Overview of Medicare Plans Washington
Are you curious or perhaps even overwhelmed about how Medicare coverage works in Washington? Medicare Plans Washington offers you some of the best health insurance policies available for senior citizens. As a Medicare beneficiary, you can choose from a variety of Medicare coverage options in Washington. Medicare health insurance coverage for Senior Citizen comes with a broad range of benefits. Medicare Plans Washington health insurance provides different ways to get your health care coverage in the Medicare program. The insurance policy plan that you choose affects a number of things like cost, benefits, doctor choice, convenience, and quality. You are reminded that these are “managed care plans”, and that Medicare is no longer your primary insurance, the health plan is.read more…
Medicare plans are federal health insurance program originally designed for individuals aged over 65 years, specific younger disabled people, and people with the End-Stage Renal Disease. There are numerous types of Medicare Plans and they all offer several benefits. For Instance, Medicare Advantage Plans refer to a form of Medicare health plan that is offered by private companies that contract with the federal health insurance program (Medicare) to provide people with all provisions of Part A and B benefits. Medicare Advantage Plans, at times called “MA Plans” or “Part C” Plans, include Preferred Provider Organizations, Health Maintenance Organizations, Private Fee-for-Service Plans, Medicare Medical Savings Account Plans, and Special Needs Plans. People who are enrolled in Medicare Advantage Plans are covered for most Medicare services under the plan and are not paid for in the original Medicare (e.g. cover for prescription drugs Washington Medicare Plans).
Enjoy All the Provisional Benefits of the Program
The first and most obvious reason why you should choose these types of Medicare Plans is that you get to benefit from all the provisions under the federal health insurance plans. If you choose the program, you still have your Medicare Plan. Medical Advantage Plans will cover all the services covered by original Medicare except hospice care since original Medicare already covers hospice care regardless of whether you are already enrolled in a Medicare Advantage Plan. This means that you will get your Part A for Hospital Insurance, as well as your Part B for Medical Insurance cover from the Medicare Advantage Plan rather than from your original Medicare. Furthermore, you will still have Medicare protections or rights, and even people who have pre-existing medical conditions are eligible to join Medical Advantage Plans, except for those with End-Stage Renal Disease.
You Can Choose from Different Forms of Medicare Advantage Plans
One of the strongest reasons why you should choose Medicare Advantage Plans is that you have wide range of Medicare plans to choose from. The main types include:
- Preferred Provider Organization Plans-(PPO) Plans– These types of programs fall under Part C of the Medicare Advantage Plan. They are offered by private insurance companies. Under the PPO plans, you pay less if you go to health care providers that are under the plan’s network and more if you use health care providers that are outside the network.
- Health Maintenance Organization Plans (HMO): In these Medicare Plans, you only get to go to healthcare providers that are listed under the plan except in the case of an emergency. Your primary care provider might be required to provide you with a referral.
- Private Fee-for-Service Plans (PFFS): this is also a type of Part C plan that is offered by private insurance companies. The plan is different because it determines the amount of money you will pay health care providers, as well as how much you will pay whenever you seek health care services.
- Special Needs Plans (SNPs)-SNPs are different from HMO and PPO Plans in the sense that they restrict membership to individuals with certain medical conditions or diseases. The restrictions and rights are tailored to their benefits, drug formularies, and provider choices to best cater for the special needs of the groups they are meant to serve.
Besides these four, there are two Medicare Advantage Plans that are less common. These include:
- Medical Savings Account Plans (MSA)-these plans combine a bank account with a high-deductible health plan. Medicare will deposit money that is less than the deductible amount into the user’s account. The money can be used to pay for healthcare needs in the course of one year.
- HMO Point of Service Plans- these plans may permit you to get certain health care services from out-of-network providers for a higher cost.
Medicare Advantage Plans are available in all the States in the U.S., and if you live in the State of Washington, you can choose from a variety of unique Medicare Advantage Plans. One of the unique Washington Medicare Plans is the Washington Medicare Advantage-Plus Prescription Drugs Plans. This plan is normally referred to as Part D. The Part D element helps to cover for prescription drugs. However, not all the plans will be available to all residents across the state and certain plans will only cover specific Zip Codes.
Medicare provides substantial cover to policy holders. However, depending on individual cases, you may be required to obtain additional medical or health attention. This calls for Medicare Supplemental Insurance. The plan is designed to alleviate the burden of elderly people who are vulnerable to complex health conditions. While it is well intended, there are ethical issues that arise out of its design and implementation. They revolve around eligibility, level of cover, existing conditions and change in status, among others. Below are some of these ethical concerns.
