plaable e delaimis providininsuran outpatient redifficult to choose the planis doesn't. Te er wondof tage Plans don't show their Supplementred to the average health. anies during any Regardiess of current or preen insurance company before the for Chemothpitaliration, 30% Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to the contimuation of Part 4 of my, "New to Medicare" series which I'm writing to help guide those who will soon be going on Medicare Parts, Á. B, or both for the first time. QUESTION: What are the pros and cons of both Medicare Supplements and Advantage Plans? ANSWER: Last week was devoted to Supplements. This week we will do the same with Advantage Plans. I recommend reading this issue side by side with last weeks, if possible, which along with the full series can be found on our website, I'm going to start by listing cons of Advantage Plans to coincide with the pros of Supplements and vice versa hopes of making how they differ a bit clearer. If you're new to the series, Ialso suggest golng to our website and reading them from the choose from. Premlums range from $0 to over $300/month. Co-pays for the same exact medical service can There are plans that offer what ! consider very good value for little or no cost and most come with both medical and Part D prescription drug coverage. In 321 we have yet to recommend an Advantage Plan that had a monthly premium also vary quite widely For example, the same 6 day hospital stay can be $00 to $1,800 depending. What one can be responsible for in total medical bills each calendar year also varies and is known as the annual Maximum Out of Pocket (MOOP). The M00P can be as low as $1.000 and as high as $7.550. I realize this may not make sense but paying more premium for an Advantage Plan doesn't guarantee lower co pays or MOOP. Advantage Plans are HMO's and PPO's and have networks of doctors and hospitals one can use Except for emergencies, those who have HMO's must utilize network providers. The insurance company will pay for any voluntary ndical services provided out of network. Those on PPO's can the network if the mediel agrees to take their plan, however, the insured can be billed thousands more than paid in network. Network access to both UPMC and AHN is also not available with all Advantage Plan companies, nor is access to other world class facilities such as the Mayo Clinic, Cleveland Clinie, MD Anderson, and others over 850. twith premiums averaging $100 plus per month including Stand-Alone Part D coverage, savings over a five-year period can be as mach as $2500 to $6.000 for those who choose Advantage Plans, even more for people who are in their late 20's and older. In addition, Part D coverage in Advantage Plans doesn't have deductibles for Tier 3, 4. and 5 medications like Stand Alone Part D. the prescription coverage those on Supplements generally need to purchase. Select Advantage Plans also offer what can be very valuable comprebensive dental benefits such as cleanines, fillings, extractions, root canals, crowns, and dentures: in beginning. Let me start by explaining Medicare Advantage Plans are not secondary to Medicare or designed to pick up the portion of the bil Medicare Medicare. in lieu of In other Medicare paying all but $1.684 of a ert A inpatient hospital 20 of Part B outpatient services stay and Medicare pays an approved private insurance company of one's choice provider approximately $800 a month, In return, that private company agrees to take on the burden of the Medicare beneficiary Iwhat they would have surance benefits d paying all approved e sone C CmA and giasses ruotine hearing es hins o exams and gym membersnips, aide: frve oum the counter (OTC)allowances to over es cost sharing generally in the form of co-pays and co insurance (percentage of the total bill one is responsible for.) Those on Advantage Plans have a cost for virtually every medical service. Some examples are: 85 for PCP visits, $40 for and X-ray S90 for the ER, $200 for an. ride, S25 for an MRI, $250 for an n S/day for surgery minus Spend on practically that can be found on the s pharmacy; and more. Those who maximize their OTC and vision benefits, use just a minimum amount of dental, and go to the gym regularly can receive $1.000 or more worth of goods and services annually. Please be advised that not 1 plans offer the same amount or guality of ancillary benefits and upplements don't provide them at all. at a Advantage Plan companies ultimatel y decide what is medically necessary. MRI's CT scans, Outpatient Surgeries, home health lother services must be care, and o prior authorized, meaning claims must be submitted by a doctor and approved by an inpatient ror Durable Those with l Equipment. or t can recelve services and is guaranteed. Although