What will it be for 2010, Original Medicare or an Advantage plan? Typically, the average person turning 65 and about to be enrolled into Medicare is unclear on just how to receive his or her benefits. Do you choose Original Medicare or one of the many private, Medicare Advantage plans? 2010 is a year of great financial change for many Medicare insurance companies due to the recent health insurance reform of the Obama administration. However, this will not affect the actual working of either traditional Medicare or the privately managed Advantage plans.
Medicare Advantage plans in 2010
How Medicare Advantage plans work in 2010 is pretty much the same as they did in 2009. This is true regardless of whether we are talking about Advantage PPO plans, HMO, or any other sort, such private fee for service plans. One major difference, however, is that premium and out-of-pocket costs have generally gone up from 2009. We also find that there are far fewer Advantage plans with zero monthly premiums. Also, in past years there were more plans whose cost sharing was less expensive than Original Medicare. In 2010, we find more Advantage plans whose out-of-pocket costs are nearly the same or greater than those 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 plans and HMOs, like all Advantage plans, are in charge of all of your health care and billing for the duration of your enrollment. The PPO plans include a network of doctors, hospitals, and other health care providers you can go to but also allow you to go out of network to doctors of your own choosing as long as they agree to accept the plans payment terms. In contrast, an HMO, or health maintenance organization, requires you to only use the health care providers who are in the network and have a contract with the plan. In an HMO, if you go out of network, you generally pay all costs out of your own pocket unless you are receiving emergency or urgent care.
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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