If you are in Medicare this year, in 2010, you may be trying to decide if you will join a Medicare Advantage plan or remain with Original Medicare. The choice is between private management of your Medicare benefits and Federal management. Which is best for you? Many of the Medicare insurance companies are re-evaluating their 2010 Advantage program in light of the health insurance reform passed into law by President Obama. The new law will mean significant financial change as subsidies for the plans will be reduced. Although this will not affect the benefits offered to members, it may affect their experience in the plans.
Medicare Advantage plans in 2010
The essential working of the plans, whether they are Medicare Advantage PPO plans, HMO plans, or private fee for service plans, remains largely the same as the Advantage plans in 2009. One significant difference for 2010 is that the costs premium and out-of-pocket costs appear to have generally increased from 2009, and that there are far few plans offering zero premium options, and more plans whose cost sharing more closely mirrors that of Original Medicare.
What are you getting when you join a 2010 Medicare Advantage plan? The Medicare program requires that the Advantage plans offer you the same core services that you receive in Original Medicare. However, the Advantage plans deliver your benefits according to their own policies and procedures. When you join an Advantage plan, that plan takes over management of all of your Medicare health benefits and become the only and single payer on your medical expenses. You are still in the Medicare program, but instead of the Federal government managing your benefits, the private, Advantage insurance takes over. The Advantage plans are not supplemental insurance and will never pay after Medicare. They pay instead of Medicare, and Original Medicare will never pay on charges while you are enrolled in a private plan.
Medicare Advantage PPO Plans and HMOs
Medicare Advantage PPO and HMO plans are in charge of all of your benefits. As mentioned above, that remains true for as long as you remain enrolled in such a plan. The health maintenance organization (HMO) is made up of a network of health care providers, and when you become a member, you are generally required to receive all of your care from within the network. Normally, if you go out of the network, you would pay the charges out of your own pocket. The only exception to that rule is if you need emergency or urgent care services. A PPO, or preferred provider organization, also includes a network of providers. However, the PPO allows you to receive services out-of-network from providers of your choosing as long as they agree to submit claims to the insurance company.
Most Advantage PPO plans and HMOs include drug coverage, also known as Medicare Part D. In 2010, the rules for Advantage Part D coverage remain largely unchanged from 2009. That is, if you need drug coverage and want to join either a PPO or HMO, then you must accept the Part D coverage offered by the PPO or HMO. In other words, you would not be allowed to enroll into a PPO or HMO and have a separate, stand alone prescription drug plan on the side.
So, how do you choose? How do you decide which is the best decision? These are not easy questions, and ultimately how you choose will depend on your research and what makes you feel most confident. It is important to keep in mind that the core benefits of both programs should be the same as Medicare law requires that all beneficiaries have equal access to the same set of benefits. It is also important to carefully weigh your health care needs against the relative costs of private care versus Original Medicare. And finally, when considering the Advantage plan program, be sure to talk not only with plan representatives but to the Original Medicare customer service staff, as well.
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