Healthfirst Health Plan, Inc., offers HMO plans that contract with the Federal Government. Healthfirst Medicare Plan has a contract with New York State Medicaid for Healthfirst CompleteCare (HMO SNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the Healthfirst Life Improvement Plan (HMO SNP). Enrollment in Healthfirst Medicare Plan depends on contract renewal. Healthfirst Medicare Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132). 注意：如果您使用繁體中文，您可以免費獲得語言援助服 務。請致電1-866-305-0408 (TTY 1-888-542-3821).
Since the mid-1990s, there have been a number of proposals to change Medicare from a publicly run social insurance program with a defined benefit, for which there is no limit to the government's expenses, into a program that offers "premium support" for enrollees. The basic concept behind the proposals is that the government would make a defined contribution, that is a premium support, to the health plan of a Medicare enrollee's choice. Insurers would compete to provide Medicare benefits and this competition would set the level of fixed contribution. Additionally, enrollees would be able to purchase greater coverage by paying more in addition to the fixed government contribution. Conversely, enrollees could choose lower cost coverage and keep the difference between their coverage costs and the fixed government contribution. The goal of premium Medicare plans is for greater cost-effectiveness; if such a proposal worked as planned, the financial incentive would be greatest for Medicare plans that offer the best care at the lowest cost.
One benefit of Medicare Advantage plans is that you can get your prescription drug benefits (Medicare Part D) included under the same plan, instead of having to enroll in a separate stand-alone Medicare Prescription Drug Plan. Also known as Medicare Advantage Prescription Drug plans, these plans give you the convenience of having your Medicare Part A, Part B, and Part D coverage through a single plan. If you want prescription drug benefits, you should get it through a Medicare Advantage plan that includes this coverage; you shouldn’t enroll in a Medicare Prescription Drug Plan, which typically works with Original Medicare.
For doctors and medical procedures (Part B) at the hospital and at home: You would pay 20% of all costs after meeting your $147 deductible. Unlike many other health insurance policies, there is no cap or maximum out-of-pocket amount on what you could owe. The American Heart Association says that the average cost of heart surgery is $62,509 – in that case, your Part B copay would be over $12,000.
Medicare has four basic parts – A, B, C and D. If you’re unfamiliar with how they work, read Medicare 101: Do You Need All 4 Parts? Taken together, Parts A (hospital care), B (doctors, medical procedures, equipment) and D (prescription drugs) provide basic coverage for Americans 65 and older. What's relevant for this article is what these parts don't cover – deductibles, co-pays and other medical expenses that could wipe out your savings should you become seriously ill. That's where Part C comes in. Also known as Medicare Advantage, it's one of two ways to protect against the potential high cost of an accident or illness. Here's what could happen.
Since 1997, Medicare enrollees have had the option of going beyond their Original Medicare coverage by enrolling in Medicare Advantage. As of 2017, there were a record 19 million people enrolled in Medicare Advantage plans, accounting for about 33 percent of all Medicare beneficiaries. Enrollment in Medicare Advantage has been steadily growing since 2004. Managed care programs administered by private health insurers have been available to Medicare beneficiaries since the 1970s, but these programs have grown significantly since the Balanced Budget Act – signed into law by President Bill Clinton in 1997 – created the Medicare+Choice program.The Medicare Modernization Act of 2003 changed the name to Medicare Advantage, but the concept is still the same: beneficiaries receive their Medicare benefits through a private health insurance plan, and the health insurance carrier receives payments from the Medicare program to cover beneficiaries’ medical costs.
You will pay one-half of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $5240 each calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.
In general, all persons 65 years of age or older who have been legal residents of the United States for at least five years are eligible for Medicare. People with disabilities under 65 may also be eligible if they receive Social Security Disability Insurance (SSDI) benefits. Specific medical conditions may also help people become eligible to enroll in Medicare.
