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Medicare Advantage Vs. Medicare

You’re probably already familiar with Original Medicare, especially if you’re nearing the age of 65 and getting ready to enroll. You may not be aware, though, that there are some gaps in Original Medicare’s coverage, which lead many people to either add a Medicare Supplement Plan or choose a Medicare Advantage Plan. Medicare Advantage Plans, also known as Medicare Part C, are very similar to Original Medicare. However, there is a slight difference between the two, mainly that Medicare Advantage Plans offer more coverage than Original Medicare.

caucasian hand over an older caucasian hand bringing it towards blocks — *Medicare Part B covers physical therapy, doctor visits, and more.*

Original Medicare Overview

Medicare is a government health insurance program consisting of:

Part A– Hospital insurance that covers hospital stays, skilled nursing care facilities, hospice care, and limited home healthcare services.
Part B– Medical insurance that covers preventive services, doctors’ office visits, flu shots, physical therapy, durable medical equipment, diabetes screening and supplies, and mental health care.

In most cases, you will not pay a monthly premium for Medicare Part A; the Medicare taxes that you paid while you were working are what pay for Part A. However, Part A does have a deductible, coinsurance, and co-payments.

Part B, on the other hand, does have a monthly premium: the Medicare Part B premium for 2020 is $144.60, but could be higher depending on your income. Like Part A, Part B also has a deductible, coinsurance, and co-payments for most services. Medicare Part B covers 80% of your costs, meaning you will need to pay the remaining 20% of any bills.

Medicare Advantage Overview

Medicare Advantage is an “all-in-one” alternative to Original Medicare. Private insurance companies approved by Medicare can offer Medicare Advantage Plans. Unlike Original Medicare, most Medicare Advantage Plans include prescription drug coverage, and some plans offer more benefits, like routine dental or hearing care. In order to be eligible for Medicare Advantage, you have to be enrolled in Medicare Part A and Part B. You must also live in the plan’s service area, and you cannot have end-stage renal disease.Medicare Advantage Plan premiums differ from plan to plan. Many Medicare Advantage Plans have low-cost, or even $0, premiums. The average Medicare Advantage premium is only $30 a month. Remember, you will still have to pay your monthly Medicare Part B premiums in addition to any Medicare Advantage premium.

The Similarities

All Medicare Advantage Plans have to offer at least the same benefits as Medicare Parts A and B do. This means that if Original Medicare covers hospital care at a certain level, then so will a Medicare Advantage Plan.

The Differences

The benefit of Medicare Advantage Plans is that they offer more coverage than Original Medicare. The following chart breaks down the differences between the two:

Medicare Spent $1.4B on Discarded Medicare Drugs

According to a recent study, Medicare spent $1.4 billion on drugs in 2017 and 2018 that ended up being discarded. More specifically, Medicare spent $695 million on discarded Part B drugs in 2017, and $725 million in 2018. Most of these wasted tax dollars went towards chemotherapy and cancer-treating drugs that were not used. Medicare now has plans for utilizing that $1.4 billion rather than wasting it.

Wasted Resources

hundred dollar bills and other bills crumbled in a trash can — *$1.4 billion of wasted money was on drugs that were discarded, that could’ve been used for other things.*

Most of the drugs that were discarded in this two-year period were unused units of chemotherapy drugs. They ended up being disposed of because many units were single-dose vials that contained a higher dose than was needed to treat the average patient. This $1.4 billion of essentially wasted money accounts for 16% of Medicare spending, and 2% of Part B drug spending.

According to a report put forward by MedicareAdvantage.com, this amount of spending could:

Cover a year’s worth of insulin for more than 3.3 million Part D beneficiaries
Buy 87,000 hospital ventilators, which the country is in desperate need of due to the coronavirus pandemic
Buy more than 1 billion N95 masks
Cover the cost of 31.6 million flu shots
Go towards necessary women’s health treatments

Why Is So Much Money Wasted?

