Thursday, April 21, 2022

Do Medicare Advantage Plans Include Part B

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Additional Humana Vision Coverage

Medicare Advantage Part C

Its important to remember that cataract surgery will generally be covered by the medical insurance portion of your Humana plan and not the vision coverage portion of your plan.

Vision coverage is typically included in Humana Medicare Advantage plans at no extra cost.

Humana vision benefits can include:

  • Annual routine vision exams

Recommended Reading: Does Medicare Part A Or B Cover Prescriptions

Does Medicare Cover Chemotherapy Drugs

If youre a cancer patient in a hospital, outpatient clinic, or doctors office, Medicare typically covers chemotherapy drugs and treatment, as long as its medically necessary.

If your chemo is administered through an IV at a doctors office or as an outpatient, it may be covered by Part B. If its administered orally or IV in a hospital or as an inpatient, it will likely be covered by Part A.

Chemotherapy, which can be administered orally through pills, capsules or liquids, intravenously through a vein, or by injection into a muscle, is used to treat cancer. There are many types of chemotherapy drugs, and what you receive depends on the type of cancer you have, how advanced it is, and whether or not you have other health issues or risk factors.

Recommended Reading: How To Sign Up For Medicare Part B Online

Medicare Advantage Coverage Of Cancer

Medicare Advantage plans cover the same Part A and B services as Original Medicare. However, how you access your benefits and what you pay for services will be different.

Heres how they work:

Most plans have an HMO or PPO network of providers. Youll seek care within the network to get the lowest copays. Sometimes the oncologist or hospital you wish to see may not be in the plans network.

With Medicare Advantage plans, you have cost-sharing or copays for treatment as you go along. Some cancer services under Medicare Advantage plans require up to 20% coinsurance from you. You pay a percentage of the cost of that treatment.

We see many plans where your cost-sharing for chemotherapy and radiation will be as much as 20%. You will pay this until you reach the plans Out-of-Pocket Maximum. That maximum can be as high as $7550 per calendar year in the network in 2021, and even higher out-of-network.

Lets check out an example:

Doug is undergoing radiation for prostate cancer. His Medicare Advantage plan requires him to pay a 20% coinsurance for his radiation treatments. While he is getting treatment, he also has twice monthly appointments with his oncologist at which he pays a $50 copay for a specialist visit.

He pays this 20% radiation cost and all of his doctor copays until he reaches $7550 out of his own pocket. Then the plan covers 100%.

Bottom line?

Be aware of this before you enroll in a Medicare Advantage plan.

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How Does Medicare Part D Work

Whether your prescription drug coverage is through an MA-PD or a standalone Part D plan, there are four coverage phases:

  • During the Deductible Phase, you are responsible for 100 percent of your prescription drug costs. In 2022, the maximum Part D deductible is $480, although some plans set a lower deductible. Review your plan’s information to determine your yearly Part D deductible.
  • In the Initial Coverage Phase, you pay 25 percent of the cost for covered prescription medications. Your Part D plan pays the remaining 75 percent. Check your PDP’s drug formulary to determine whether it includes your prescriptions.
  • You continue paying 25 percent of costs in the Coverage Gap Phase. But now your plan’s share drops to 5 percent for brand-name drugs with the manufacturer picking up the remaining 70 percent of the cost. For generic medications, you still pay 25 percent with Medicare covering the 75 percent your Part D plan paid during the initial coverage stage.
  • The final stage is Catastrophic Coverage, which you reach when your total out-of-pocket spending equals $7,050 in 2022. Few Medicare beneficiaries ever reach this stage. If you do, though, expect your Part D coinsurance or copayment for covered prescriptions to be either 5 percent or $3.95 for generic drugs or $9.85 for name brand drugs, whichever amount is higher.
  • If you qualify for Extra Help, you will never enter the coverage gap phase.

