California Health Insurance

If you are in Medicare this year, in 2010 and thinking about 2011, 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 plans, whether they are a PPO or HMO include coverage for medication. The drug coverage benefit is often referred to as Part D, and in 2010 the rules are practically the same as in 2009. One important change is that in 2010, if you enter the coverage gap, also known as the “donut hole,” you will receive a $250 rebate. If you plan on joining an Advantage plan and want drug coverage, you must join a plan that bundles Part D into its package of benefits. In other words, if you join a PPO or HMO, you will not be allowed to join a separate, stand-alone prescription plan.

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.

Learn more about cheap health insurance for your family. Get more information on cheap Medicare PPO insurance right now!

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.

Learn more about cheap Medicare PPO insurance and get free tips on cheap health insurance for your family.