- Private Plan– the fact that the plan is run by private health insurance companies is considered an indication that the government has abdicated on its role to provide health services to the masses. Governments operate for the common good as opposed to private institutions whose target is profit. This means that private institutions have hijacked the role of the government and are making money out of it. This happens at the expense of elderly people who have toiled all their lives for the same nation. This is acts as a call to the government to resume its duty of providing health care services to the lowest classified individual.
- Increase in Premium with Age– the design of the medigap is such that premiums increase as the client advances in age. It is common knowledge that at an advanced age, everyone becomes weaker which comes with a reduction in productivity. This plan does not recognize such a fact. In fact, it works in reverse. A person whose contribution was immense during his or her energetic years is forced to contribute more as he or she gets frail. This amounts to failure to recognize the realities of life and may be considered as abandonment of the elderly at their point of need.
- The Exemptions – some conditions are covered by the plan while others are not. This exposes some people to a greater health care burden than others. Persons with disability and those with existing conditions are placed under special categories. The variation in premiums points at a plan whose design lacks a humane approach. Some of the disabilities are in the course of national duty and should be recognized as such. In other cases, disabled people have to deal with numerous challenges and therefore should be considered for a lighter health care burden.
- Exclusion of Prescription Drugs- it is impossible to imagine health care without drug prescription especially at old age. Medigap plans require the clients to pay extra for the prescriptions. This arraignment defeats logic. In fact, prescription drugs are considered among the largest out-of-pocket burdens for the subscribers of these plans. It defeats logic to pay for a plan that does not guarantee comprehensive cover.
- Convenience- some Medicare packages restrict the hospitals and doctors you can visit whenever you need medical assistance. These doctors are not readily available in neighborhoods. As such, it is challenging and an additional burden on subscribers. This denies the patient an opportunity to visit a health professional who he or she is comfortable with.
- Out of Pocket Limits– despite paying premiums throughout the year or period, there are limits on the amount that can spend out of pocket. This is a principle that defeats the essence of insurance cover. In reality, a person is exposed to health conditions that are restricted to humans. Placing a limit on the amount you can spend is therefore unethical. It should be considered that some of the years go by without clearing your cover. Such should cover for the days when the cover hits the cap.
There is a call to address the unethical issues about supplemental insurance. The government should be at the forefront protecting the health interests of the masses. Abandoning the elderly at the point of need amounts to abdicating it duty.
Medicare plans are offered by any private company for the assurance of any being in any bad state of health. People who enroll in this plan can take the advantage of medicare health insurance plans. These plans includes various categories in which one has to choose which benefit they want from the company depending upon their health conditions and most importantly their financial status to pay for these plans.
These plans have become more common now because people are becoming conscience of their health issues and have started to make a long term future planning’s. More of the seniors are enrolling in this plan to get the health benefit at the time of adversity. They cover from doctor bills to dental and vision checkup to hefty hospital bills too depending upon the plan you have chosen.
Below are few points to consider that can ease you out in choosing the appropriate plan for your health:
- Seek your doctor’s advice: You must consider the advice of your doctor that what problems you can expect in your future and if you have such health conditions that you must go for the medicare supplemental insurance Ask them if they can continue with you in your medicare plans or not. Going out of the list of the doctors that have been proposed by the insurance company can charge you at your own risk. So, better go through the list of doctors and hospitals that you find better for you.
- Acknowledge your health status: If you have some chronic disease or illness, it is better to go for the original medicare plans. As the original medicare plans allows you to visit any doctor or hospital of your comfort. Any specialist of your ailment can do treatment for your ailment.
- Choose drug plans: You must cross check for the drug stores that have been included in the list as medicines are very important part for the treatment of your health. There might be a possibility that the drug stores that have been included in the cover plan are far away from your place that can create a big problem for you. Drugs are routine requirement; one needs a nearer drug store that is quite convenient to them.
- Roll on to the snowbird coverage: Snowbird coverage is the health coverage for the people who like to spend months and years away from their country. They not only travel too much but, for long term also. It is necessary to have benefits at that place also where you are deciding to vacate for a small or long period of time.
- Fine prints of terms and conditions: All that glitters is not gold. One needs to ponder upon this. While signing any agreement check all the terms and conditions of the health coverage plan. Clear all your doubts and ask as many as questions as you can as this will get to know more about your coverage plans. Research all costs involved in the plan, taxes to be implied and extra costs that can be halted to you.
- Research for the company status: Before finalizing any plan from any public or private company, check for their stars and review from the people who have availed their services. You will get to know all their positive and negative points to be known to you. Check for their history and what their progress is in the last five years.
Basically, keeping in count all these factors, one can choose for the health coverage plan.
Medicare provides basic health cover and is accessible to everyone at understandable terms. The confusion comes when you have to buy supplementary cover. It is a chance to boost the cover offered by conventional Medicare insurance. Here are tips to help you avoid confusion and get the best cover for your budget and health condition.