red, white, and at the doctor or hospital e Medicare card They Lastly Advantage Plans don't utiline medical underwriting, meaning all companles and plans ran insuran ns can be denied inform the prowider they don't deem addtionalo in a hospital or Skilled Nursing necessary in the event this would Occur an appeal can be filed and expedited on behalf of the patient. y can ecompatiett just show the card issued from the private company We actually tell our Advantage Plan clients to file their Medicare card away with their other important documents. days must accept anyone who has both Original Medicare Parts A and B. can sand Medicare Advantage Plans are regulated but are not as nearly as cut and dry as Supplements. Advantage Plans all must cover the same benefits as Original and as good or better enrollment period. The Advantage Plans, uplike Supplements, can change benefits from year to year, which can result in higher co-pays, more total out of insurance companies must also pay claims the first day the policy goes into effect and there are no pre existing condition clauses Medicare. than Medicare, but that's about where the similarities between plan benefits end when comparing Advantage Plans or con the cons of Advantage pocket costs, and/or removal or reduction in ancillary benefits. These can be difficult to keep up with or larger do und in a lo0 page Annual Notification of Change (ANOC) that must be mailed out to all Advantage Plan members by October Ist each year. Remember that my columns and this series are not designed as a substitute for working closely with a licensed agent like those at The Health Insurance Store The goal is to start the education process, not make a final decision. Trcommend everyone call or email us to set up an appointment for a no cost consultation so your individual needs and concerns can be addressed. called the One of sin my opinion is it's much urms that offer the best value i t of premiums, out of pocket costs and ancillary benefits. There are five companies competing in this market in Southwestern PA and approximately 80 different plans to The number one benefit of Advantage Plans in my opinion is the opportunity to save a significant amount of money on premiums. 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents plaable e delaimis providininsuran outpatient redifficult to choose the planis doesn't. Te er wondof tage Plans don't show their Supplementred to the average health. anies during any Regardiess of current or preen insurance company before the for Chemothpitaliration, 30% Paid Advertisement Ask the Medicare Specialist by: Aaron Zolbrod Welcome to the contimuation of Part 4 of my, "New to Medicare" series which I'm writing to help guide those who will soon be going on Medicare Parts, Á. B, or both for the first time. QUESTION: What are the pros and cons of both Medicare Supplements and Advantage Plans? ANSWER: Last week was devoted to Supplements. This week we will do the same with Advantage Plans. I recommend reading this issue side by side with last weeks, if possible, which along with the full series can be found on our website, I'm going to start by listing cons of Advantage Plans to coincide with the pros of Supplements and vice versa hopes of making how they differ a bit clearer. If you're new to the series, Ialso suggest golng to our website and reading them from the choose from. Premlums range from $0 to over $300/month. Co-pays for the same exact medical service can There are plans that offer what ! consider very good value for little or no cost and most come with both medical and Part D prescription drug coverage. In 321 we have yet to recommend an Advantage Plan that had a monthly premium also vary quite widely For example, the same 6 day hospital stay can be $00 to $1,800 depending. What one can be responsible for in total medical bills each calendar year also varies and is known as the annual Maximum Out of Pocket (MOOP). The M00P can be as low as $1.000 and as high as $7.550. I realize this may not make sense but paying more premium for an Advantage Plan doesn't guarantee lower co pays or MOOP. Advantage Plans are HMO's and PPO's and have networks of doctors and hospitals one can use Except for emergencies, those who have HMO's must utilize network providers. The insurance company will pay for any voluntary ndical services provided out of network. Those on PPO's can the network if the mediel agrees to take their plan, however, the insured can be billed thousands more than paid in network. Network access to both UPMC and AHN is also not available with all Advantage Plan companies, nor is access to other world class facilities such as the Mayo Clinic, Cleveland Clinie, MD Anderson, and others over 850. twith premiums averaging $100 plus per