Everything You Need to Know about Medicare Advantage Plans (Medicare Part C)

10/13/20 • 21 min

Some of the highlights of the show include:

A brief refresher on Medicare Part A and Medicare Part B and the associated gaps in coverage
The various types of Medicare Advantage plans, including HMOs, PPOs, and SNPs, and the differences between each of them
Why it’s important to consider in-network coverage when shopping for Medicare Advantage plans
The coverage benefits of Medicare Advantage Prescription Drug plans (MAPDs)
Three big things that Medicare doesn’t cover
What Medicare Advantage covers that Medicare plans do not
Why Medicare Advantage may be more convenient than other Medicare coverage options
When the Annual Enrollment Period is
Factors to consider when shopping for an MAPD
Why you should review your options every Annual Enrollment Period no matter what
And more!

Quotes

“There are two options, really, when it comes out there to filling in gaps in your Medicare: Medicare Supplements andMedicare Advantage Plans.” — Zach

“The HMO plans are primary care physician-based. Their networks are typically county-based or sometimes multi-county based, but they're for individuals that don't do a lot of traveling. They do have set copays on a lot of services, and they typically are relatively inexpensive.” — Nick

“And then the PPOs: there is no requirement for a referral on a PPO. They typically are going to have larger networks, regional, or in some cases, national networks.” — Nick

“The only thing that a Medicare Advantage Plan has to do is offer benefits equivalent to original Parts A and B of Medicare.” — Nick

“It's important to note that Medicare Advantage Plans wrap up and replace Part A and B, but also incorporate Part D of Medicare in the same type of plan. So, unlike Medicare, and a supplement and a stand-alone drug plan, it's all in one card.” — Nick

“Medicare Advantage Plans give you additional benefits that original Medicare does not cover. It basically Medicare Advantage Plan will pick up, like, deductibles, and coinsurance, things of that nature traditional Medicare does not cover.” — Tausha

“Medicare Advantage over traditional Medicare has a stopgap in place that caps the amount of spending that you would do each year, which is called a max out of pocket.” — Tausha

Links

Aetna: https://www.aetna.com/
Seniors Living Healthy: seniors-livinghealthy.com
Facebook: facebook.com/seniorbenefitinc
Contact Zach:
- [email protected]
- 1-844-437-4253

Transcript

Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.

Zach: Hello, and welcome back to another episode of Seniors Living Healthy. As always, I'm your host, Zach, and beside me is Nick.

Nick: Hello, folks.

Zach: You guys, this episode we're going to look into the different options to fill in those gaps that Medicare covers where we've talked about in the previous episodes, with Part A being your hospitalization, and Part B being your outpatient. There are two different options out there. One of them is Medicare Supplements, which we're going to touch on next episode, where this episode we're going to focus on Medicare Advantage. You may see him also called MAPD or Part C of Medicare. Especially with Annual Enrollment Period coming up, you're going to see a lot of TV advertisements, radio advertisements, billboards, things in your mail, all of that stuff, in regards to that.

So, guys, as always, usually do a product review in our episodes, but since this whole episode is on a product, we're just going to jump right into it and just cover the whole product as a whole. And then, as always, we'll go into our interview, our confession section, and then wrap up the episode. So, now that we've talked about A and B has all these gaps, this episode—and we're going to spill over into next episode—we're going to talk about what covers those gaps that Medicare doesn’t. Some different options, everything out there for you. So, Nick, give me a quick rundown just to refresh everybody, what some of those gaps are?

Nick: Sure, absolutely, Zach. So, the main two parts of Medicare Part A and Part B. As you alluded to, Part A is the hospitalization, Part B is the outpatient. So, some of the major gaps under Part A of Medicare are, Medicare Part A has a $1408 deductible per 60-...

