Medicare Open Enrollment and Advantage Plans

Did you know Medicare Open Enrollment is happening now through December 7th?  Do you have a Medicare Advantage Plan or wondering what one is? Medicare Advantage Plans are basically private versions of Medicare.  They sometimes cover more services than Medicare A and B, such as include Medicare Part D.  However, sometimes they do not cover all services provided by Medicare.

The Federal Government used to subsidize these private health insurance plans but the Patient Protection and Affordable Care Act is reducing this subsidy to save costs.  

One of California’s largest Medicare Advantage plans is pulling out of Medicare in 2012.

As of 2012, Freedom Blue Medicare Advantage Plan will no longer be available.  If you are currently covered through Freedom Blue, you should have been notified of the upcoming change and your need to choose a new Medicare Plan. The Open Enrollment period is October 15 – December 7, now is the time you can change your Medicare health plan and Part D coverage and/or return to Original Medicare. Coverage changes become effective January 1, 2012. We know this can be an overwhelming task and want to help you understand what this means to you.

Freedom Blue is a PPO plan, which means you select an "in network" doctor from a long list of providers.  You don't usually need a referral to see a specialist or an "out-of-network" doctor.   However, if you see an out of network provider, the PPO covers you at a lower rate than in-network and you will have a larger coinsurance or patient responsibility amount. PPO is the most flexible type of plan with the largest list of in network providers. 

With the termination of Freedom Blue, there will no longer be a PPO Medicare Advantage Plan available to Beneficiaries in Fresno County.  The options available are:

Traditional Medicare, you can use any doctors and facilities that accept assignment for Medicare.  Most doctors and facilities do accept Medicare assignment, such as avecinia.      

HMO, which requires you to use only doctors and facilities that are contracted with that particular HMO.  You generally need a referral from your primary care doctor to see a specialist.   Avecinia is not a contracted with any HMOs

HMO-POS,  similar to an HMO, you also have the option to receive some services from doctors or hospitals that are not in the plan's network, usually at a higher cost than a standard HMO plan. Avecinia is not contracted with any HMO-POS plans.

**Some Medicare Advantage plans offer Medicare prescription drug coverage, but other plans do not.    Don't forget to explore your prescription drug options.

    

These plans all have their pros and cons, and varying degrees of out of pocket costs.  Make sure that you educate yourself so you can choose the best plan for your health and your budget.  In our experience with Medicare and Medicare Advantage plans, we have found traditional Medicare the easiest to work with.  Traditional Medicare may not offer all the services some Medicare Advantage plans offer, but we have found that traditional Medicare is less likely to deny or request prior authorization for benefits it does cover. 

A great resource to help you better understand your Medicare choices is HICAP (the Health Insurance Counseling & Advocacy Group - http://www.cahealthadvocates.org/HICAP/).  HICAP provides free, objective information and counseling about Medicare.  The Fresno representative is Wayne McMillen at Clovis Senior Center.  Appointments can be made by calling 559-324-2750 (here’s a link to their October Newsletter with an article by Mr. McMillen: http://www.ci.clovis.ca.us/SiteCollectionDocuments/SeniorServicesDivision/October2011Newsletter.pdf)

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!