Dems, Please Investigate: There Are Insurance Companies Which Oversea Medicare Advantage Plans

Image result for images of medicare advantage

As a senior citizen living in the State of Florida I am very familiar with health insurance companies like Aetna, Humana, United, etc. which manage very popular Medicare plans called Medicare Advantage.

I mention this as a fact which can be used by Democratic Party candidates to counter the GOP talking point that a ‘Medicare for All’ plan would involve the insured no longer dealing with a health insurance company. Please advise these GOP politicians to talk to their elderly folks in their communities to learn more about how Medicare Advantage plans work.

Related image

Here’s how Medicare Advantage works (Source: medicare.gov)…

“You can get your Medicare benefits through Original Medicare, or a Medicare
Advantage Plan (like an HMO or PPO). If you have Original Medicare, the
government pays for Medicare benefits when you get them. Medicare Advantage
Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies
approved by Medicare.”

“Medicare pays these (health insurance) companies to cover your Medicare benefits.”

“If you join a Medicare Advantage Plan, the plan will provide all of your Medicare
Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.
This is different than a Medicare Supplement Insurance (Medigap) policy.”

Image result for photos of seniors on medicare advantage plans

There are the different types of Medicare Advantage Plans:

• “Health Maintenance Organization (HMO) plans—In most HMOs, you can
only go to doctors, other health care providers, or hospitals in the plan’s network,
except in an urgent or emergency situation. You may also need to get a referral
from your primary care doctor for tests or to see other doctors or specialists.”

• “Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you
use doctors, hospitals, and other health care providers that belong to the plan’s
network. You usually pay more if you use doctors, hospitals, and providers outside
of the network.”

Related image

• “Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.”

• “Special Needs Plans (SNPs)—SNPs provide focused and specialized health care
for specific groups of people, like those who have both Medicare and Medicaid,
live in a nursing home, or have certain chronic medical conditions.”

• “HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow
you to get some services out-of-network for a higher copayment or coinsurance.”

• “Medical Savings Account (MSA) plans—These plans combine a high-deductible
health plan with a bank account. Medicare deposits money into the account
(usually less than the deductible). You can use the money to pay for your health
care services during the year. MSA plans don’t offer Medicare drug coverage. If
you want drug coverage, you have to join a Medicare Prescription Drug Plan.”

Image result for photos of seniors on medicare advantage plans

“Who can join a Medicare Advantage Plan?”

“You must have Medicare Parts A and B and live in the plan’s service area to be eligible
to join. People with End-Stage Renal Disease (permanent kidney failure) generally can’t
join a Medicare Advantage Plan.”

“How much do Medicare Advantage Plans cost?”

“In addition to your Part B premium, you usually pay one monthly premium for the
services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has
different premiums and costs for services, so it’s important to compare plans in your
area and understand plan costs and benefits before you join.”

Image result for photos of seniors on medicare advantage plans

What do Medicare Advantage Plans cover?

“Medicare Advantage Plans must cover all of the services that Original Medicare covers
except hospice care. Original Medicare covers hospice care even if you’re in a Medicare
Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for
emergency and urgent care. Medicare Advantage Plans must offer emergency coverage
outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage
Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.
Most Medicare Advantage Plans include Medicare prescription drug coverage
(Part D). In addition to your Part B premium, you usually pay one monthly premium
for the plan’s medical and prescription drug coverage.”

7 comments

  1. Several years back, I decided to forego any Medicare Advantage programs and instead set money aside each month to cover medical costs not covered by Medicare. I’ve been extremely fortunate (especially at my –unrevealed– age) to be very healthy so my doctor visits are minimal. My biggest costs have been dental, but even at that I don’t feel a Medicare Advantage plan would be to my benefit.

    As for “Medicare for All,” I do think it has advantages, but there are numerous considerations that would need to be worked out before it could be put into effect. And no one seems to want to do that. It tends to be all talk and no action.

    Liked by 1 person

    • Dear Nan,

      I don’t recommend Medicare Advantage plans, per se. I’m just trying to inform Democratic candidates that health insurance companies are managing some Medicare plans.

      I’ve noticed some GOP folks using the fact that ‘Medicare for All’ would eliminate an entire health insurance industry as a talking point trying to paint this concept as an overly drastic measure. I’m guessing that some of these young-uns may not be aware of the reality that health insurance companies have been managing Medicare Advantage plans for years.

      Hugs, Gronda

      Liked by 1 person

      • IMO, most politicians don’t have a clue on most things they’re supposed to be looking at and/or voting on. They just do what the lobbyists “suggest” (via $$$ in their pockets).

        Liked by 1 person

    • Dear Holly,

      This post is in response to comments made by a pundit in the presence of Sen. Kamala Harris that if there was Medicare for All, the consumers would have to forgo going through insurance companies, and that this would do away with an entire industry. Sen. Kamala Harris didn’t have an informed come-back to this GOP talking point which means she might not be aware that there are health insurance companies managing Medicare programs.

      There’s no reason for Dems to be caught flat-footed on this issue.

      Hugs, Gronda

      Liked by 1 person

Comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.