Some of the highlights of the show include:

A brief refresher on Medicare Part A and Medicare Part B and the associated gaps in coverage
The various types of Medicare Advantage plans, including HMOs, PPOs, and SNPs, and the differences between each of them
Why it’s important to consider in-network coverage when shopping for Medicare Advantage plans
The coverage benefits of Medicare Advantage Prescription Drug plans (MAPDs)
Three big things that Medicare doesn’t cover
What Medicare Advantage covers that Medicare plans do not
Why Medicare Advantage may be more convenient than other Medicare coverage options
When the Annual Enrollment Period is
Factors to consider when shopping for an MAPD
Why you should review your options every Annual Enrollment Period no matter what
And more!

Quotes

“There are two options, really, when it comes out there to filling in gaps in your Medicare: Medicare Supplements andMedicare Advantage Plans.” — Zach

“And then the PPOs: there is no requirement for a referral on a PPO. They typically are going to have larger networks, regional, or in some cases, national networks.” — Nick

“The only thing that a Medicare Advantage Plan has to do is offer benefits equivalent to original Parts A and B of Medicare.” — Nick

“Medicare Advantage over traditional Medicare has a stopgap in place that caps the amount of spending that you would do each year, which is called a max out of pocket.” — Tausha

Links

Aetna: https://www.aetna.com/
Seniors Living Healthy: seniors-livinghealthy.com
Facebook: facebook.com/seniorbenefitinc
Contact Zach:
- [email protected]
- 1-844-437-4253

Transcript

Zach: Hello, and welcome back to another episode of Seniors Living Healthy. As always, I'm your host, Zach, and beside me is Nick.

Nick: Hello, folks.

Previous Episode

Everything You Need to Know about Medicare Part D

Some of the highlights of the show include:

The two most common times Medicare beneficiaries are able to make changes to their prescription drug coverage
The downfalls of not selecting drug coverage
What Zach and Nick do to ensure their clients get the right prescription coverage
The differences between the four different tiers of Medicare Part D prescriptions
The four different stages of prescription drug plans
What the maximum deductible is for 2020
How prescription drug plans operate a lot like car insurance
What the Medicare doughnut hole is and why it’s a bear for so many people
Why beneficiaries are most likely to complain about Medicare Part D vs. other types of Medicare
What patients should do if they are prescribed a drug that isn’t on their plans
Why it’s important for Medicare beneficiaries to choose a national drug chain as their pharmacy
What Aetna has in store for 2021
What the process of enrolling in a prescription drug plan looks like
And more!

Quotes

“These drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.” — Nick

“Your Tier 1 drugs are typically going to be the most inexpensive in most cases. Lots of drug plans offer these drugs free of cost. Tier 2 are going to be preferred generics in a lot of cases or non-preferred generics that are a little more expensive but still relatively inexpensive; Tier 3 are going to be your brand name drugs, and Tier 4 are going to be your specialty drugs, like cancer drugs.” — Nick

“You're going to pay the full cost of your prescriptions until you get through the deductible phase of your prescription drug plan.” — Nick

“The reason the doughnut hole can be such a bear is for people that have higher, more expensive medications, their cost-sharing within this period goes up pretty substantially.” — Nick

“We're going to be able to tell you when to expect to hit that doughnut hole, or if you're going to hit it at all, or when you hit that catastrophic phase moving forward there.” — Zach

“We always try to make sure when we're running PDPs for our clients, you know, making sure—a lot of them like those little local drugstores; we try to get them to at least check the big chains out there in case they do travel.” — Zach

“The key is always to choose a preferred pharmacy for lower drug costs. That's always the key.” — Tausha

“CVS is now allowing patrons to use PayPal, which I think is pretty cool. And then possibly in the future, they might be able to use Venmo as well.” — Tausha

“I just really wanted to just highlight the support that CVS Aetna has given around COVID-19. We waived all COVID related copayments, and I think what's probably stands out the most for me is that we opened multiple COVID-19 testing sites throughout the United States where we kind of had those hotspots. And CVS acted quickly and implemented those hotspots to help with testing.” — Tausha

Links:

Aetna: https://www.aetna.com/

Transcript

Zach: Hello, and welcome to episode three of our inaugural season of Seniors Living Healthy. I'm your host Zach, and here with me, as always, is Nick.

