Consider this re: Ohio Medicare Advantage

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couple hugAs the Affordable Care Act “progresses”, we can expect many changes and reductions of benefits relating to Medicare Advantage plans in Ohio and around the country.

Currently the PPACA has no foreseen negative effects on Original Medicare or Medigap/Supplement plans. For this reason, I recommend comparing apples to oranges before deciding on a plan this Medicare season.

A High-Deductible Medigap Plan F is often misunderstood. Many people think it combines the deductible with Medicare. This is not true. The deductible is only applied to the Medicare Supplement portion – Medicare pays the same regardless of which Medicare Supplement a person has.

For many seniors, a premium of $0 for Medicare Advantage plans can be very enticing.

In many cases with an MA plan, if you goes to a Primary Physician, the Co-Pay would be $10 and a Specialist $40 for each visit. Keep in mind that this amount does not apply to the Out-of-Pocket Max (which is almost guaranteed to increase with healthcare “reform”)

With a High Deductible Plan F(HDF) – The $140 Part B Deductible will be applied before Medicare pays 80% of their approved amount until the deductible is paid and then the supplement begins to pick up the other 20% of Medicare approved amount.

With an MA – If you have to be hospitalized, there is a $225 Co-Pay for the first 7 days. Since the average hospital stay is 3 days, that would be $675. This is amount would apply toward the Out-of-Pocket Maximum of $3,750.

With a HDF – The Part A deductible of $1,156 would have to be paid for the first 60 days. Any of the other provider expenses and out-of-pocket costs on Part B would apply towards the $2,000 Deductible. If it was satisfied the HDF would pay the full Part A Deductible of Medicare.

A Medigap plan G or N can also be a better choice than Medicare Advantage. Run the numbers and compare benefits for your situation.

Compare Medicare Supplements
to Medicare Advantage Plans:

Concerns of Seniors:

Medicare
Supplement

Medicare
Advantage

Restrictive Network of doctors and hospitals

NO

YES

Co-Payments to Providers

NO

YES

Up to $3,000 yearly
Out of Pocket Costs

NO

YES

Health Plan Decides What Test and Procedures
Are Approved For You

NO

YES

Can Your Plan
Be Cancelled?

NO

Cannot be cancelled as long as premiums
are paid

YES

Plans are approved yearly and can be dropped.

Ability to Travel the Country and Use AnyDoctor or Hospital

YES

NO

Is Pre-Certification Required for some Treatments?

NO

YES

Penalties apply if pre-cert not done.

MD Anderson Cancer
Treatment Center Included?

MAYO Clinic Included?

YES

YES

NO

NO

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