    Why Are Medicare Advantage Plans Bad

    Medicare Facts

    If you do opt for Medicare Advantage, youll need some cushion against an expensive emergency calamity.

    Kunkle Roberts advises someone considering MA to have a rainy day fund or health savings account worth at least $30,000 to weather the storm of out-of-pocket costs for an illness that might span a few calendar years.

    And dont think you can just switch over to Original Medicare when you do get sick. In most states you will be unable to qualify for a Medigap policy, effectively making it prohibitive to join Original Medicare.

    Read Also: What Preventive Services Are Covered By Medicare

    Choosing A Medicare Advantage Plan

    Medicare Advantage Health Plans are similar to private health insurance. Most services, such as office visits, lab work, surgery, and many others, are covered after a small co-pay. Plans might offer an HMO or PPO network and all plans place a yearly limit on total out-of-pocket expenses. Each plan has different benefits and rules. Most provide prescription drug coverage. Some require a referral to see a specialist while others do not. Some may pay a portion of out-of-network care, while others will cover only doctors and facilities that are in the HMO or PPO network. There are also other types of Medicare Advantage plans.

    Selecting a plan with a low or no annual premium can be important. But it’s also essential to check on copay and coinsurance costs, especially for expensive hospital stays and procedures, to estimate your possible annual expenses. Since care is often limited to in-network physicians and hospitals, the quality and size of a particular plans network should be an important factor in your choice.

    How Has Health Reform Impacted Medicare Advantage

    The Patient Protection and Affordable Care Act has restructured payments to Medicare Advantage plans in an effort to reduce budget spending on Medicare, but for the last few years, the payment changes have either been delayed or offset by payment increases. When the law was first passed, many people including the CBO projected that Medicare Advantage enrollment would drop considerably over the coming years as payment reductions forced plans to offer fewer benefits, higher out-of-pocket costs, and narrower networks.

    But that has not been the case at all. Medicare Advantage enrollment continues to grow each year. There were nearly 28 million Advantage enrollees in 2021, which accounts for more than 43% of all Medicare beneficiaries Thats up from just 13% in 2004, and 24% in 2010, the year the ACA was enacted.

    The number of Medicare Advantage plans available has increased for 2022 to the highest in the last decade, with a total of 3,834 plans available nationwide. The majority of beneficiaries still have at least one zero-premium plan available to them, and the average enrollee can select from among 39 plans in 2022.

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    Eligibility And Enrollment Part B Vs Part C

    Original Medicare and Advantage plans vary in their eligibility and enrollment requirements.

    Part B

    After a person gets Social Security benefits at age 65, Medicare automatically enrolls them in Part A and Part B. If a person meets the age requirement but does not receive Social Security benefits, they will not automatically get Medicare and will need to sign up for it.

    If someone does not sign up for Part A and Part B during the Initial Enrollment Period when they first become eligible, they may sign up during the general enrollment period, which is from January 1 to March 31 every year.

    An individual may apply for Medicare online here.

    Part C

    A person who has Medicare Part A and Part B and does not have end stage renal disease is eligible for an Advantage plan. An individual may switch from Part A and Part B to an Advantage plan during the initial enrollment period or the open enrollment period, which is from October 15 to December 7 of every year.

    To enroll in an Advantage plan, a person first needs to select a plan in their area. After they decide on a plan, they may request an enrollment form from the insurance company offering it or enroll on the companys website.

    Does Medicare Part B Cover Chemotherapy Drugs

    Medicare Basics: Parts A, B, C & D

    Medicare Part B covers several chemotherapy drugs that are administered through the vein in an outpatient setting.

    Part B coverage includes certain oral and intravenous drugs along with anti-nausea drugs to offset the symptoms of chemotherapy. In fact, chemotherapy and other cancer-treating drugs account for the majority of units of Medicare-covered drugs that are thrown away or otherwise discarded by health care providers.