If you’ve been in in the Medicare Advantage plan for less than a year, you’re still in your trial period and you do have the option to enroll in a guaranteed issue Medigap plan when you switch back to Original Medicare; if you enrolled in Medicare Advantage when you were first eligible and are switching back to Original Medicare within a year, you can enroll in any Medigap plan sold in your state. If you dropped your Medigap plan to enroll in a Medicare Advantage plan and you switch back within a year, you can enroll in the Medigap plan you had before, or if it’s no longer available, you can enroll in any plan A, B, C, F, K, or L sold in your state.
The Annual Election Period (AEP) runs from October 15 to December 7 each year. You can switch from Original Medicare to a Medicare Advantage plan at this time, and make other coverage changes. If you’re already enrolled in a Medicare Advantage plan and want to switch plans, in most cases a good time to do so is during the Annual Election Period. When you change Medicare plans during the Annual Election Period, your new coverage generally begins on January 1 of the following year.
The Patient Protection and Affordable Care Act ("PPACA") of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. The most substantial provisions slowed the growth rate of payments to hospitals and skilled nursing facilities under Parts A of Medicare, through a variety of methods (e.g., arbitrary percentage cuts, penalties for readmissions).
The Congressional Budget Office (CBO) wrote in 2008 that "future growth in spending per beneficiary for Medicare and Medicaid—the federal government's major health care programs—will be the most important determinant of long-term trends in federal spending. Changing those programs in ways that reduce the growth of costs—which will be difficult, in part because of the complexity of health policy choices—is ultimately the nation's central long-term challenge in setting federal fiscal policy."
In 2013-14, an estimated 88% of California youth ages 12-17 received a routine health check-up within the past 12 months, up from about 77% in 2001. However, about 7% of all California children—and 10% of lower-income children—had no usual source of health care in 2013-14. Estimates by race/ethnicity ranged from 5% (multiracial and white) to 11% (African American/black) with no usual source of care. Among children who did have a regular source of care, the majority (63%) used a doctor’s office or HMO, rather than hospitals, clinics, urgent care, emergency rooms, or other settings. For children living below 200% of the Federal Poverty Level, only 48% used a doctor’s office or HMO, compared to 77% for children from higher-income families.
People often ask us our opinion on which plan is the best Medicare Advantage plan. This varies based on a number of personal factors. What’s right for your friend or neighbor may not be right for you. Don’t risk making a mistake on something as critical as your health insurance. Get help from an experienced agent who can explain your options in detail.
Medicare Part C in Minnesota offers the same coverage as Medicare Part A and B. The reason that applicants might want Medicare Part C over any of the other plans is because it comes from a private insurance company. Applicants have more freedom in pricing, since they can shop with multiple providers. Certain plans might have more appealing payments, such as lower premiums or offering more appealing co-pays on specific services.
CMS and MedPAC now believe the "like beneficiary" calculations (those on A/B vs those on A/B/C) that have been used for a decade and that underlay many changes made by PPACA and subsequent regulations are not comparative and are misleading (see slide 8 of the January 12, 2017 MedPAC session on Medicare Advantage and other discussions on this subject since that time). That is because the calculations include the increasing number of people only on Part A (primarily because they did not "retire" at 65 given the higher Social Security full retirement age but did join Medicare Part A at 65 as recommended) whereas a "like" Medicare Part C beneficiary has to be on both Parts A and Part B. On an absolute basis, in 2015 Medicare spent 4% less on Medicare Advantage and other Part C beneficiaries per person than they did per person on Medicare beneficiaries under FFS Medicare. In 2014 the difference in parity on an absolute basis was 2% less per person on Part C. It appears from both points of view—per "like beneficiary" and absolutely—that the latest formula delivers the original cost-saving promise of Managed Medicare. But an absolute comparison is not totally accurate either.
In most instances, prescription drug coverage is included in Medicare Advantage plans, with the exception of the MSA plan. If you want to have prescription drug coverage and you’re choosing an HMO or PPO Medicare Advantage plan, it’s important to select a plan that includes prescription coverage (most of them do), because you can’t purchase stand-alone Medicare Part D (drug coverage) if you have an HMO or PPO Advantage plan. SNPs are required to cover prescriptions. PFFS plans sometimes cover prescriptions, but if you have one that doesn’t, you can supplement it with a Medicare Part D plan.
