Choosing What’s Best for You
Whether you’re in the thick of it or far removed, Medicare touches your life in big and small ways. It affects all of us at some point. Often it’s hard to grasp even the basics, let alone the numerous choices presented.
Medicare beneficiaries have several options to choose from: Original Medicare, Medicare Supplement Plans (also known as Medigap), Medicare Advantage Plans and Prescription Drug Plans (PDP).
An option to consider is to stay on Original Medicare (fee-for-service) and choose a Prescription Drug Plan (PDP). Another option is to add a Medicare Supplement Plan to help pay for the cost-shares (i.e., deductibles, coinsurance) associated with Original Medicare.
By far the most popular option with Medicare eligibles in Brevard County are Medicare Advantage Plans. Health First Health Plans offers four distinct and quality benefit plans. Three include prescription drug coverage (Medicare Advantage Prescription Drug) and one does not (Medicare Advantage). The Medicare Advantage only option is intended for those that have prescription drug coverage through another option, such as employer, union or Veterans Administration (VA).
What’s the Advantage?
Medicare Advantage plans are different from Original Medicare in that beneficiaries receive Medicare benefits plus additional value-added benefits through Health First Health Plans. Health First Health Plans aims at keeping members healthy and improving their quality of life. Along with providing free fitness memberships to our four Pro-Health and Fitness Centers and other facilities, we offer dental, vision and hearing benefits. In addition, our plans cover urgent and emergency care anywhere in the United States and worldwide.
Health First Medicare Advantage plans do not have deductibles, thereby making it more affordable and financially predictable for our members. On the contrary, beneficiaries on Original Medicare have a $1,216 inpatient admission deductible per benefit period under Part A and a $147 annual deductible plus 20 percent coinsurance for medical services under Part B (deductibles can change from year to year). This means if a beneficiary is admitted into the hospital a few times per year or requires numerous outpatient/physician services, their out-of-pocket costs could vary and be substantial.
A big plus to Medicare Advantage Plans is that pre-existing conditions and/or underwriting do not apply. This may not hold true with a Medicare Supplement Plan (also known as a Medigap Plan), which can be higher in premiums and out-of-pocket costs. If a member applies for a Medigap policy during the Open Enrollment Period, which lasts for the first six months after they are entitled to Medicare and enrolled in Part B, they have a guaranteed issue regardless of their health status. After this period, the beneficiary would be subject to underwriting and could receive a premium rate increase or be denied coverage altogether.
Who Is It For?
Medicare Advantage plans appeal to people who prefer to have predictable costs. They offer financial security by providing a maximum-out-of-pocket (MOOP) limit, which allows the member to fully understand their maximum financial exposure for covered medical services within a given calendar year. There are typically no MOOP amounts on Original Medicare or Medicare supplement plans, which means they could incur significant out-of-pocket costs.
Medicare Advantage plans have a network of providers that their members can access. Our plans appeal to those who appreciate an extensive network of providers, and who enjoy the convenience of not needing referrals. Our Medicare Advantage members have exclusive access to Health First Medical Group, the largest multi-specialty physicians’ group in Brevard County as well as more than 1,100 physicians in Brevard and Indian River Counties.
New to Medicare?
When you first become eligible for Medicare, you can join a Medicare Advantage Plan during the seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.
If you get Medicare due to a disability, you can join during the seven-month period that begins three months before your 25th month of disability and ends three months after your 25th month of disability.
Changing Your Plan
The Annual Enrollment Period (AEP) for Medicare is from October 15 through December 7. This is the time in which a beneficiary can join, switch or drop a Medicare Advantage Plan for the upcoming year. However, if you qualify for a Special Enrollment Period (SEP), you may be able to make changes outside of AEP. SEP’s include:
- You move out of your plan’s service area
- You are losing your employer group coverage
- You are eligible for LIS (low income subsidy) and receive extra help to pay for prescription drug coverage
- You have both Medicare and Medicaid
- You reside in, or recently moved out of, a nursing home or long-term care facility
Quality and Service Matters
According to the Centers for Medicare and Medicaid Services (CMS), Health First Health Plans is one of the highest rated Medicare Advantage organizations in Brevard and Indian River Counties (Medicare.gov). CMS evaluates Medicare Advantage Plans on their quality and performance, and for the past four years, Health First Health Plans has earned a 4.5 out of 5 Star Rating. Some of the areas they review include: how members rate a plan’s services and care; how well the doctors detect illnesses and keep members healthy; and how well plans assist members in their recommendation of safe prescription medications.
Let us Help You Understand Your Options
If you’d like help navigating your options, Health First Health Plans offers two different seminars to assist you. We’ll even give you a $10 gift card for attending.
The ABCD’s Seminar is a great option for those new to Medicare. It offers a brief overview of how Medicare works, what coverage options are available and the different enrollment periods.
If you already understand how Medicare works, but want more detailed information about Health First Health Plans Medicare Advantage offerings, then attend one of our Sales Seminars. To reserve your seat for one of these seminars, please call 1-855-729-8414 or TDD/TTY relay 1-800-955-8771 weekdays from 8 am to 8 pm and Saturdays from 8 am to noon. From October 1 to February 14, we’re available seven days a week from 8 am to 8 pm.
Ed Griese is president and CEO of Health First Health Plans, Central Florida’s only fully integrated delivery network, located in Brevard County.
Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. One gift card available to all Medicare eligible who RSVP and attend a sales seminar with no obligation to enroll in the plan. A salesperson will be present with information and applications. For accommodation of persons with special needs at sales meetings, call toll-free 1.855.729.8416 or TDD/TTY relay 1.800.955.8771.