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How do Medicare Advantage plans work? Why are they like a store credit card? Did you know your Advantage plan is not accepted everywhere? Have you ever been told "We don't take that card here"? GA Medicare expert Bob Vineyard explains how Medicare works in this Georgia Medicare Minute video . Call (404)252.5859
Original Medicare has 4 parts. Your red, white and blue card is broadly accepted by doctors and hospitals alike. No networks!
Medicare Part A covers hospital inpatient charges and has a per admission deductible
Medicare Part B is for outpatient health care treatment. Doctor visits, labs, X-rays, MRI, CT scan (CAT scan), ambulance, ER, outpatient clinics, etc. Essentially any Medicare approved health care received outside the hospital setting. Treatment considered medically necessary under Medicare guidelines. Medicare Part B has a calendar year deductible. Once satisfied, Medicare pays 80% of the approved charge, you are responsible for the remaining 20%.
Most seniors worry about hospital stays, but your major expenses will more than likely fall under Medicare Part B outpatient expenses. Original Medicare stand alone has no cap on your out of pocket expenses.
You pay until you run out of money, get well or die.
Did you know that some doctors and hospitals do not accept ANY Medicare Advantage plans? What happens if your claim is DENIED?
Medigap and Advantage plans cover the same things, but what you pay out of pocket for your care, and where you receive your care, is very different.
Original Medicare does not have networks. You can use any doctor or hospital anywhere in the US. Another plus is the ABN form which is only used with Original Medicare.
Advantage plans are managed care plans. Some are PPO, some are HMO. In 2018 about half the plans are HMO with the balance being PPO.
If you receive non-emergency out of network care under a PPO you may have higher copay’s and deductibles. Your max OOP may also be higher. Some plans do not cap out of network charges.
Non-emergency out of network care charges may be denied if you have an HMO.
In 2019 most Advantage plans issued in Georgia limit your out of pocket for approved in network health care expenses to $6700.
The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.
Medicare Advantage and Cancer Treatment
Some cancer centers, such as Mayo Clinic, Sloan Kettering and MD Anderson may not participate in certain Medicare Advantage plans.
Not all cancer responds to chemotherapy, but 80% of cancers are treated with chemo. Those treatments occur in an outpatient setting and are covered under Medicare Part B.
Chemotherapy drugs administered in a doctor's office or clinic normally fall under Part B. Medication from a retail pharmacy or by mail fall under your PDP.
This is why most of us chose a Medicare supplement plan in 2019. Bob Vineyard, independent Medicare insurance broker in Georgia, can explain your Georgia Medicare insurance options and will allow you to decide.
We represent several carriers including Aetna, Anthem Blue Cross, Humana and more.
According to the Mayo clinic, "new cancer treatments are routinely priced at over $100,000 per year of treatment."
You may not know it, but the Mayo Clinic does not participate in any Medicare Advantage plans.
M D Anderson is another cancer treatment facility that does not accept Medicare Advantage plans.
A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was “provider access problems”. Number 4 on the list was “cost sharing too high”.
You may never receive a cancer diagnosis. I hope you don’t. But one thing I can tell you with certainty is this. Original Medicare and a supplement plan provides assurance the funds will be there to pay for almost all of your care.
A good insurance agent will help you navigate the Medicare maze. He or she will take the time to explain how Medicare works. They will ask questions to find out what YOU want and expect from your coverage.
Bob Vineyard has over 40 years experience in the health insurance field. All your questions will be answered. People love to buy but they hate to be sold.
You have questions. We have answers. Georgia Medicare Plans
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Which is better? Original Medicare red, white and blue card or an Advantage Plan store card that can only be used at a few places? anthem ga medigap rates