Choosing Your Medicare Advantage Plan: HMOs vs. PPOs

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Choosing the right health plan shouldn’t be complicated. In this blog, we’ll explain the main differences between them, providing insights to help you make informed decisions. Think of this as your handy guide, with essential questions to make your healthcare choices easier and help you confidently pick between HMOs and PPOs.

HMO vs. PPO: What You Need to Know

HMOs are known for being cost-effective with designated provider networks, while PPOs offer more flexibility at a higher cost, allowing you to access out-of-network care. Your choice between the two ultimately depends on your preferences regarding costs and restrictions.

Understanding HMOs:

Health Maintenance Organization (HMO) plans typically consist of an approved network of healthcare providers. In most cases, your medical care is covered only if you visit a provider within the plan network. Going outside this network might mean paying the full cost of services, except in emergencies.

Understanding PPOs:

Preferred Provider Organization (PPO) plans provide you with the flexibility to choose your healthcare provider. Like HMOs, PPOs establish a provider network, usually resulting in lower out-of-pocket expenses when staying within the network. However, partial coverage for out-of-network care is possible, with higher anticipated costs for services beyond the designated network.

Commonalities Between HMOs and PPOs:

Despite their differences, both HMO and PPO Medicare Advantage plans share common ground. They offer the same coverage as Medicare Part A (hospital insurance) and Part B (medical insurance) in a unified plan.

Many Medicare HMO and Medicare PPO plans also include additional benefits beyond what Original Medicare covers.

Key Questions to Consider when choosing between an HMO plan and a PPO plan:

  1. Provider Accessibility:
    • HMO: Do you prefer a plan with a specific network of approved providers?
    • PPO: Is having the flexibility to choose your healthcare provider important to you?
  2. Cost Considerations:
    • HMO: Are you looking for a cost-effective plan with potentially lower out-of-pocket expenses within the network?
    • PPO: Can you afford the higher cost for the flexibility to access both in-network and out-of-network care?
  3. Primary Care Physician Preference:
    • HMO: Do you value having a primary care physician coordinate your care within a network?
    • PPO: Is having the freedom to choose specialists without referrals more appealing to you?
  4. Network Restrictions:
    • HMO: Can you commit to receiving most, if not all, of your care within the plan’s network?
    • PPO: Are you willing to pay higher costs for the flexibility to see providers outside the designated network?
  5. Coverage Beyond Medicare Parts A & B:
    • HMO and PPO: Are you interested in additional benefits beyond what Original Medicare covers, offered by both plan types?
  6. Coordinated Care Preference:
    • HMO: Do you appreciate a team approach to your care within a coordinated network?
    • PPO: Does the idea of having more individual control over your healthcare decisions appeal to you?
  7. Freedom of Choice:
    • HMO: Is having a more structured healthcare experience with a designated network preferable?
    • PPO: Do you value the freedom to seek care from any healthcare provider without network restrictions?
  8. Personal Healthcare Needs:
    • HMO and PPO: When deciding, consider your specific health requirements, provider preferences, and overall comfort level with each plan’s features.
  9. Customer Service and Support:
    • HMO and PPO: What is the quality of customer service for each plan, and how responsive are they to your inquiries?
  10. Travel Considerations:
    • HMO: How does the plan handle healthcare needs when you’re outside the plan’s service area?
    • PPO: Are there additional benefits or coverage when seeking care outside the designated network, especially during travel?

Choosing between an HMO and a PPO requires considering key aspects. By asking these questions, you can pinpoint what matters most to you in terms of cost, flexibility, and healthcare preferences. Your ideal plan is the one that aligns with your lifestyle and budget.

To help you weigh the pros and cons and make a confident decision, download this FREE HMO vs PPO Guide.

Your health coverage should cater to your needs, ensuring you receive the best care for your unique situation.

If you would like additional assistance with plan comparisons, please contact our office today and we would be happy to schedule a review to ensure your Medicare needs are properly in place for 2024.

Resources:

Medicare.gov

www.uhc.com/news-articles/medicare-articles/the-difference-between-medicare-hmo-and-ppo-plans

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What is the Upcoming Medicare GEP?

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If you’re new to Medicare, understanding the various enrollment periods can be a bit overwhelming. With the Annual Enrollment Period (AEP) coming to a close, two crucial enrollment periods are just around the corner: the General Enrollment Period (GEP) and the Medicare Advantage Open Enrollment Period (MAOEP).

