Thursday, July 11, 2024

How Do Zero Premium Medicare Plans Work

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Consider Your Particular Needs And Costs

How Can Medicare Advantage Have Zero Dollar Premium?

It’s not a one-size-fits all, said Chuchanis. Often spouses will benefit from enrolling in different plans, depending upon their medical needs, she said.

Look at the costs of services you use most, like specialists or medications, when comparing Medicare Advantage plans, said Chuchanis.

It is especially important to look at the total yearly cost of plans, including premium and drug costs, as well as out-of-pocket limits, when weighing the best plan for you, she said.

People with high medical costs also need to look at what their maximum out of pocket will be, she said. Once they hit that limit, they dont have to pay for high medical expenses.

Look at the services you use the most, Chuchanis said. If youre going to get a knee replacement, look at your potential hospital costs. If you see a lot of specialists, compare the copays among plans, she said.

For prescription drug costs, input your medications into the site and do an analysis of costs, said Chuchanis. She also warns people to stay in network for your pharmacies.

When they go to the drugstore, don’t ask, Do you take this plan? ” she said. “You need to ask, Are you an in-network pharmacy with this plan?

Sometimes mail order can be cheaper, but not always, so check the Medicare website, she said.

Overall, Chuchanis said in analyzing plans in the Akron region, she saw very little increases in overall monthly premiums. Reeg said her experts noticed premiums statewide stayed steady.

Braven Health Unveils Zero Dollar Premium Plans For New Jersey Medicare Advantage Consumers

Braven Health plans also provide members with a customized experience

Braven Health the first and only New Jersey Medicare company jointly owned and operated by New Jerseys largest and most trusted health insurer, Horizon Blue Cross Blue Shield of New Jersey and one of the states leading health systems, Hackensack Meridian Health , is offering zero premium products to its individual consumers and cost effective plans for group customers. These new plans offer Medicare beneficiaries a personalized and customized approach to Medicare Advantage. To further support Braven Healths innovation, HMH and Horizon BCBSNJ are working with RWJBarnabas Health to join Braven Health, subject to approval by the New Jersey Department of Banking and Insurance.

We listened to Medicare-eligible members and built Braven Health based on their health care wants and needs, which include more coordination, more simplicity, more affordability, and flexible benefits, said Luisa Y. Charbonneau, Chief Executive Officer of Braven Health. Our plans reflect the lifestyles and health goals of our members. Braven Healths approach and care delivery are unique for New Jersey with every plan backed by our doctors and health insurer partners.

Braven Health is the product of years of work and collaboration by Horizon BCBSNJ and HMH in value-based care an approach to care delivery based on high standards of quality, an improved patient experience and lower costs.

What Is A Zero

A zero-premium plan is a Medicare Advantage plan that has no monthly premium. In other words, you dont pay anything to the insurance company each month for your coverage. Thats in comparison with the average Medicare Advantage premium of $23/month in 2020. . If you have a zero-premium plan, you pay $0/month instead.

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When Can You Enroll In Zero

You can sign up for an MA plan once youre eligible for Medicare Parts A and B. Youre eligible for Medicare if youre 65 or older.15 Some younger people with disabilities also qualify.

You can sign up for Medicare starting three months before you turn 65 until three months after. You have to enroll in Medicare before you can sign up for a Medicare Advantage plan.

After you enroll in a Medicare Advantage plan, you can switch for any reason between October 15 and December 7 or during the Medicare Advantage Open Enrollment Period every year from January 1 through March 31.

Outside those two periods, you can join or switch plans under special circumstances, for example, if you move, you lose your current coverage, or your current plan changes.16

After your initial sign-up, open enrollment or a special enrollment period is your chance to switch MA plans. If zero-premium plans are offered in your area, you might choose one during open enrollment.

What You Pay In A Medicare Advantage Plan

How Can Medicare Advantage Plans Have Zero


depend on:

  • Whether the plan charges a monthlypremium. Many Medicare Advantage Plans have a $0 premium. If you enroll in a plan that does charge a premium, you pay this in addition to the Part B premium .
  • Whether the plan pays any of your monthlyMedicare Part B premium. Some plans will help pay all or part of your Part B premium. This is sometimes called a “Medicare Part B premium reduction.”
  • Whether the plan has a yearlydeductible or any additional deductibles.
  • How much you pay for each visit or service . For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those underOriginal Medicare.
  • The type of health care services you need and how often you get them.
  • Whether you go to a doctor orsupplierwho acceptsassignmentif:
  • You’re in a PPO, PFFS, or MSA plan.
  • You goout-of-network.

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Free Can Be Good But Watch Costs

Zero-premium plans can provide good coverage for consumers, but make sure you look at all of the out-of-pocket costs, experts said.

Unlike the old adage of you get what you pay for, there are many zero-premium Medicare Advantage plans with good coverage because Medicare pays plans to participate and subsidizes some costs, Reeg said.