The PPACA also made some changes to Medicare enrollee's' benefits. By 2020, it will close the so-called "donut hole" between Part D plans' coverage limits and the catastrophic cap on out-of-pocket spending, reducing a Part D enrollee's' exposure to the cost of prescription drugs by an average of $2,000 a year. This lowered costs for about 5% of the people on Medicare. Limits were also placed on out-of-pocket costs for in-network care for public Part C health plan enrollees. Most of these plans had such a limit but ACA formalized the annual out of pocket spend limit. Beneficiaries on traditional Medicare do not get such a limit but can effectively arrange for one through private insurance.
Evidence is mixed on how quality and access compare between Medicare Advantage and "traditional" Medicare. ("traditional" in quotes because it is not the same as Original Medicare; everyone in Medicare must begin by joining Original Medicare; the term "traditional" typically refers to FFS and almost always means the beneficiary has a private group or individually purchased supplement to Original Medicare). Most research suggests that enrollees in Medicare HMOs tend to receive more preventative services than beneficiaries in traditional Medicare; however, beneficiaries, especially those in poorer health, tend to rate the quality and access to care in traditional Medicare more favorably than in Medicare Advantage. It is difficult to generalize the results of studies across all plans participating in the program because performance on quality and access metrics varies widely across the types of Medicare Advantage plans and among the dozens of providers of Medicare Advantage plans.
This measure involves only Part A. The trust fund is considered insolvent when available revenue plus any existing balances will not cover 100 percent of annual projected costs. According to the latest estimate by the Medicare trustees (2016), the trust fund is expected to become insolvent in 11 years (2028), at which time available revenue will cover 87 percent of annual projected costs. Since Medicare began, this solvency projection has ranged from two to 28 years, with an average of 11.3 years.
Medicare.gov provides tools that will allow you to compare plans, but the decision is complicated. Insurance agent Graves recommends that you “work with a licensed insurance agent who can show you both Medicare Supplement Plans and Advantage Plans from multiple companies. Each type has its positives.” The questions to cover, he says: “You need to understand the costs, doctor networks, coverage levels and maximum out-of-pocket for each. Enroll in what suits your situation best.” Organizations such as Consumer Reports and the Medicare Rights Center can also help you research your decision.
A number of different plans have been introduced that would raise the age of Medicare eligibility. Some have argued that, as the population ages and the ratio of workers to retirees increases, programs for the elderly need to be reduced. Since the age at which Americans can retire with full Social Security benefits is rising to 67, it is argued that the age of eligibility for Medicare should rise with it (though people can begin receiving reduced Social Security benefits as early as age 62).
Medicare Medical Savings Account (MSA) plans: These plans combine a high-deductible Medicare Advantage plan with a medical savings account. Every year, your MSA plan deposits money into a savings account that you can use to pay for medical expenses before you’ve reach the deductible. After your reach the deductible, your plan will begin to pay for Medicare-covered services. These plans don’t cover prescription drugs; if you want Medicare Part D coverage, you may enroll in a stand-alone Medicare Prescription Drug Plan.
Beneficiaries are primarily defaulted because they do not receive the enrollment packet, they do not understand the information because it was sent in English and they speak another language, or they submitted an incomplete enrollment form. Some are defaulted due to administrative and processing errors. Beneficiaries that are defaulted are not prevented from later choosing a health plan of their choice.
Nearly one in three dollars spent on Medicare flows through one of several cost-reduction programs. Cost reduction is influenced by factors including reduction in inappropriate and unnecessary care by evaluating evidence-based practices as well as reducing the amount of unnecessary, duplicative, and inappropriate care. Cost reduction may also be effected by reducing medical errors, investment in healthcare information technology, improving transparency of cost and quality data, increasing administrative efficiency, and by developing both clinical/non-clinical guidelines and quality standards.