Both run simultaneously from January 1st to March 31st.

First, some background. When you are new to Medicare, you have an Initial Enrollment Period (IEP) that runs for a total of 7 months: 3 months before the month you turn 65, the month you turn 65 and the 3 months following that month.

Example: If your birthday is December 3rd, your IEP starts on September 1st and ends on March 31st.

This is the best time to enroll in Original Medicare (Parts A and B together) because you’ll avoid potential penalty fees and delays in healthcare coverage.

However, if you happen to miss your Initial Enrollment Period (IEP), don’t worry. You get another chance each year during the General Enrollment Period (GEP) to sign up for Medicare Part A and/or Part B. During the GEP, you can only enroll in Medicare Part A and/or Part B.

During this time, you cannot:

  • Enroll in a prescription drug plan (Part D)
  • Buy a Medicare Advantage plan (Part C)
  • Change any existing coverage you might have (like going from one Advantage plan to another or dropping Part D)
  • Make any other changes to your coverage

Penalties for Signing Up Late

If you sign up for Parts A and/or B during the General Enrollment Period, you might have to pay extra on your usual premiums – that’s the penalty for signing up late. That’s why it’s a good idea to enroll during your Initial Enrollment Period (IEP).

  • Part A Late Enrollment:

If you need to purchase Part A and miss your first Medicare eligibility chance, your monthly premium may increase by 10%. The penalty lasts for twice the number of years you delayed. For example, if you wait 2 years to sign up, you’ll pay a higher premium for 4 years. Special Enrollment Periods may exempt you from penalties – check your eligibility.

  • Part B Late Enrollment:

You usually won’t face a Part B penalty with a Special Enrollment Period. Expect an extra 10% for each year you could have enrolled but didn’t. Your income may also affect your premium. Learn more about Special Enrollment Periods for your options here: Special Enrollment Periods | Medicare

During the GEP, there is another period called the Medicare Advantage Open Enrollment Period (MAOEP). The main difference between Medicare Advantage Open Enrollment and General Open Enrollment is who can use each one and what changes you can make.

The Medicare Advantage Open Enrollment Period (MAOEP) lets you:

  1. Change Medicare Advantage Plans: You must be already enrolled into a Medicare Advantage plan. If both Medicare Advantage plans are offered in your area, you may change from one to another.
  2. Go Back to Original Medicare: You can drop your Medicare Advantage plan and return to Original Medicare (Parts A and B), with a Part D prescription drug plan. You also have the option to add a Medicare Supplement (Medigap) policy. However, this is not a guaranteed issue. You will most likely have to go through Medical Underwriting.

During this time, You cannot:

  • Enroll in Medicare Advantage for the first time if you are currently on Part A and Part B (Original Medicare).

Understanding and navigating these enrollment periods is crucial for ensuring that you have the right Medicare coverage. If you have any questions or need more information on changing your plan, feel free to reach out to our office today at  (631) 476-4015 and we would be happy to assist you.

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November is Diabetes Awareness Month

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November is a crucial month in the health calendar as it is recognized as Diabetes Awareness Month. This is a time to bring attention to the disease and the millions of people affected by it. It’s also an excellent opportunity for us to shine a light on the importance of health, reminding everyone that your health matters!

  1. Type 1 Diabetes: An autoimmune condition where the body’s immune system attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes need lifelong insulin therapy.
  2. Type 2 Diabetes: The most common form, often linked to lifestyle factors like poor diet and lack of exercise. It results in the body not using insulin properly or not producing enough, leading to elevated blood sugar levels.
  3. Gestational Diabetes: A temporary form that occurs during pregnancy, usually resolved after childbirth, but it increases the risk of developing type 2 diabetes later in life.

Diabetes Management and Medicare: Know the Updates for 2024

One of the most significant challenges for those managing diabetes is the cost of the necessary supplies and medications. However, for Medicare recipients, there will be some important changes starting in 2024 that could make managing diabetes more affordable.

