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Information Regarding Medicare Advantage Plans

Want Your HMO Insurance Plan to Pay?

Are you going to see a specialist such as an orthopedic doctor?  Did you get a referral?  Health insurance is changing.  With the exception of original Medicare and many of the pre-Affordable Care Act plans (ACA – also called Obamacare), many plans require a referral from your primary care doctor PCP before they will cover a specialist.

That brings forth another question, if you have a Medicare Advantage HMO or an ACA plan HMO – have you declared a PCP?  If you have an HMO (Health Maintenance Organization or managed care plan, you probably need to declare a PCP or the insurance company will automatically assign a PCP for you. Most people would prefer keeping their doctor – so be sure to declare a PCP.

Getting a referral sounds fairly easy and how would one this goof up?  Easy – Do you think about getting a referral when you go to the eye doctor?  Well, in many HMO plans, whether Medicare or ACA, you need to get that referral.  So what happens if you do not get a referral – usually that expense is not covered.  It’s not enough now to have insurance, you need to use it properly or you will bear unnecessary costs.

The Future of Medicare Plans in 2018

The proposed change by CMS (Medicare) for Medicare Advantage Plans (MA) would result in a 2 percent reduction in MA net revenues, which would mean cuts to beneficiary coverage and benefits, according to a Feb 22 report by Oliver Wyman, sponsored by America’s Health Insurance Plans.  Add medical inflation to this reduction, MA plans probably will need to raise co-insurance rates 2018.  In 2017 many plans have approximately a $250 – $300 per day out of pocket cost for 1- 6 days of a hospital stay.

MA plans can be a good purchase for people in relatively good health or older people, especially if they are not going to be aggressive with care. Note: There are many other factors to consider. Due to the possible increase of co-pays for 2018 and beyond, it is recommended that you are comfortable with paying these co-pays if you have the medical need.  There are now some low cost plans to assist a person with these types of out of pocket co-pays.  It may be a good idea to ask about “indemnity plans”.

On a Personal Note:

April 2017 marks my writing for 50 Plus News & Views for 30 years.  It seems like yesterday I started and continued to write about real life experiences people of the people we serve.  For you: I hope the articles have enlightened you.  For me: as I tell people getting into any business, writing professional articles, blogging, etc caused me to read, research and learn.  I have always strived to be the best I could be and serve people well.  News & Views, radio, TV and public speaking has allowed me that growth.  Without readers like you, this wouldn’t have happened.  For this I am humbled and most grateful; and I thank you from the bottom of my heart.

As always, feel free to contact our office if you have questions at 309-693-1060.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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