The report also suggests that Medicare’s “buy and bill” drug supply model is likely to blame for the waste. In the “buy and bill” model, healthcare providers and hospitals purchase, store and administer drugs to patients, and then bill insurers or patients for the drug. All drugs purchased by providers must either be administered or thrown away after opening, which often happens because many vials contain higher doses than is appropriate for patients.

“Because of this model, drug manufacturers are incentivized to produce medication amounts that are more likely to end up discarded when single-dose vials or containers include higher doses than are necessary,” says the report on MedicareAdvantage.com. “Profits are increased by billing for the whole vial even if only a portion of it is needed and used. Doctors and hospitals also enjoy bloated profit margins under this system.”

The Government’s Considerations

The information in this study has prompted CMS to consider enacting two possible solutions:

Require drugmakers, hospitals, and doctors to refund CMS for discarded drugs
Require pharmaceutical companies to right-size drug containers so that no medication gets wasted/discarded
Do both of the above

Preparing For Medicare Open Enrollment: What You Need To Know for Your First Open Enrollment

If this was your first year as a Medicare beneficiary, then you are heading into your first Medicare Open Enrollment Period. When you enrolled in Medicare, you chose whether to stick with Original Medicare, add a Medicare Supplement Plan, or go with a Medicare Advantage Plan, and now is the time to evaluate your plan to see if it’s still working for you. You’ll have the option to stay with it, or change your plan this fall during Medicare’s Open Enrollment Period, which runs from October 15 through December 7.

When it comes to your Medicare plan, you shouldn’t simply sit back and let your plan renew. Medicare plans come and go, and yours might not exist next year – or there might be a plan that better suits your needs. If this is your first time preparing for Medicare’s Open Enrollment, there are some things you need to review and consider. Taking a little time to do this will not only help you get the best coverage next year, but will also help put money back in your pocket.

magnifying glass over "Jan 1" — *Any changes you make during fall Medicare Open Enrollment will not take effect until January 1st.*

Changes Won’t Take Effect Immediately

Because this is your first Medicare Open Enrollment, it is important to know that whatever decisions you make during the open enrollment, it will go into effect January 1st. So, if you choose to switch plans, know that your new plan will not begin until the new year. This is important so you can budget accordingly for the rest of this year.

Your Options

During Medicare’s Open Enrollment Period, existing Medicare beneficiaries can make changes to their plan, including:

Switching from Original Medicare to a Medicare Advantage Plan or vice versa.
Adding a Medicare Supplement Plan if you switch to Original Medicare.
Changing your Medicare Advantage Plan.
Joining a Medicare prescription drug plan or picking a new drug plan

yellow post it not with a red exclamation point drawn on it — *Before making any changes to your Medicare plan, you will receive some important documents you need to review.*

Important Documents You Need To Review

As Medicare Open Enrollment approaches, you will start receiving some notices in the mail – usually in September. These notices include:

Annual Notice of Change – Lists changes to your current plan, such as changes to coverage, costs, included drugs, or provider network.
Evidence of Coverage – Lets you know whether your plan will be available next year.
Medicare And You Book – Provides you with a list of plans in your area, including their costs and coverage rules.

Determine If Your Existing Plan Is Still A Good Match For Your Needs

The last thing that you should do is blindly accept your current plan and renew it for the coming year. This can end up costing you a lot of money out-of-pocket. You should review the above documents carefully in order to be aware of any changes that are coming to your current plan. You might find out that your current plan will not be available in your area anymore, that costs are going up drastically, or that something you need coverage for will no longer be covered.

Review your plan, and if it no longer meets your needs, then the next step is to start searching for other options. EZ.Insure’s agents can help you compare plans in your area in minutes.

How You Can Save

What some people are unaware of is that they can save a lot of money next year by adding a Medicare Supplement Plan if they have Original Medicare, or are switching to Original Medicare. One of the biggest advantages of Medicare Supplement Plans is that they will generally cover your Part B 20% out-of-pocket costs – all you have to do is pay a low monthly premium, and you’ll have more coverage, and save more money. There are 10 different plans to choose from; it is important to review all the different plans to see which one will offer you the most coverage for your specific needs.