month including Stand-Alone Part D coverage, savings over a five-year period can be as mach as $2500 to $6.000 for those who choose Advantage Plans, even more for people who are in their late 20's and older. In addition, Part D coverage in Advantage Plans doesn't have deductibles for Tier 3, 4. and 5 medications like Stand Alone Part D. the prescription coverage those on Supplements generally need to purchase. Select Advantage Plans also offer what can be very valuable comprebensive dental benefits such as cleanines, fillings, extractions, root canals, crowns, and dentures: in beginning. Let me start by explaining Medicare Advantage Plans are not secondary to Medicare or designed to pick up the portion of the bil Medicare Medicare. in lieu of In other Medicare paying all but $1.684 of a ert A inpatient hospital 20 of Part B outpatient services stay and Medicare pays an approved private insurance company of one's choice provider approximately $800 a month, In return, that private company agrees to take on the burden of the Medicare beneficiary Iwhat they would have surance benefits d paying all approved e sone C CmA and giasses ruotine hearing es hins o exams and gym membersnips, aide: frve oum the counter (OTC)allowances to over es cost sharing generally in the form of co-pays and co insurance (percentage of the total bill one is responsible for.) Those on Advantage Plans have a cost for virtually every medical service. Some examples are: 85 for PCP visits, $40 for and X-ray S90 for the ER, $200 for an. ride, S25 for an MRI, $250 for an n S/day for surgery minus Spend on practically that can be found on the s pharmacy; and more. Those who maximize their OTC and vision benefits, use just a minimum amount of dental, and go to the gym regularly can receive $1.000 or more worth of goods and services annually. Please be advised that not 1 plans offer the same amount or guality of ancillary benefits and upplements don't provide them at all. at a Advantage Plan companies ultimatel y decide what is medically necessary. MRI's CT scans, Outpatient Surgeries, home health lother services must be care, and o prior authorized, meaning claims must be submitted by a doctor and approved by an inpatient ror Durable Those with l Equipment. or t can recelve services and is guaranteed. Although red, white, and at the doctor or hospital e Medicare card They Lastly Advantage Plans don't utiline medical underwriting, meaning all companles and plans ran insuran ns can be denied inform the prowider they don't deem addtionalo in a hospital or Skilled Nursing necessary in the event this would Occur an appeal can be filed and expedited on behalf of the patient. y can ecompatiett just show the card issued from the private company We actually tell our Advantage Plan clients to file their Medicare card away with their other important documents. days must accept anyone who has both Original Medicare Parts A and B. can sand Medicare Advantage Plans are regulated but are not as nearly as cut and dry as Supplements. Advantage Plans all must cover the same benefits as Original and as good or better enrollment period. The Advantage Plans, uplike Supplements, can change benefits from year to year, which can result in higher co-pays, more total out of insurance companies must also pay claims the first day the policy goes into effect and there are no pre existing condition clauses Medicare. than Medicare, but that's about where the similarities between plan benefits end when comparing Advantage Plans or con the cons of Advantage pocket costs, and/or removal or reduction in ancillary benefits. These can be difficult to keep up with or larger do und in a lo0 page Annual Notification of Change (ANOC) that must be mailed out to all Advantage Plan members by October Ist each year. Remember that my columns and this series are not designed as a substitute for working closely with a licensed agent like those at The Health Insurance Store The goal is to start the education process, not make a final decision. Trcommend everyone call or email us to set up an appointment for a no cost consultation so your individual needs and concerns can be addressed. called the One of sin my opinion is it's much urms that offer the best value i t of premiums, out of pocket costs and ancillary benefits. There are five companies competing in this market in Southwestern PA and approximately 80 different plans to The number one benefit of Advantage Plans in my opinion is the opportunity to save a significant amount of money on premiums. 724-603-3403 The Health Insurance Store.e Connellsville 412-349-8818 Forest Hills Email your question to: aaron@getyourbestplan.com www.getyourbestplan.com No-cost, unbiased Medicare plan review and consultation with local, licensed agents