicare advantage plans, which cover the space between what the initial plans will not, users can specialize their coverage to meet their needs.
Not all Medicare advantage plans are created as equal, however. In fact, there are significant differences designed to meet as many specialized claims while still remaining affordable and reliable coverage.
Original Medicare versus Medicare Advantage
As it stands, traditional Medicare might only cover up to 80% of a user’s claim, requiring that person to seek additional coverage at an added expense to cover the ‘Gap’ left behind. The alternative is to not have any form of additional coverage, leaving significant bills to be paid in full by the user. This Gap coverage falls under the Medicare Advantage plans, each designed to provide specific coverage elements without adding in unneeded portions that simply cost more money.
In order to properly price out these Medicare advantage plans, seek advice from your open market agent, or call the number provided by the national exchange. Situations vary, with pricing for additional coverage, replacement plans, and Gap plans somewhere between $20 a month to several hundred dollars.
Regular Medicare versus Medicare Advantage
By reviewing the different qualities and qualifiers for the replacement plans – such as the Advantage plans, HMO, and PPO – a variety of pros and cons arise to demonstrate the proper coverage application depending on a person’s status. For the Advantage plans, these coverages are expatiated in order to provide the proper amount of affordable coverage. By reviewing your current health prognoses with your physician, you can identify what gaps there are in your standard Medicare coverage and seek the additional plans that you need in order to be fully covered.
For the HMO plans, these relate directly to the regional providers, providing a simplified and extremely reduced monthly and annual rate simply because the decisions of choice care providers are removed from the equation. Standard Medicare coverage plans are augmented with additional cost saving measures, by assigning a populous group of those covered to a specific, pre-approved network where all of their non-emergent cares are dealt with.
HMO plans offer an affordable advantage when seeking lower costs for health care, though many providers cannot handle the influx of incoming patients. By expanding their coverage area in order to deal with the increased costs of increased patients, many HMO providers then become less personal and less specialized, supporting an assembly line medical situation where patients are lost in the shuffle.
Traditional Medicare versus the PPO
It is within the PPO system where many Medicare recipients find an affordable solution without losing tightly budgeted assets to poorly run HMO scenarios. PPO providers allow for a balance of lower incomed patients with high incidents of need coverage, while also fitting in higher incomed patients with less medical issues to balance out the cost sharing structure.
Users in a PPO system are able to select their own doctors and dentists – in fact, any provider of the services they need insurance coverage from. By transplanting pre-identified conditions from a non-covering physician to a provider who can assist with the attention and prescription plans required, patients often see improved health and coverage.
However, there can also be pitfalls of using an identified physician through the PPO system. Physicians often assign expensive tests and procedures when they are not necessary in order to increase the costs, therefore increasing their billable fees to the Medicare system. The tests can be arguable so as to not be a complete waste of time, but often cheaper solutions are available that keep the costs down and manageable. The more cost efficient, the more can be accomplished. The more billing is sent out, the less the overall pool for Medicare funding remains.
The Advantage plan, HMOs, and PPO addendums also do not spend considerable time when configuring the remaining 20% of gap- often filled with prescription needs and various requirements concerning generic brands and required name brand medications. PPOs have a little more leeway in what they can prescribe, and using Medicare A or B supplemental plans will dictate what type of prescription medications are available for consumers.
Medicare versus Medicare Advantage
What it comes down to is not a conflict of interest between Medicare and its various additional coverage plans, but rather a balance of finding appropriate coverage within the spectrum of what plan works best for your current medical conditions and requirements, as well as your budget. Applying your current knowledge to your selection process will help with streamlining your appropriate levels of medical coverage without overextending your available budget.
Start by logging online and reviewing the available Advantage and Gap plans as showcased on the National Healthcare Exchange, then drill down further to explore those offered by your state. Generally speaking, the more local your healthcare provider and insurance provider, the less expensive they will be. If you have had major changes in your life at the time of your exploring, you might qualify for an out-of-open-enrollment plan, such as life events involving births, death, job changes, divorces, or other things that would spur an application beyond the open enrolment period in November.
Once a plan has been reviewed, check for specific plans that will bring your coverage up beyond the standard 80% coverage to 100%, with particular attention paid toward budgeted, out of pocket expenses related to premiums, as well as the prescription coverage plans in order to further reduce monthly costs as charged by the various vendors. The more you know, the better off you will be when the time comes to actually use your coverage.