If you find yourself in a Medicare Advantage plan you do not like, you have an escape hatch to another plan. The Medicare Advantage Open Enrollment Period is a short period of time when you can escape from your current enrollment, switch to another Medicare Advantage plan, or return to Original Medicare with a Part […]
Posts related to Medicare Advantage plans which are original Medicare health benefits provided by private companies.
The team at FairStreet had to overcome my built-in skepticism. One aspect of their company that they inadvertently revealed to me was that they were not a sales company. They had a different approach and perspective. The emphasis was on providing clear information for appropriate analysis of Medicare options. This is what we need in the senior Medicare market. We need less emphasis on sales and more focus on education, information, and beneficiary compatibility with the Medicare plans.
Once you know which plans support your providers, you can begin to build your benefit comparison spreadsheet. I have broken this spreadsheet into 3 categories: medical, prescription drug, and supplemental benefits. I created a fictitious plan sponsor, Solar System Health Plans, and fictitious plan names: Mercury 212, Venus 72, and Saturn 25. The benefits and costs are similar to what might be available in your area.
The great thing about Medicare is that you can build your train the way you want. You can change the train cars every year. But the important aspect is that you own the Medicare engine. You are the engineer and you can build your train the way you want it.
In California, there are thirteen counties where the Medicare Advantage capitation amount will exceed $1,000 per enrolled member. This does not include any possible bonuses based on quality scores OR for any Part D Prescription drug benefits included in the Medicare Advantage plan. The lowest capitation amount is $841.14 in Imperial County and the highest is $1,158.97 in Inyo County. These figures are from the Medicare RateBook2020 that lists the capitation amounts for all counties in the United States.
If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
You must have been enrolled in a Medicare Advantage medical plan to take advantage of the MA OEP. If you never enrolled in a MA or MA-PD, you can’t join one during the MA OEP. You can’t switch standalone Part D Prescription drug plans during the MA OEP. Additionally, if you go from a MA-PD to a MA plan, you can’t add a standalone Part D Prescription Drug plan. The MA OEP doesn’t apply to Medicare Savings Accounts (MSAs) or Cost Plans.
For eligible members, there is no additional cost to participate in this program or for services provided by Landmark. Covered services provided by non-Landmark providers through a referral from Landmark may be subject to cost-sharing based on members’ health plan benefits and coverage.
This high level overview and will not address every situation that a Medicare beneficiary may find them self in. This short primer is meant help you understand the different parts of Medicare and how they work, or don’t work, together. The following information can also be found in the Medicare and You Handbook.
Anthem Blue Cross of California Medicare Advantage dual eligibility with Medi-Cal Special Needs Plans May 30, 2015 This guidance is generally applicable for all health insurance companies that offer Medicare Advantage Special Needs Plans for dual eligible beneficiaries. Dual Eligibles (Duals) are individuals who are entitled to benefits from both the federal Medicare and state-run […]