- Do not be in a rush- whenever the window opens for enrolment into Medicare supplemental insurance, dishonest salesmen will rush you through terms and conditions that you do not understand. Demand for more time to seek clarification since you will be paying a premium for the package. Where possible, engage a relative or friend who understands healthcare insurance and has no vested interests.
- Scrutinize the details- most seniors get disappointed because they signed into schemes that they did not understand. The allure of a free t-shirt or a mug for every sign-up may cause you ignore these details leading to a raw deal.
- Decline cold calls- the law prohibits unauthorized cold calls. You are allowed to drop the call if you did not give approval. They use ‘request a contact’ form to get your authorization without your knowledge. You will meet most of these agents during events.
- Seek clarification on what you get. Many agents will up-sell the policy to you. This leaves you in the dark on the details of the plan. You will end up with a policy that does not suit your needs. The solution is to as direct questions like ‘what type of policy am I buying? Is it Medicare Advantage or Medigap?’ A positive response on such a question offers the answers you need as opposed to escapist answers.
- Be clear on what you buy- the options available are Medicare advantage and Medigap plans. It is sometimes very challenging to change your selection later. Further, the amounts you pay and the coverage you receive will be determined by the choices you make. By the time the opportunity to change arises, you might have lost a lot.
- Consider a brief note- the details contained in the terms and conditions might prove difficult to understand. There is a document referred to as Evidence of Coverage. It summarizes your insurance plan making it easier to understand. Your agent should be in a position to provide that. This document will inform you of the prescription drugs covered, co-pays, premiums and what is covered.
- Know your agent- reputable companies make it easier to identify the agencies and agents doing the documentation. Demand to see accreditation and where possible verify it through their website or other means available. Words like official agents are invented since the plan does not have such ranks. Medicare does not endorse any agent as well.
- Be cautious of extras- there are stipulated items covered under Medicare plan. However, some agents try to sell extra insurance over this package. Identify the package you are interested in and only sign up for it. The most common packages sold are long term insurance and Medicare Advantage while you have only requested for Medigap. This act is illegal and should raise a red flag on the credibility of that agent.
- Work with your doctor- Your doctor understands your health needs better than an insurance agent. He is better placed to provide guidance on the best package for you. Further, if the doctor is not enlisted in the package you are signed-up to, you may need to change the doctor. This may affect the manner in which your health issues are handled.
- Maintain all your records- a controversy may arise calling for verification of your claim. This can only be done officially using records. Your bills should be paid in a way that is easier to trace like money order or check. Always get a receipt whenever you pay. Get the names and identifications of the agents to make it easier to contact them in case you need assistance or clarification.
During the normal days of the year, you are limited to switch your Medicare enrollment plan of any type while, during the open period of Medicare plan, one has the full liability to change the plans and switch to the other one of their requirement or even the new clients can join the medicare insurance companies for the better state of their health in the future. The medicare open enrollment plan starts from October 15 and runs till December 7 every year. Well, the dates may alter a bit due to some important occasions or causalities without any prior information to the customers. During this period, the beneficiaries of the medicare insurance plans have the full freedom to access the plans available with the company. The medicare coverage plans can be customized as per the user’s requirement. After the open enrollment period, it comes in to implementation from 1st January i.e. beginning of the year. It is best to make minimum changes in your plan so as to avoid any kind of uncertainty. While if there are many points to be changed, then you can directly look for the other type of plan if it suits you, you can immediately change the plan.
While finalizing any of your plan during this period, it is best to compare your existing plan with the other plans of the company and justify which plans suits you the best and lies in your comfort zone. For some special cases or intense conditions, the medicare plans can change within any time of the year and the plan probably comes in to practice from the start of the upcoming month. This period is generally called as the special enrollment period.
Apart from this original medicare plans comes the medicare supplemental coverage plans, which basically covers the other beneficiaries like the health insurance in overseas and other extra charges. The medical supplemental plan also known as the medigap can be availed only if you are the user of Original medicare part A and part B. the medigap insurance plans are only for the people who are above the age of 65 as per the Federal government rules. While the persons with certain disabilities can avail for this plan after they pass the eligibility test. The eligibility test for this supplemental plan is decided upon your current health status. Various companies have the strict policies that the individuals can enroll for the health insurance plans only during the open enrollment period but not in the rest period of the year. Any of the supplemental coverage plans does not cover the guaranteed rights in any normal case but, under certain circumstances, one can hold the guaranteed issues along with the plan.
Acknowledging the medical history of the user is very crucial so as to review what plan suits the best to you. So, you must bring your all medical details while enrolling for any medical plan from any company. What benefits you will be getting at the open enrollment period are not there if you go for the medical plan at some other period of the year that too under special cases only. While going for any plan, it is necessary for every customer to review all the benefits they are availing and all the drug stores and hospitals.s