    Chemotherapy drugs can be expensive, which is why Part B may not cover all of them. Further coverage for chemotherapy drugs can be found in Medicare Part D or Medicare Advantage plans that include prescription drug coverage.

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    What Are The Benefits Of Medicare Advantage

    With Medicare Advantage plans, the essential Medicare Part A and Part B benefits except hospice services are automatically covered. If you need hospice services, thats covered under Original Medicare, even if youre enrolled in a Medicare Advantage plan, although CMS debuted a small pilot program in 2021 in which a limited number of Advantage plans are providing hospice services through the Advantage plan rather than through Original Medicare.

    Advantage plans also cover urgent and emergency care services, and in many cases, the private plans include Part D prescription drug benefits, and also cover vision, hearing, health and wellness programs, dental care, and various other supplemental benefits. Since 2019, Medicare Advantage plans have been allowed to cover a broader range of extra benefits, including things like home health aides, medical transportation, and the installation of in-home safety devices. Relatively few plans have started offering these benefits as of 2021, but more appear poised to do so for 2022.

    Some Medicare Advantage plans also offer giveback rebates, which reduce the amount thats deducted from the beneficiarys Social Security check to cover the cost of Medicare Part B .

    Plans that have giveback benefits, also known as premium reduction plans, are not available in all areas, although they are available in the majority of US counties .

    Discuss your Medicare Advantage coverage options today with a licensed Medicare advisor. Call

    Which Companies Offer Part B Premium Reduction

    Humana Medicare Advantage options include the give-back feature on some plans. In some areas, Cigna may also have a Part B premium reduction plan. Even Aetna has a Part B give back in some areas.

    Further, there are likely more companies offering this type of policy than just the ones weve mentioned. Also, consider the plan ratings before you enroll.

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    Are Your Part D Costs The Same In The Coverage Gap

    This one doesn’t have a simple answer. It all depends on the type of Part D plan you have. Although 25 percent is the standard copay until you reach catastrophic coverage, some Medicare drug plans include coverage while you’re in the donut hole that lowers your cost. This may be true for both generic and brand-name drugs. The only way to know for sure is to talk to your plan provider.

    If you thought your plan provided a discount while in the coverage gap but you haven’t seen it yet, review the Explanation of Benefits . You should get this statement monthly . Always review it for errors and contact your plan if you notice any discrepancies.

    Find more information on Medicare.gov here. Or, you can call 1-800-MEDICARE or TTY 1-877-486-2048.

    The Pros And Cons Of Medicare Advantage

    The ABCs of Medicare

    Medicare Advantage plans have benefits and drawbacks. While they’re a slam-dunk choice for some people, they’re not right for everyone.

    Pros:

    • Additional benefits, which may include some cost savings or subsidies toward hearing, dental and vision care.

    • Potentially lower premiums for coverage.

    • Limits on how much you may have to pay out of pocket for hospital and medical coverage. This limit is determined by the Centers for Medicare & Medicaid Services, and in 2021 it is $7,550.

    Cons:

    • Less freedom to choose your medical providers.

    • Requirements that you reside and get your nonemergency medical care in the plans geographic service area.

    • Limits on your ability to switch back to Original Medicare with a Medicare Supplement Insurance policy.

    • The potential for the plan to end, either by the insurer or by the network and its included medical providers.

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    Medicare Part C = Medicare Advantage Plans

    • Once you have Parts A and B, you can enroll in a Medicare Advantage plan
    • When Medicare Advantage plans include Part D prescription drug coverage, they’re called MAPD plans
    • MAPD plans are usually the lowest cost way to get Parts A, B and D together
    • You’ll continue to pay your Part B premium to the federal government
    • Usually, you’ll pay an additional monthly premium to your private insurance company, too
    • Medicare Advantage plans may also include extras like dental and vision coverage
    • You won’t be denied due to a pre-existing condition

    How Do The Parts Of Medicare Cover Cancer Treatment

    The amount that Medicare will cover for cancer treatments can vary based on the type of cancer you have and the type of treatment plan prescribed by your doctor.