Trust A Medicare Agent To Help You

Going over all of the paperwork that you are receiving this month can become quite overwhelming. Not only do you have to carefully review all the notices and make sure your plan is still a good fit for you, but you have to begin researching other plans to see if they might work better for you. This is a time-consuming process, but it doesn’t have to be if you use an EZ.Insure agent. Our agents are highly trained and know the ins and outs of all the different Medicare Supplement Plans. You will be provided with your own agent who will go over your notices, review your current plan, and find a Medicare Supplement Plan that will help you save as much money as possible.

And the best thing about EZ? Our services are always free! We will research, compare, and even sign you up for free! To get your free instant quotes, simply enter your zip code in the bar above, or to speak with an agent, call 888-753-7207. No hassle, no obligation!

Does Medicare Cover a CPAP Machine?

Over 18 million Americans have some form of sleep apnea, and some need a Continuous Positive Airway Pressure (CPAP) machine. If you are enrolled in Medicare and are one of these millions of people with sleep apnea, you might be wondering if a CPAP machine is covered under the Durable Medical Equipment benefits of Part B. The simple answer to this question is yes, but with some caveats. In some cases, Medicare only covers a three month trial for CPAP therapy, but you can get it covered for longer as long as you meet certain criteria.

What Is A CPAP Machine?

Obstructive sleep apnea (OSA) that is left untreated can lead to high blood pressure and possibly even congestive heart failure. If you are suffering from this dangerous condition, you will be evaluated to see whether you need a CPAP machine to help you breathe more easily while sleeping. This machine, which has an attached mask that you wear while sleeping, produces air pressure in your throat. The air pressure it produces is higher than that of the room’s air, which will help to keep your upper airway open. Before prescribing a CPAP machine, your doctor will speak to you about how long you’ve had symptoms of sleep apnea, and will assess your symptoms to see if you are a good candidate for this type of therapy.

When Medicare Will Cover CPAP

doctor room with machines and cords — *You have to complete a sleep test in a laboratory before getting a CPAP machine.*

If you are diagnosed with obstructive sleep apnea, Medicare will cover a 3-month trial of CPAP therapy as long as you:

Meet face-to-face with a treating physician to receive a clinical evaluation prior to a sleep test assessment.
Complete a sleep test in a laboratory, or use an approved at-home test.
Have a prescription for a CPAP machine from your doctor.
Get a CPAP machine from a participating Medicare supplier and receive instruction from the CPAP supplier about the proper use and care of the CPAP machine

In order for your machine to be covered for longer than the 3-month trial period, you have to use the machine more than 4 hours a night for at least 70% of nights within a consecutive 30-day period. Once you are successful with a 3-month trial of the CPAP, Medicare might continue coverage as long as you meet in person with your doctor, and your doctor documents in your medical records that the CPAP is helping you. Once that is in your medical records, Medicare will cover an additional 10 months of the machine rental.

How Much Is Covered By Medicare?

stop watch with a checklist next to it — *After meeting some requirements of 13 months and meeting your deductible, then Medicare will cover your CPAP machines cost.*

Medicare will help pay for your rental of a CPAP machine for a total of 13 months as long as you use it continuously for that time. After you are done renting it for a total of 13 months, you will own the CPAP machine.

You will need to meet your Medicare Part B deductible before Medicare pays its share of your CPAP equipment. Medicare Part B (which covers durable medical equipment) will then cover 80% of the cost, meaning you will have to pay a 20% coinsurance for the CPAP machine. Tubing, face masks, filters, and other supplies for the machine are also covered at 80%.

If your CPAP supplies get dirty or lose effectiveness, Medicare will cover replacement supplies. Depending on the part, you might need to replace it every two weeks to every six months.

