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How Medicare works when there are no networks. Keep your doctor. No referrals. GA Medicare expert Bob Vineyard explains how Medicare works in this Georgia Medicare Minute video . Call (404)252-5859
Original Medicare and supplement vs Advantage Plan
How are Medicare Advantage plans like a store credit card?
Remember "If you like your doctor you can keep your doctor"? This time it isn't a campaign promise. You will not be required to change doctors when you have original Medicare and a Medigap plan.
If you are turning 65 and enrolling in Medicare, this may be your only chance to purchase a Medigap plan. Here is your guide to understanding GA Medicare.
You don't have to receive Social Security to enroll in Medicare insurance. CMS is the agency that oversees Medicare.
Senior healthcare insurance is commonly used to describe Medicare.
How to enroll in Medicare? You may sign up for Medicare 3 months before your 65th birthday, the month you turn 65, and 3 months following your 65th birthday. You may enroll online (highly recommended), by mail or by visiting a Social Security office.
Original Medicare has 4 parts.
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.
Medicare Part C is now referred to as Medicare Advantage. More on that later.
Medicare Part D covers outpatient prescription drugs. Some Advantage plans have drug coverage built into the plan.
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 2018 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.
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 2018. 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. Some plans include SILVER SNEAKERS
According to the Mayo clinic, "new cancer treatments are routinely priced at over $100,000 per year of treatment."
But not if you have original Medicare and a Medigap insurance plan.
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”.
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Over 96% of primary care physicians participate in Medicare. Keep your doctors. There are NO NETWORKS when you have original Medicare. Georgia Medicare expert.