    The type of policy you have can also play a role in your Medicare cancer coverage and how much youll have to pay out-of-pocket.

    There are four parts of Medicare, referred to as Part A, Part B, Part C and Part D.

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    Consider Premiumsand Your Other Costs

    To see how a Medicare Advantage Plan cherry-picks its patients, carefully review the copays in the summary of benefits for every plan you are considering. To give you an example of the types of copays you may find, here are some details of in-network services from a popular Humana Medicare Advantage Plan in Florida:

    • Hospital stay$175 per day for the first 10 days
    • Ambulance$300
    • Diabetes suppliesup to 20% copay
    • Diagnostic radiologyup to $125 copay
    • Lab servicesup to $100 copay
    • Outpatient x-raysup to $100 copay
    • Renal dialysisup to 20% copay

    As this non-exhaustive list of copays demonstrates, out-of-pocket costs will quickly build up over the year if you get sick. The Medicare Advantage Plan may offer a $0 premium, but the out-of-pocket surprises may not be worth those initial savings if you get sick. The best candidate for Medicare Advantage is someone who’s healthy,” says Mary Ashkar, senior attorney for the Center for Medicare Advocacy. “We see trouble when someone gets sick.”

    How Parts B And D Work Together

    Do you know all the “extra” benefits a Cigna Medicare Advantage Plan offers?

    Medicare Parts B and D pay for medications you receive in the ambulatory setting but they won’t pay towards the same prescription. You can only turn to one part of Medicare or the other. However, you may be able to use them both for drugs you receive in a hospital setting.

    Medications you receive in the hospital when you are admitted as an inpatient will be covered by your Part A deductible. It is important to understand what happens when you are evaluated in the emergency room and sent home or are placed under observation, even if you stay overnight in the hospital. In this case, you can turn to Parts B and D to pay for your drugs.

    When you are placed under observation, Part B will still pay for the medications reviewed above. If you receive IV medications, these will generally be covered. However, you may also receive oral medications during your observation stay that are not on the Part B list of approved medications. In this case, you will be billed for each pill administered by the hospital.

    Send copies of your hospital bills to your Part D plan for reimbursement. Unfortunately, if you receive a medication that is on your Part D formulary, your plan may not pay for it.

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    Why Should I Choose Medicare Advantage

    Medicare Advantage covers some of the gaps of Original Medicare and usually offers a $0 premium through a private company. It can be an affordable option for patients who are not currently sick or in need of intense medical care. If a patient’s situation worsens, it might be difficult or expensive to switch plans.

    How To Choose The Best Medicare Advantage Plan

    Comparing Medicare Advantage plans requires you to understand your health care needs and think about what each type of plan offers. If you have a chronic health condition and want to be able to keep using a specific doctor or facility, youll want health coverage that they accept. If you take prescription drugs, some plans may offer lower out-of-pocket costs than others.

    Here are some questions to ask as you evaluate Medicare Advantage plans:

    • Do you have to get a referral to see specialists?

    • What benefits does each plan include?

    • Are all of your prescription drugs covered, and how much will they cost?

    • Are your doctors covered?

    • Whats the plan’s Medicare star rating?

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    What Infusion Drugs Are Covered By Medicare Part B

    Infusion drugs are those that are administered intravenously through a needle or catheter. To be covered by Medicare Part B, the drugs must be non-oral or biological, administered through an IV or applied under the skin for a period of at least 15 minutes. The drugs must be considered reasonable and necessary and not self-administered.

    Some common infusion drugs that may be covered by Medicare Part B include:

    • Rituxan
    • Cimzia
    • Prolia

    If you would like to check Medicare Part B coverage of a specific drug, call 1-800-MEDICARE and speak to a representative concerning your medications and the coverage requirements surrounding it.

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