Medicare Supplement Plan

If you have a Medicare Supplement Plan, your plan might cover your CPAP coinsurance payment. It will also help pay for the coinsurance of your CPAP supplies. Each plan has its own cost and coverage options. If you do not have a Medicare Supplement Plan already, EZ can help you to find a plan that covers a CPAP machine and equipment. Our agents can compare all available Medicare Supplement Plans in your area, including all the plans that cover CPAP machines. They will provide you with quotes within minutes, and help sign you up for the plan that fits your budget and coverage needs. To get started, enter your zip code in the bar above, or to speak directly to an agent, call 888-753-7207.

Preparing For Medicare Open Enrollment: Important Documents

September is here, and with it will come important documents for Medicare’s fall Open Enrollment. Medicare Open Enrollment, which is also referred to as the Annual Election Period (AEP), occurs every year from October 15th to December 7th. During this period, you have the option to change your Medicare plan for 2021. In order to be better prepared, it is important to review the information that you will be receiving this month. Check your mailbox for the following important documents:

Medicare And You Handbook

the word medicare with words pertaining to medicare insurance around it — *You will receive a “Medicare and You” handbook that will explain the benefits, your rights, and available plans.*

If you are already enrolled in Medicare, you will receive a free 2021 Medicare And You handbook in the mail this month. The handbook will provide you with:

A summary of Medicare benefits
Your Medicare rights
Answers to frequently asked questions
Lists of available health and drug plans in your area. All plans have to cover the same benefits listed in the handbook, but costs and coverage rules will vary based on your area.

If you did not receive your handbook, you can call 1-800-MEDICARE and request a copy with information for your region to be mailed to you. You can also view the handbook online at medicare.gov.

Annual Notice Of Change

If you have a Part D prescription drug plan or a Medicare Advantage plan, then you should receive a notice called the Annual Notice of Change (ANOC) this month. The ANOC will list any changes that will be made to your plan in 2021 regarding your:

Rates What you can expect to pay for your copays, annual deductibles, and drug costs for 2021.
Covered Drugs- You will be able to look through the plan’s formulary and see what drugs are being added or removed from Part D formularies.
Provider Network– Check to see which doctors, hospitals, and other providers and pharmacies will be in your plan’s network next year. Be sure to pay attention to this as networks do change from time to time, and you might find that some providers have been added or removed.

The EOC along with he ANOC are 2 very important documents that will notify you of any changes in your plans and if your plan is leaving Medicare.

Evidence Of Coverage

The Evidence of Coverage (EOC) document that you will receive will give you an in-depth explanation of the benefits and out-of-pocket costs for your plan. Your EOC should come in the mail with your ANOC, or you can look at the document on your plan’s website. Your EOC will notify you of:

Plans that are leaving the Medicare program, so you can start searching for another plan for the new year.
The quality of performance of your current plan, if your current plan has received a low rating for 3 or more years in a row. This is so you can begin to look at other, better-rated plan options in your area.

Notice of Creditable Coverage

If you get your health insurance and drug coverage through an employer, then you will receive a notice of creditable coverage. This will inform you if your coverage is still credible, and if it is as good as or better than Medicare coverage. You will need this document as proof that you had credible employer-based health insurance, so that you do not get hit with a late enrollment penalty when you decide to switch to a Medicare Advantage or a Part D plan.

the word important in written on a purple paper with a red thumbnail on it Review these notices so that you are aware of any changes being made to your Medicare plan. If you find that there are changes that you are unhappy with, then you can start searching for a new plan before Open Enrollment begins.

Once you receive these important documents in the mail and begin reviewing your coverage, you might find that your current plan will no longer fit your needs. If it is time to change your coverage, then it is time to call EZ.Insure. Our agents are highly trained in Medicare and help you compare all of the options available for your financial and medical needs. We want to make sure that you have the best coverage and care, especially during these times. To get free, instant quotes, enter your zip code in the bar above. Or to speak directly to one of our licensed agents, call 888-753-7207.