The federal government contracts with private insurance companies to provide drug and/or medical coverage to Medicare recipients who sign up for the plans. Everyone but the poorest enrollees pays a portion of the monthly premium the government picks up the rest.

Consumers have to choose a plan based on their current health needs for the next year, as well as potential costs if you have the worst health year ever, she said.

Health insurance is based on the if. You want to know whats going to happen if you are in that situation and knowing what your copay should you be admitted to the hospital,” Reeg said.

But make sure you know all of your costs as a $0 premium plan will still have other costs for copays and medications, she said.

Many Medicare Advantage plans offer extra benefits for dental, vision and hearing and other extras such as home and bath safety devices or emergency response devices.

I would suggest not choosing your health insurance based on the added benefits. Choose based on your health care benefits and look at the added benefits just as they are extra goodies or icing on the case, said Reeg.

Face The Other Factors

We know thereâs a lot more to a plan than its premium, but how can an agent determine what plans are valuable to what clients? You must know your client and your clientâs needs.

The first thing an agent should do is find out what doctors their clients will use. Ask them, âIf there were something really wrong, what hospital would you go to?â If their hospital of choice isnât in a planâs network, that plan shouldnât be considered an option.

In the case of most senior clients, they want to stay with their doctors. Put simply, their relationship with a doctor means more to them than saving a few bucks.

Additionally, agents should clearly present all benefits of a plan. Some plans may offer specific values to your client that make a higher premium completely worth it. Rather than shell out a copay each month, it might be cheaper for your clients to pay the premium of a plan that covers a particular cost.

Finally, are you ready for the super combo that could benefit both you and your client? Consider pairing a $0-premium MA with a hospital indemnity plan to ease the burden of expensive hospital copays.

A low-premium plan will yield a high MOOP, but clients can spend a part of those savings on an affordable hospital indemnity plan that helps them cover pricey copays on hospital stays.

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Are Zero Premium Medicare Advantage Plans Really Free

Although Medicare Advantage plans can have a $0 premium, there are other things you may have to pay for out of pocket. These costs can include:

  • Copays. A copayment is an amount that you pay for a service after you have met your deductible. These may be higher with plans that have a lower monthly premium, while plans with a higher monthly premium may have lower copays.
  • Coinsurance. Coinsurance is the amount that you are responsible for paying for a covered service, even after youve paid your deductible. For example, if your coinsurance is 20 percent, you will pay the first 20 percent of the amount due, and your health plan will cover the rest.
  • Deductible. A deductible is the amount that you are responsible for paying before your insurance plan begins to pay its share. Deductibles are often higher with plans that have lower premiums, meaning youll pay less each month in premiums but more out of pocket for individual healthcare services. After you pay your full deductible, your health plan will pay most of the cost for medical services, but you may still have to pay a copay or coinsurance.
  • Other Medicare premiums. Even with a Medicare Advantage plan, you are responsible for paying the premiums for all other parts of Medicare that you may have. Most people do not pay a premium for Part A, but Part B does have a monthly premium.

How Do Msa Plans Work With Medicare Advantage

How Can Medicare Advantage Plans Cost $0? | (Hint: They Aren’t Free!)

Typically you will pay your medical bills after you receive care with a dedicated debit card that your MSA plan mails to you.

The premium for an MSA is $0, but that doesnt mean your total costs are always zero. Its best to set some money aside in case you have health care costs above what is in the savings account.

Until you meet your deductible, youre responsible for paying 100% of the Medicare-approved amount for your care. You can use the money from your medical savings account to pay for these expenses. When its used up, you will pay for health expenses out of pocket until you reach your deductible. Then the plan pays 100% of the Medicare-approved amount.

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What Else Do I Need To Know About $0

Average Medicare Advantage premiums dropped 33 percent year over year in 2019, according to eHealth research. The popularity of $0-premium plans contributed to the low average premiums.

Medicare Part D plans are not available with $0-premiums.

Whether or not its a $0-premium Medicare Advantage plan that you sign up for, you still need to continue paying your Medicare Part B premium, in addition to any premium your plan may charge. Youre still in the Medicare program even when you receive your benefits through a Medicare Advantage plan.

As you can see, the cost of a Medicare Advantage plans premium isnt all there is to choosing which Medicare Advantage plan may be right for you. It could be a $0-premium Medicare Advantage plan, or a different plan that might suit your needs. Would you like help comparing $0-premium Medicare Advantage plans and other Medicare health plans? Just enter your ZIP code on this page.

New To Medicare?

Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

Who Can Buy A Zero

Most Medicare Advantage enrollees have access to at least one zero-premium plan, but only about half of them take that option. According to Kaiser Family Foundations analysis of 2019 Medicare Advantage enrollment, 90 percent of people who enrolled in an MA-PD had the option to select a zero-premium plan. But only 56 percent did so. The other 44 percent opted to pay premiums that ranged from under $20/month to over $100/month.

