Health Insurance

Many seniors are learning through mail solicitations, phone calls, 'seminar' dinners, and movie invitations that there is something called MEDICARE ADVANTAGE. What exactly is the 'advantage' and should you use it?

The government  would like to shift the burden of senior healthcare from the old Medicare system to the new Medicare Advantage Plans. These plans which are run by private insurance companies, offer more efficient and effective care by offering more coverage and benefits to seniors than the original Medicare system.

These private insurance companies offer their members additional benefits, or perks just for being members. For instance, Aetna's Premier Plan offers a health club membership; Blue Cross Secure Plan I offers eye wear and weight management programs; Health Net includes a smoking cessation program, nutritional programs and a nursing hotline; Secure Horizons Plan I offers health education seminars and health club memberships. All of these benefits come at no extra cost. Additionally, almost all of the plans offer annual routine physicals at no extra costs.

There are other plans that have premiums. These plans offer even more benefits. For example, Secure Horizons Plan II has a Prescription Mail Order Service and Alternative Health benefits for a premium of $40 a month; Blue Cross Freedom Plan II includes discounts for a variety of services including hearing aids and health club memberships through their Passport Savings Program for $80 a month.

There are Medicare Advantage Plans that do not have premiums, and all those plans offer more benefits and services than Medicare by itself. Due to the competition in the market place, the senior consumer is the recipient of many value added services.

The way it works is you contact the government and inform them that you want to sign up for a Medicare Advantage Plan and they pay the insurance company your Medicare Benefit. The insurance company then pays for your medical services, or you see their doctors as in the case of an HMO like Kaiser and some Humana Plans.

The downside is that if you are unhappy in the plan you chose, you have to remain in it until the Annual Enrollment Period (AEP). This open period usually comes at the end of the year on November 15th and lasts until December 31st. Another draw back is you may not see the doctor of your choice. If seeing your doctor is of utmost importance to you, consider enrolling in a plan such as the Humana Private Fee for Service (PFFS) Advantage Plan. Unlike many other Medicare Advantage Plans, this Humana plan is not a PPO or HMO and allows its members to go to any provider who accepts Medicare and Humana payment terms.

The questions most seniors ask, "Which are the best plans and which is the best one for me?" Because everyone has different needs and desires these are difficult questions to answer. One can see the plans offered at Medicare.gov, but there are a number of shortcomings with the government site. For one you need to know where you are going and what you are looking for, or you will be clicking and re-clicking to find the information you want.

The only Medicare comparison website outside of the government's site is Chriscompares.com. Compared to Chriscompares.com the government website is less user-freindly. There are more fields of information and benefits covered on Chriscompares.com than on the government website. Chriscompares.com covers over 70% of the senior population in over 800 counties offering more than 4,000 pages of information. In time Chriscompares.com will cover every state in the U.S.

On Chriscompares.com visitors just select their state and county and all the Medicare Advantage Plans, Medicare Supplement, Special Needs, Prescription 'Part D Drug' Plans will appear right at their fingertips. Visitors can compare plan premiums, maximum out-of-pocket expenses, hospital co-pays, skilled care co-pays, rehabilitation co-pays, Rx co-pays, as well as hearing, vision and dental co-pays, plus so much more. The Medicare.gov Web site covers less than half the information available on Chriscompares.com. As an added feature Chriscompares.com has the A.M. Best Rating for all the Medicare Supplemental Insurance companies which helps the visitor decide on the insurance company that is best for them. This valuable information is not on the government site. Contact information for each insurance company is also available on the site.

Unlike other Web sites that advertise themselves as comparison Web sites, but in fact turn out to be fronts for insurance companies, Chriscompares.com lets visitors view every insurance company and every plan that serves their county. Visitors do not have to disclose any personal information to access the medicare infomation.

Finally, Chriscompares.com has a glossary of definitions to aid visitors with terms that may be unfamiliar. Any extra information can be obtained through the Contact Us tab.

The Medicare world is changing and seniors enrolled or about to enroll in Medicare need to know about the many benefits available to them in these Advantage plans that are not available if they just stay in Medicare.

About the Author

Dr. C.W. Ullman has been in practice 29 years in Southern California. His practice is primarily a geriatric chiropractic practice. When his senior patients asked questions regarding medicare insurance, he, his staff and his patients researched the best plans. This article is a result of the their research.