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Seniors Living Healthy

11 EpisodesProduced by Senior Benefits, Inc.Website

Join your hosts Nick Keene and Zach Haire fireside as they discuss the things you need to know as you or your parents begin to live out your golden years. With over 50 combined years in the senior market across the country, Nick and Zach are experts in the senior market and are here to help you live… read more

21:22

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

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



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-day benefit period. And then also beyond that, for individuals that required skilled facility care beyond hospital stays, Medicare covers all but $176 day 21 through 100, with Medicare paying 100 percent, day 1 through 20 provided that an individual is in the hospital three days or more and admitted to that facility within 30 days. Then as far as Part B, Zach, as you know, Part B of Medicare has an 80/20 coinsurance. The clients are responsible for the remaining 20 percent that Medicare does not pay, as well as a annual deductible of $198 per year.


Zach: Great, Nick. So, now we're caught up with the different gaps and everything out there. There are two options, really, when it comes out there to filling in gaps in your Medicare. One of them is Medicare Supplements; we're going to spend next episode talking about this one. So, this episode, we're going to talk about Medicare Advantage Plans. You may see that also referred to as Part C, or MAPD. That's a couple of different lingo we use in our industry. You'll see it, especially with Annual Enrollment Period coming up. So, you're going to see a lot of advertisements, billboards, radio ads, things like that for those products. And so, Medicare Advantage Plan, lack of better terms, it replaces A and B of Medicare.


Nick: Absolutely. Yep.


Zach: So, Nick, looking out there, there are several different types of MAPDs, you want to run through those real quick, maybe touch on the two main ones that are out there, and we'll go from there.


Nick: Sure, absolutely. So, there's a number of different types of Medicare Advantage Plans that are offered on the market, Zach, but the few that are the most common are going to be the HMO, which stands for Health Maintenance Organization, the PPO, which is a Preferred Provider Organization, and then SNP plans: Special Needs Plans. Those plans are specified for specific portions of the population, whether that be dual-eligible Medicare beneficiaries, institutionalized Medicare beneficiaries or Medicare beneficiaries with chronic conditions. 


But back to the main two, the HMO plans are primary care physician based. What that means, Zach, is the beneficiary's care is all handled directly through their primary care physician, and any doctors or specialists within that network or outside, are only available to the client with a referral from that primary care physician. And their networks are typically county-based or s...

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