Why Replacement Plans for Medicare : share my experiences in the Medical Insurance Industry
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Written by: decey
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Date: Thu, 17 Dec 2009 |
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A US Government Health Program for 65 years and above is “Medicare” for those who have a permanent renal disease, or a disability. However, several commercial insurance companies also offer “Medicare Replacement Plan” which is a similar policy. They are sometimes called Medicare Part C or Medicare Advantage Plans.
I’d like to share my experiences in the Medical Insurance Industry.
The first query is:
Are there any requirements before an individual could acquire a Medicare Replacement plan?
Well the answer is yes. Firstly, the patient must have Medicare Parts A (Hospital/Facility Insurance) and B (Medical/Professional Insurance). So if he/she is eligible to have A and B, he/she has the option to have Part C as well, however, Parts A and B will become inactive while he/she has Part C (since this covers both hospital and medical insurance). Subsequently, if the patient chooses to eliminate Part C, Parts A and B will be active again.
Consequently if Part C is a combination of Parts A and B, why choose Part C over the two?
Good question. There are certain advantages of Medicare Replacement plans such as low Out of Pocket limits and the choice to have additional Pharmacy, Vision, Dental, and Mental Health benefits which typically are not covered by Medicare. However, some services can not be obtainable in Medicare Replacement plans. Well Hospice is one of them; this can only be covered through the original Medicare.
How does Part C relate to benefits?
In view of the fact that commercial insurance companies manage Medicare Replacement plans, an applicant can select from similar types of base plans available. This means applicant the can opt to have a Medicare Replacement HMO, PPO, or PFFS. The Medicare Fee Schedule is the benefit one would get. Here the Part C covers the benefits in a similar manner that regular Medicare would. The disparity would be in the additional benefits and the commercial insurance companies may endow with higher percentages or coverage.
What about the provider network? Who are the people or organizations that I can use my Medicare Replacement Plan with?
In this case the base plan will be considered. If it's a Medicare Replacement HMO, as a rule it works like a regular HMO. You can simply go to providers who are in-network list with Medicare Replacement HMO of that insurance company. Referrals may be required from your Primary Care Physicians.
Be Aware that plans and benefits may change anytime in either or both commercial and Medicare plans.
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