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Three Medicare Questions
Old 11-13-2014, 09:17 PM   #1
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Three Medicare Questions

Please Correct if this understanding is wrong:

Not for Medicare D, but...

1. For Medicare Supplements (Medigap)

If you have the Original Medicare, and move to a different state, you CAN keep the plan from the state where you originally purchased it. If you move and decide to change to a policy in the 'new' state, you may be subject to membership review and fees based on your current health situation.

2. For changes involving Medicare Advantage.

Medicare Advantage vs. Medicare Supplement Program Designs

Medicare Advantage and Medicare Supplement plans have different program designs. When you buy a Medicare Supplement plan, you are still enrolled in Original Medicare. Medicare pays the majority of your healthcare bills while the private insurance simply covers the extra copayments and deductibles.

When you enroll in a Medicare Advantage plan, you move completely into a private health insurance plan. That means your insurance company covers all your healthcare bills. Insurance companies must provide the same level of coverage as Original Medicare with their Medicare Advantage plans, with the exception of hospice care. The end result of the two programs is about the same; they just go through a different setup.

3. Medicare Advantage may not provide out of area services other than Emergency or Urgent Care, and Dialysis.
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Old 11-14-2014, 08:56 AM   #2
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Quote:
Originally Posted by imoldernu View Post
Please Correct if this understanding is wrong:

Not for Medicare D, but...

1. For Medicare Supplements (Medigap)

If you have the Original Medicare, and move to a different state, you CAN keep the plan from the state where you originally purchased it. If you move and decide to change to a policy in the 'new' state, you may be subject to membership review and fees based on your current health situation.
I am not sure whether one state's plan will cover you in a different state or not, but if you change your original medigap policy from your current state, you will be subject to a review and fee adjustment based on your health situation.
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Old 11-14-2014, 11:47 AM   #3
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Quote:
Originally Posted by imoldernu View Post
Please Correct if this understanding is wrong:

2. For changes involving Medicare Advantage.

Medicare Advantage vs. Medicare Supplement Program Designs

Medicare Advantage and Medicare Supplement plans have different program designs. When you buy a Medicare Supplement plan, you are still enrolled in Original Medicare. Medicare pays the majority of your healthcare bills while the private insurance simply covers the extra copayments and deductibles.

When you enroll in a Medicare Advantage plan, you move completely into a private health insurance plan. That means your insurance company covers all your healthcare bills. Insurance companies must provide the same level of coverage as Original Medicare with their Medicare Advantage plans, with the exception of hospice care. The end result of the two programs is about the same; they just go through a different setup.

3. Medicare Advantage may not provide out of area services other than Emergency or Urgent Care, and Dialysis.
#2 You still are enrolled in original Medicare - you must pay your Part B premium to remain eligible for an Medicare Advantage (MA) plan. The mechanical differences are that Traditional Medicare is no longer responsible for processing claims or taking the hit (except for kidney transplant) if your claims exceed the Part B premium.

They (CMS) pay a significant portion of your Part B premium to the insurer who then becomes responsible for quality assurance, case management, claims processing, customer service, and risk - that you'll stay healthy and your costs will be less than the per month payment they get from CMS (and sometimes from you if you have a premium).

In addition, your Part D prescription coverage is included in an MA plan (along with some other benefits, coverages you don't get with Medigap). You would need a separate Part D plan if you use a Medigap plan.

#3 That depends on the carrier. Certainly any carrier will limit you to Emergent/Urgent care, and dialysis. However, if you sign up with a Blue plan (Blue Cross or Blue Shield), they have an agreement whereby if you are travelling, you can use your MA ID card for the same benefits anywhere within the U.S. However, if you snowbird (relocate for 6 months or more), you may not be able to keep your coverage with your plan.

-- Rita
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