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Why Medicare Advantage Plans Can Fall Short

For many older Americans, Medicare Advantage plans can work well. A JAMA study found that Advantage enrollees often receive more preventive care than those in traditional Medicare. Advantage plans are competing not just on cost but on delivering quality care, says Kenton Johnston, PhD, associate professor of health management and policy at Saint Louis University, co- author of the study.

But if you have chronic conditions or severe health needs, you may want to think twice about Medicare Advantage because of the requirements for pre-authorization and staying in-network, says Melinda Caughill, co-founder of 65 Incorporated, a firm that provides Medicare enrollment guidance to financial advisers and individuals.

If you need to see multiple specialists, and you have to get referrals for each appointment or fight to overturn denials, it can be really challenging, Caughill says.

Steven Feld, 65, a retiree in South Pasadena, Fla., struggled to get coverage for an injection to treat his arthritic knee. The treatment, a prefilled injection administered in a doctors office, is deemed a medical device by the FDA, so the plan twice denied the coverage. When I was on my employers group plan, there was no problem getting the injection covered, says Feld, who joined his Medicare Advantage plan in May.

Are There $0 Medicare Advantage Plans Near Me


Not all insurers offer $0 plans, and those that do might not provide them in all areas. Typically, $0 premium plans are more common in urban areas than rural ones.

Its usually easier for insurers to offer $0 premium plans in three situations:

  • When there is stiff competition: When there are many plans offered in an area, insurers may try to lure more Medicare recipients into their plans with low or $0 premiums.
  • When there are many providers: When insurers can pick and choose from a large pool of hospitals and doctors to include in their network, they have more leverage to secure low prices and cut costs.
  • When there are plenty of beneficiaries: When theres the potential to lure a lot of enrollees away from the completion, insurers are more likely to use this strategy.

All three of these circumstances are common in densely populated areas like large cities, whereas only one or none of these circumstances may occur in a rural area. But you never know until you ask.

To find out if theres a $0 premium plan near you that fits your lifestyle, call a licensed Medicare agent or put your zip code in the box below.

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What Does Medicare Part C Cover

Part C plans must be authorized by Medicare and offer at least the same benefits by private health insurance companies. Many Medicare Advantage plans provide further benefits to be competitive, such as prescription drug coverage, wellness and fitness memberships, or even include help with dental care, eyeglasses, or hearing aids.

Will You Stay Within Your Medicare Advantage Network

With any Medicare Advantage plan, choosing in-network providers minimizes out-of-pocket costs. Those choices have an even bigger impact with $0 premium Medicare Advantage plans and their higher copays.Take a look at your preferred providers. Check them against the provider networks of the $0 premium plans youre considering. If you wont be staying in-network, the $0 premium plans may cost you more throughout the year.

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Most Medicare Advantage Enrollees Have Access To Some Benefits Not Covered By Traditional Medicare In 2021 And Special Needs Plan Enrollees Have Greater Access To Certain Benefits

Medicare Advantage plans may provide extra benefits that are not available in traditional Medicare. The cost of these benefits may be covered using rebate dollars paid by CMS to private plans. In recent years, the rebate portion of federal payments to Medicare Advantage plans has risen rapidly, totaling $140 per enrollee per month in 2021, a 14% increase over 2020. Plans can also charge additional premiums for such benefits. Beginning in 2019, Medicare Advantage plans have been able to offer additional supplemental benefits that were not offered in previous years. These supplemental benefits must still be considered primarily health related but CMS expanded this definition, so more items and services are available as supplemental benefits.

Most enrollees in individual Medicare Advantage plans are in plans that provide access to eye exams and/or glasses , hearing exams/and or aids , telehealth services , dental care , and a fitness benefit . Similarly, most enrollees in SNPs are in plans that provide access to these benefits. This analysis excludes employer-group health plans because employer plans do not submit bids, and data on supplemental benefits may not be reflective of what employer plans actually offer.

Will I Still Have Other Costs If I Enroll In A Zero

Do Zero Dollar Premium Medicare Advantage Plans Exist?

Note that regardless of how much your Medicare Advantage plan costs, you also have to pay your Part B premiums. In 2020, Part B costs $144.60/month for most enrollees. So if you have a Medicare Advantage plan that costs $30/month, youll pay about $174.60/month in total premiums. Whereas if you have a zero-premium Medicare Advantage plan, youll pay $144.60/month .

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Medicare Advantage Managed Care Plans: Beneficiary Protections

  • The plan cannot charge more than a $50 copayment for visits to the emergency room.
  • You or your doctor can appeal a denial of service and the appeal must be handled in a “timely” way. The plan must make an initial determination within 14 days. Reconsideration of a decision must be made within 30 days. Decisions regarding urgent care must be made within 72 hours.
  • The plan must have a process for identifying and evaluating persons with complex or serious medical conditions. A treatment plan must be developed within 90 days of your enrollment.
  • If your treatment plan includes specialists, you must have direct access to those specialists. You do not need a referral from your primary care physician.

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