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.
Part of the blame for the increase in complaints lies with Medicare. First, Medicare allows plan sponsors of the Medicare Advantage plans to offer multiple plans with almost identical names. Second, Medicare is allowing the plan sponsors to offer non-health supplementary benefits – benefits not covered by Original Medicare – within the Medicare Advantage plans. These two elements lead to confusion on the part of the beneficiary and agent when comparing multiple plans.
A health plan without your preferred doctors is not health insurance. Similarly, dental or vision benefits without it being accepted by your preferred dentist or optometrist is just a selling gimmick. Consequently, before favoring a Medicare Advantage plan because of the dental or vision benefits embedded in the plan, it is important to learn about the network of providers and if your preferred doctor is in the network.
There are a couple different ways to structure Medicare coverage. In the absence of any extra help from Medicaid or Social Security for Part D prescription drug coverage, the average Medicare beneficiary will realize the $170.10 for Part B and approximately $35 (national average) for a Part D plan. If the beneficiary adds a Medicare Supplement to cover most of the deductibles, copayments, and coinsurance of Original Medicare, there could be an additional cost of approximately $150 (Plan G in California.) That brings the monthly insurance costs up to $355.
Medicare Advantage plans more closely resemble a traditional health insurance plan you may have had from your employer or individual and family plan. They have predictable copayments for many routine health care services such as office visits, labs, tests, and x-rays. Most Medicare Advantage plans include the Part D prescription drug coverage within the plan. For medical services, Medicare Advantage plans have a maximum out-of-pocket amount. Once the dollar amount is met, the Medicare Advantage plan covers all future medical services at zero cost to the plan member.
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.
The rallying cry in the 2020 presidential primaries is Medicare For All. But Original Medicare is the sort of health insurance that the Affordable Care Act set out to ban from the market place. Original Medicare has no annual caps on the maximum out-of-pocket a consumer must pay for either hospitalization or outpatient services. People can incur multiple Part A hospitalization deductibles during the year. The 20 percent coinsurance for medical services can mean some tests, imaging, and procedures can cost the consumer hundreds of dollars. Plus, there is no prescription drug coverage.
A five star Medicare Advantage will be paid $890 in Sacramento County, $947 in San Francisco County, $951 in Los Angeles County and $856 in San Diego County per month by the Centers for Medicare and Medicaid for each enrolled member. The data and calculations that go into determining the monthly reimbursement or capitation rate for Medicare […]