Insurance companies and employers wait every year so that Centers for Medicare & Medicaid Services
(CMS) can reveal their plans and fees and schedules for payments for insurance in the current year. Well,
those have arrived for 2019. And, there is one surprise: daily maintenance, i.e. supplemental benefits, will
be covered for the first time by Medicare Advantage Plans.
Managed care has become very popular in recent years as a way of insuring oneself. Why? First of all,
this is a way to lower the costs of insurance in a way that unneeded costs are completely reduced by
promoting the idea of prevention and preventive medicine in regards to one’s health. There would be a
flat one-month payment for this managed care. There are two outcomes of it. The first one is a company
getting money if a patient is healthy and does not need treatments and the second one is a company losing
money if a patient is frequently ill or has an illness. It is not a secret at all the Medicare fees have become
very high and this is the reason why the managed plans have been designed.
Medicare Advantage Plan
At any point in time, you can get covered by Medicare but you can still be covered by Medicare
Advantage Plan by getting the full needed coverage that Medicare would provide. The exceptions would
be those policies with large deductibles and copayments. Medicare Advantage Plan is a better solution for
all those that are in need to exceptional coverage and services that are not usually or completely provided
by Medicare. These may include drugs or custodial care. It may also happen, that the number of days you
need to stay in hospital is not covered in full since a lesser number of days is allowed by a plan.
Furthermore, the quality of a nursing home a person can choose is way lower than the one that people with
Costs and The Doctor
Why Medicare advantage plans are bad? The first thing that you should know is that you are limited in
terms of choosing your own doctor and another health service provides. There is a network of health service
providers that is given under health maintenance organization (HMO), and you are limited to those. Fees
and rate are predetermined. Using a service or going to a doctor that is not in the network will result in
non-payment of the bill. There are several types of plans, such as: preferred provider organizations
(PPOs), private fee-for-service plans, Special Needs Plans, and Medicare medical savings account plans
etc. You need to bar in mind that if you choose a plan because a doctor you prefer is there, that is not a
guarantee that that doctor would stay. Namely, if a doctor starts to cost a network too much, he/she is
usually removed from it.
A primary care physician is the one who is there to provide care and serves the function of lowering the
costs to a company. That is the person who will decide whether you would go to a specialist or not. The
exception may be patients in severe health conditions who can avoid a primary care physician and go
directly to a doctor. There are also a lot of co-payments. Namely, there are some drugs that are not
covered by the plan, and you simply have to pay extra to get them.
What are the good sides?
On the other hand, there are some good sides of Medicare Advantage Plans in comparison to Medicare
ones. First of all, there is short-term custodial care. Secondly, there is the full, 100%, covering of the
equipment needed. Then, there is Chiropractic care, acupuncture and acupressure. Apart from this, there is
the coverage when traveling abroad. Eye examinations are also covered as well as some dental work.
Apart from this, there is care after working hours as well as testing hearing and hearing aids.
Prior to finally deciding whether to go for a managed plan, investigate and weigh your options. See each
and every possible outcome and help you may need, whether it is covered by a plan or not, whether it will
cost extra or not.