Preparing For Medicare Open Enrollment: Getting Great Coverage For 2021

Medicare Open Enrollment Period (October 15 – December 7) is right around the corner, so it’s time to start reviewing your current plan. Is it working for you? If you’re not totally satisfied with your coverage, then you might want to look for a better plan that has everything you need and saves you money. One of the best ways you can get the best coverage for next year is to add a Medicare Supplement Plan to your Original Medicare plan.

calculator with the word cost on it with a hospital bed in the background and money below the calculator — *Healthcare costs are on the rise, and with Medicare only covering 80% of costs, the rest that you pay out-of-pocket can add up quickly.*

Why A Medicare Supplement Plan?

Medicare Part B only pays for 80% of your medical costs, leaving you to pay 20% of all of your bills out-of-pocket. 20% might not sound like a lot, but if you are living on a fixed income, living with a chronic medical condition, or need to see the doctor regularly, then those bills can really add up. A Medicare Supplement Plan will cover your 20% share, which can save you hundreds of dollars a year! All you have to do is pay a low monthly premium, and let your plan to take care of the rest.

Healthcare and out-of-pocket costs are on the rise, so it’s better to be fully insured in case of an emergency or accident. Having a Medicare Supplement Plan means you won’t have to worry about setting money aside to pay any unexpected bills that you may accumulate.

There are 10 different types of Medicare Supplement Plans to choose from, with each plan offering different coverage and different prices, so you’re sure to find one that fits your financial and medical needs. Medicare Supplement Plans cover:

hundred dollar bills in a glass jar — *A Medicare Supplement Plan will cover the costs Original Medicare does not cover, which will save you hundreds of dollars.*

Medicare Part A and Part B deductibles
Skilled nursing facility costs after you run out of Medicare-covered days
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B coinsurance or copayment
Part B excess charges
Part A hospice care coinsurance or copayment
Blood transfusions for up to three pints of blood

Some will cover:

Foreign travel emergencies (up to plan limits)

Another advantage to these plans is that there is no network, so you can go to any doctor or hospital that accepts Medicare assignment.

How To Add A Medicare Supplement Plan

silhouette of a person standing in front of 3 arrows pointing in 3 different directions — *You have different options during Medicare Open Enrollment Period to add a Medicare Supplement Plan.*

With Medicare Open Enrollment approaching, you’re probably getting a lot of information in the mail about your plan. If all of this has you rethinking your coverage, then now is the time to add a Medicare Supplement Plan. These are your options during this period:

If you currently have Original Medicare, you can choose to stay on your Original Medicare plan and add a Medicare Supplement Plan to fill the gaps. You may not be eligible for guaranteed issue, but the sooner you apply for a plan, the better.
If you are on a Medicare Advantage Plan, but are considering switching over to Original Medicare, then Open Enrollment is the best time – you’ll be able to add a Medicare Supplement Plan with guaranteed issue, meaning you won’t have to face the underwriting process.
If you’re enrolled in Original Medicare and your employer-based coverage is ending, you can choose to add a Medicare Supplement Plan for extra coverage.

The Medicare Open Enrollment Period is the time to look at all your options so you can save money in the coming year. You can choose to stay with Original Medicare, or consider switching from a Medicare Advantage Plan to Original Medicare while adding a Medicare Supplement Plan. A Medicare Supplement Plan will provide you with more coverage, while putting more money back into your wallet. This will ensure that you have great coverage next year, plus you’ll have peace of mind knowing that all you have to pay (aside from your Medicare Part B deductible) is one low monthly premium, and all of your medical costs will be covered.

If you want the best Medicare Supplement Plan from one of the top-rated Medicare Supplement companies, EZ can help. Our agents work with all of the top-rated Medicare Supplement companies, and we’ll compare all available plans in your area within minutes. We’ll find you the best plan with the most savings. To get free Medicare Supplement Plan quotes, enter your zip code in the bar above, or if you prefer to speak to an agent directly, call 888-753-7207. Our agents are ready to help you get the best coverage for next year!

Tag: medicare