 Personal Finance PowerPoint Presentation Medicare Advantage Prepare to get financially fit by practicing personal finance. Insurance is part of our long-term risk and mitigation strategy where we follow the adage of major twice cut once put in a formal process and place something like setting the goals, develop a plan to reach them, put the plan in action, review the results and repeat the process periodically. Most of this information can be found at Investopedia Medicare Advantage which you can find online. Take a look at the references, resources, continue your research from there. This is by Julia Kagan, updated January 27, 2022. In prior presentations, we've been taking a look at insurance in general, moving on into the medical insurance which is a bit more complicated due to the complexity of the medical field, laws and regulations around it and the insurance related to it. And now we're looking at, then we went to Medicare and now we're thinking about the Medicare Advantage in conjunction or alignment with our discussion about liability insurance in general about insurance in general and medical insurance. So what is Medicare Advantage? Medicare Advantage is part of the Medicare program offered to older people and disabled adults who qualify. Also referred to as Medicare Part C, Medicare Advantage MA Plans are provided by private insurance companies instead of the federal government. So they generally include hospital, medical and prescription drug coverage. Anyone who joins an MA plan still has Medicare. How Medicare Advantage works, how are all the puzzle pieces put together here? It's confusing. I'm a little bit confused. Let's take a look at it. We got the Medicare is generally available for people age 65 or older, younger people with disabilities and people with in-stage renal disease, permanent kidney failure, requiring dialysis or transplant or amortrophic lateral sclerosis, otherwise known as ALS. So we talked about Medicare in general in prior presentations. Now we're focusing on the Medicare Advantage. Medicare Advantage is a type of Medicare health plan offered by private companies that are Medicare approved. They are considered an alternative to original Medicare and cover all the expenses incurred under Medicare. So the general Medicare, they include the same Part A hospital and Part B medical coverage. So you got to know your alphabet and what the alphabet kind of stands for. Kind of like learning the chords when you're learning your guitar and your music theory. You know, we've got Part A and Part B of the Medicare coverage. And then, but not hospice care. So we got to keep hospice care right in our mind too. Most MA plans also include Part D prescription drug coverage. So then you play the D chord on the Medicare stuff, which usually is related to those prescription drugs that you got to tack that on there for a little bit more complexity. But not too bad. We can get that under our belt. Private companies receive a fixed amount each month for Medicare Advantage Plan care. In turn, these companies can charge out-of-pocket costs to policy holders and are able to establish their own rules for service, such as the need for referrals or provider networks for both non-urgent care and emergency services. Some Medicare Advantage plans cover additional costs, not paid by Medicare, including vision, dental, hearing-related expenses. You want to take a look at those and see if those are things that you need and or whether they should be included if you're considering the Medicare Advantage. Medicare Advantage plans don't work with Medigap, which is also called Medicare Supplement Insurance. You want to think about your options basically doing your comparing and contrasting between the Advantage and the Medigap or Supplement. Medicare pays the premiums for participants in Medicare Advantage plans. The average monthly premium for a Medicare Advantage plan in 2022 is projected to be $19 versus $21.22 in 2021. In contrast, the 2021 monthly premium and annual deductible for Medicare Part B are $170.10 and $233 in 2022. Regional preferred provider organizations, those are the PPO's, were established to provide rural beneficiaries greater access to Medicare Advantage plans and cover entire statewide or multi-state regions. So you've got this kind of considerations. You've got the PPO and the HMO kind of considerations. We took a look at when we're looking at insurance in general, thinking about how broad the insurance coverage is and how restricted you could be in terms of a network. Regional PPO's accounted for 5% of all Medicare Advantage-enrolled ease in 2020. About 26 million people or 42% of those receiving Medicare benefits were enrolled in Medicare Advantage plan in 2021. Types of Medicare Advantage plans. The most common type of Medicare Advantage plans are Health Maintenance Organizations. Those are the HMO plans, which account for the majority of total Medicare Advantage enrollments, PPO plans, private fee for service, PFFS plans, and special needs plans, SNPs. So we got some of this terminology that we understand from the past. Now we're looking at the HMO. That's the one that usually has the more restrictive networks, but possibly in exchange for the more restrictive network being possibly cheaper in terms of the premiums. The basic qualifications to join one of these plans include living in the plan service area and having Medicare Part A and B. So you got the Medicare Part A and B, and then you're within the area, the service area for whatever the Medicare Advantage that you're looking into. HMO point of service, HMO POS plans, and medical savings account, MSA plans are less common. So we got the Medicare Advantage plans have been unavailable to people who have in-stage renal disease ESRD unless they could find an ESRD specialist special needs plan nearby. But starting in 2021, people with ESRD will be able to sign up for any Medicare Advantage plan in their area. Those who have ESRD should compare the cost of medical Advantage plans versus original Medicare plus Medigap and a Part D plan and check that their doctors in hospital or in network with any MA plan they are considering. So obviously you got this whole network situation and your doctor and to see if your doctor fits in there and what kind of options you have if you're subject to a network similar to the discussions we've had with insurance in general. So we have the special considerations. Medicare's online plan finder tool includes information about Medicare Advantage plans to enroll in a Medicare Advantage plan. A consumer must provide the information on their Medicare card, including their Medicare number along with the dates when their Part A and Part B coverage began. People can change their Medicare Advantage plans during a specified open enrollment period in the fall that typically spans from a mid-October to early December. Like other types of health insurance, each Medicare Advantage plans has different rules about coverage for treatment, patient responsibility costs and more. Joining a Medicare Advantage plan may make someone ineligible to continue receiving health care coverage through their employer or union. So if employer-based coverage fits a person's need, they may want to hold off on enrolling in Medicare. So we talked a little bit about that in prior presentations. Obviously this whole transitional period of saying, okay, I have insurance. If you're still working, then that kind of complicates the situation because, again, a lot of this stuff was kind of thought that, well, after 65 when it was put in place, most people are close to dying. They clearly might be in retirement at that point in time. People are living a lot longer now, so they could quite well might be working at that point in time at these days and age. And obviously then you have the health care and benefits through the employer that you got to consider what's that whole transition going to look like. All Medicare Advantage plans have an annual limit on out-of-pocket costs, which may make them more cost effective for certain beneficiaries. In 2022, the annual maximum in-network range from as low as $399 to as high as $7,550. What is Medicare Advantage? Medicare Advantage, also known as Medicare Part C, is private health insurance designed to cover the gaps of Medicare Part A and Part B. Some Medicare Advantage plans cover vision, dental, and hearing expenses. What are the disadvantage of Medicare Advantage? That's kind of confusing. What are the disadvantage of Medicare Advantage? Medicare Advantage can become expensive if you're sick due to co-payments. You've still got those co-payments you're dealing with. The enrollment period is limited and you won't be eligible for Medigap coverage if you have Medicare Advantage. So you've got to do that consideration between the Medigap and the Medicare Advantage if you want some kind of supplemental information. So you've got to do your homework on those items. Additionally, providers can leave and join their network at any time. Can I sign up for Medicare Advantage with a pre-existing condition? Yes, you can. Medicare Advantage offers coverage for individuals with pre-existing conditions.