Nick: Hey, folks.

Zach: So, this month's episode, we're going to talk about Part D of Medicare, which is your prescription coverage. Nick, what is our number one complaint?

Nick: Prescription drug plans, no doubt, Zach. For whatever reason, these drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.

Zach: That's right. With our hands being so tied, it's really, really hard. We can't tell the future. So, we can't see what people are going to be doing, taking prescription-wise down the road; really, all we can do is what's working for them there in October when those annual enrollment period comes. So, I know we've touched there briefly on enrollment period but, Nick, what are the two most common times people can enroll in drug coverage?

Nick: So, the two most common times people can make changes to their prescription drug coverage is going to be their initial enro...

Next Episode

Covering the Medicare Gap with Medicare Supplements

Some of the highlights of the show include:

A brief primer on the history of Medicare Supplements
Why Danny believes that Medicare Supplements are a great option for people
How Medicare Supplements plans can’t be canceled based on a year of high claims
The difference between when you can buy Medicare Advantage plans and when you can buy Medicare Supplements plans
What happens if your doctor drops out of the Medicare Advantage plan you’re enrolled in
The more popular Medicare Supplements plans that Zach and Nick see most commonly
Changes to the Medicare Supplements program that just went into effect on Jan. 1, 2020
How Nick was able to help a couple save upwards of $2,400 on Medicare Supplements plans
How Nick and Zach’s persistency can be a boon for clients
And more!

Quotes

“President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way.” — Danny

“That's what makes Medicare Supplements a great deal for people because it leaves them in control of what they want to do as far as their healthcare is concerned.” — Danny

“Medicare Supplemental policies are secondary to Medicare, meaning Medicare is still their primary, meaning it's a nationwide program, they can go anywhere that accepts Medicare. And they're also standardized. So, the coverage from one company to another is identical from plan to plan.” — Nick

“You can only buy Advantage plans at certain times of the year with the annual enrollment period, whereas you can buy a Supplement any time of the year.” — Zach

“If you're in a Medicare Advantage Plan and your doctor drops out of it, there's nothing you can do until the open enrollment period.” — Danny

“Medicare has evolved, coverages have been added, things have changed, and the same is true with the Part D. It's been evolving where it gets better and better as time goes on.” — Danny

“Since the plans are standardized, we had the capability to find the same benefit package, the same coverage with another provider saving them a ton of money.” — Nick

Links

Seniors Living Healthy: seniors-livinghealthy.com
Facebook: facebook.com/seniorbenefitinc
Contact Nick and Zach:
- [email protected]
- 1-844-437-4253

Transcript
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.

Zach: Welcome back to episode five of season one of Seniors Living Healthy. I'm your host, Zach, and with me as always, is Nick.

Nick: Hello, folks.

Zach: Also, we're pleased to be joined this week by Danny Haire, owner of Financial Services, Inc.

Danny: Hi. How are y'all today?

Nick: Doing well, sir. Thanks for joining.

Zach: Thanks for jumping on here with us, Danny. So, he has been in the business for over 40 years, and can even remember back when Medicare Supplement Plans first came out. Danny, real quick, do you kind of want to just give us a quick historical rundown of Medicare Supplements, where they came from, who brought them out, that type of thing.

Danny: Well, of course, President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. The difference from those plans compared to today is there were no government standardized plans. Companies pretty much got to put together whatever they wanted to do. I mean, of course, they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way.

And then as time went on, of course, the government standardized these plans. So, that was pretty much, I think, in the ’80s, when that happened, that these plans become standardized and everybody was selling the same thing, and there could not be any deviation from those.

Zach: Gotcha. So, as we did discuss last episode, Medicare's got those gaps in it, and so there are plans out there to fill those gaps. As we talked about last episode, those Medicare Advantage Plans. So, this episode we're going to look at Medicare Supplements, and also, kind of similar to our last episode, instead of doing a product revie...