What’s Covered Under Medicare Part B:

  • Injectable insulin used with a traditional insulin pump
  • Insulin used with a disposable insulin pump
  • Diabetes screenings and exams
  • Diabetes self-management training (DSMT) – Medicare may cover up to 10 hours of this initial training – 1 hour of individual and 9 hours of group training. You may also qualify for up to 2 hours of follow-up training in each calendar year that falls after the year you got your initial training.
  • Therapeutic shoes & inserts covered each calendar year:
  • One pair of custom-molded shoes and inserts
  • One pair of extra-depth shoes

Medicare will also cover:

– 2 additional pairs of inserts each calendar year for custom-molded shoes

– 3 pairs of inserts each calendar year for extra-depth shoes

In 2024, Medicare Part B will be extending the $35 monthly co-pay for insulin provided through durable medical equipment (DME). This is a significant improvement that will help many people manage their diabetes more effectively. Furthermore, blood sugar testing supplies will also be available with a $35 monthly co-pay, making it easier to monitor and manage diabetes-related complications.

Medicare Part D Coverage

For those using injectable insulin not associated with a traditional insulin pump or insulin used with a disposable pump, Medicare Part D has got you covered. Additionally, Part D covers certain medical supplies required for insulin injections, including syringes, gauze, and alcohol swabs. Insulin that is inhaled is also covered under Part D.

Starting January 2024, Medicare Part D will extend its coverage to include diabetes-related expenses. Under this plan, individuals can benefit from a $35 monthly co-pay for diabetes medications, and this cost won’t be subject to the plan’s deductible. This expansion is a positive step in making diabetes management more accessible and affordable for Medicare beneficiaries.

Medigap Coverage

If you have Part B and Medigap covering your Part B coinsurance, your plan should cover the $35/month (or less) cost for each covered insulin.

Reversal and Prevention- Keep Diabetes in Check!

Type 2 diabetes, which constitutes about 90-95% of all diabetes cases, is often associated with lifestyle factors. According to the International Diabetes Federation, over 50% of type 2 diabetes is preventable.  It’s essential to address preventive measures and potential reversals for individuals with type 2 diabetes or those at risk. For those with type 2 diabetes or at risk, lifestyle changes play a crucial role.

The 3 pillars to battle Diabetes are Weight loss, adopting a balanced diet, increasing physical activity.

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3 Common Mistakes to Avoid During the Medicare Annual Enrollment Period (AEP)!

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The Medicare Annual Enrollment Period (AEP) is a crucial time of year for Medicare recipients to reevaluate their coverage and make necessary changes. This period, which runs from October 15 to December 7 annually, offers the opportunity to find more affordable coverage, reduce prescription drug costs, or even get more coverage for a similar price. To help you make the most of the AEP, we’ve identified three common mistakes to avoid.

  1. Ignoring Your Medicare Annual Notice of Change (ANOC)
    The Annual Notice of Change (ANOC) is a vital document sent to Medicare beneficiaries, outlining any upcoming changes in plan coverage, service area, or costs starting in January. Don’t overlook this document; it provides insight into what adjustments you may need to make to your Medicare plan. According to a survey in 2020, 46% of beneficiaries did not review their current plan’s coverage. It is important to take the time to review your ANOC  to help ensure you are properly covered in the upcoming year.
  2. Not Considering Prescription Drug Coverage (Medicare Part D)
    Even if you don’t currently take prescription medications, signing up for a Medicare Prescription Drug Plan (Part D) is essential to avoid potential late penalties in the future. The only exception is if you have creditable drug coverage from another source.

    Don’t forget to compare your plans! Fewer than 2 in 10 Medicare Advantage prescription drug plan (MA-PDs) enrollees (18%) and 3 in 10 stand-alone prescription drug plan (PDPs) enrollees (27%) compared their plan’s drug coverage with drug coverage offered by other plans in their area. To help minimize costs, select a Part D plan with the lowest premium and adjust it as your medication needs change. Alternatively, consider a Medicare Advantage plan with built-in prescription drug coverage for comprehensive benefits.
  3. Not Being Alert to Medicare Scammers
    Medicare fraud is a sad reality, and beneficiaries need to remain vigilant. Protect your personal information, including your Social Security number, bank account details, and Medicare ID number. Only share this information with authorized individuals and trusted sources. Beware of scammers seeking to exploit your Medicare information.

The Medicare Annual Enrollment Period is a valuable opportunity to optimize your healthcare coverage. By avoiding these common mistakes and staying informed, you can make the most of this period and secure the benefits you deserve. Be proactive in reviewing your options, considering prescription drug coverage, and safeguarding your personal information to ensure a smooth and beneficial AEP experience. 

Contact us today to schedule your Medicare coverage review appointment to ensure the proper benefits are in place for 2024.

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