Employee Insurance Coverage and Medicare Advantage

As part of health reform, employers with fifty or more workers will be fined by the government when they do not provide their employees with insurance coverage. Voluntary profit sales should continue to expand and not just for small businesses. Employers continue to reduce worker-sponsored insurance coverage at an alarming rate. Many large companies and corporations have experienced a steady increase in insurance premiums over the past ten years as medical costs have risen. After months of debate, health reform is finally a reality! What does this mean for insurance companies? This is a good thing? Is it a bad thing? Is it a mixed bag? From my perspective, health reform is a big thing. Health care reform focuses on primary health insurance, not life insurance, voluntary benefits, or Medicare supplements.

No plan is suitable for everyone. Many people are very happy with Medicare Advantage PPO or HMO policies because they like network providers and health benefits. Others like the flexibility of a Medigap or Any Doc MA plan. A person’s budget will also affect their choice. Medsups come with a premium, but some MA plans do not have an additional price. When you have a supplement, you can consult any doctor or hospital that accepts Medicare.

An Advantage plan is a contract Medicare has with a private insurance company to manage its benefits. You don’t pay after Medicare, you pay instead of Medicare. Premiums associated with medicare Advantage plans are generally lower than premiums; however, when you go to a doctor or hospital, you get paid. There are different types of Advantage plans. There are PPO, HMO, and PFFS (i.e. private service charge) plans. With HMOs, you are restricted to “networked” doctors and will need “referrals” to consult a specialist.
According to the Medicare employees, the overall average prices charged for prescription drug plans do not determine what an individual beneficiary will eventually pay. Jon Blum, deputy administrator of Medicare, said a general conclusion cannot be reached because each person’s medication needs are individualized. You must consider the specific plan and medications that the individual takes.

The health care review law is helping high-cost drug recipients save money. For those who fall into Medicare’s “overdraft period” coverage gap, beneficiaries can get a 50% discount on branded drugs. Approximately 47 million people with disabilities benefit from Medicare and approximately nine out of 10 beneficiaries have a prescription drug plan. Medicare Part D plans have different coverage levels. The policy which is most common has 5 levels: non-preferred generics, preferred generics, non-preferred brands, preferred brands, and special drugs.

How to Choose the Right Insurance Company for Part D

Medicare part D plansIf each individual plan is exactly the same from one company to another, how do you choose the right insurance company?

First, you should learn as much as possible about each of your independent health insurance agent’s Medicare part D plans, which makes choosing the right health insurance agent your first priority. You need an experienced licensed agent who takes the time to explain the various plans in a way that you can understand.

So customer service varies from company to company, so word of mouth, whether good or bad, can help you decide.

Because past history is the best indicator of future results, consider past customer service experiences or complaints that you or someone you know may have had with any of the leading insurance companies.

Now that you know that all plans must be exactly the same from one company to another, why not go with the company that offers the lowest monthly premiums, assuming, of course, that it’s a national brand that owns heard?

In other words, if Company A, which sends an email every other day for three months before turning 65 and up to three months later, charges much more than Company B for exactly the same coverage, why not go with company B?

Part D, as most of you know, is a prescription drug insurance plan designed by Medicare but operated by several companies. However, companies are not doing this as a favor to Medicare. While a company can pay for their medicines, Medicare reimburses them an additional 10% for operating costs.

Ten percent may not sound like much, but when it comes to millions of people, whether they are elderly, disabled or Medicaid beneficiaries, who qualify for a drug plan, their profit is millions of dollars.

Medicare’s prescription drug program was created as a result of the Prescription Drug Improvement and Modernization Act of 2003 (MMA). Although the act became law in 2003, people eligible for Medicare did not start enrolling in those plans until January 1, 2006. This plan is known as a PDP or simply Part D.

Part D is available to anyone who has Medicare, regardless of income or medical history. Private insurance companies offer coverage. Affiliates select a plan from those available in their geographic region and pay the insurer a monthly premium for coverage. Although registration is voluntary, there is a late registration penalty that will be discussed a little later.

HUMANA MEDICARE PLANS IN BOISE

Humana Medicare AdvantageMedicare Advantage plans are offered by private health insurance companies and differ from region to region. More and more people are switching to Medicare Advantage plans from Original Medicare, because of the fact that they provide much more benefits than the original medicare. There are multiple options for Humana Medicare advantage plans and they all cater to different sections of the society. Humana Medicare Advantage plans in Boise are discussed below.

 

Humana Choice H5216-132 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $0. The plan has no annual deductible and a maximum out of pocket expense of $5000. While visiting a primary health care provider, you have to pay no copay for an in-network doctor, and a 20% coinsurance for out of network healthcare providers. Along with this plan also provides prescription drug services, with a deductible of $200. The deductible is applicable to preferred brand, non-preferred drug, and specialty tier. For generic and brand name drugs you have to pay a coinsurance of 25%. The plan also covers your annual lab tests, radiology scans, outpatient surgery as well as rehabilitation services.

 

Humana Honor (PPO)

With an overall rating of 4.2, the Humana honor plan has a monthly premium of $0. It is a preferred provider organisation plan, which lets you choose a healthcare provider of your choice. In this plan, you don’t even have to get a referral to see any special doctor. The plan has no annual deductible, and an out of pocket maximum of $3600. Under this plan, you do have to pay a $0 copay for visiting your primary doctor. Humana Honor plan provides added services like dental coverage, oral exams, vision care, hearing services, and transportation services. You are also entitled to fitness, and over the counter benefits. However, the plan does not cover prescription drug services and you have to enrol in a Part D plan separately.

 

Humana Gold Plus H5619-079 (HMO)

With an overall rating of 4, this plan is offered at a monthly premium of $0. The plan has no annual deductible and a maximum out of pocket expense of $6000. For visiting your primary care provider you have to pay a $5 copay and a $50 copay for a specialist doctor. The plan also covers prescription drug services, and provide a deductible amount of $200. The deductible amount applies to preferred brand, non preferred drug, and specialty tier. For generic and brand name drugs you have to pay a coinsurance of 25%. Along with this it also provides vision services, dental services, over the counter benefits, fitness benefits, hearing services, as well as SilverSneakers program, also providing the skilled nursing facility at a $0 copay for the first twenty days.

 

Humana Gold Plus H5619-077 (HMO)

With an overall rating of 4, the plan is offered at a monthly premium of $32. The plan has no annual in-network deductible and a maximum out of pocket expense of $5000. You do not have to pay any copay for visiting your primary health care provider. The plan also covers inpatient hospital stay both psychiatric as well as acute at a copay of $0. It also provides prescription drug services with a deductible of $150. The deductible applies to preferred brand, non-preferred drug and specialty tier. The plan also covers a meal program at $0 copay, up to 40 meals for 20 days.

 

Humana Choice H5216-044 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $38. The plan has no annual in-network deductible and an out of pocket maximum expense of $6000. You have to pay a $10 copay for visiting your primary health care provider, and a $40 copay for an office visit to a specialist. The plan covers your prescription drug needs as well with a deductible amount of $200. This is applicable to preferred brand, non-preferred drug, and specialty tier. For generic and brand name drugs you have to pay a coinsurance of 25%. The plan also provides extra benefits like home health care services, preventive care services, eye exams, eyewear, contact lenses, eyeglasses, glaucoma screening, routine hearing exams, fitness benefits, Silver sneakers program, outpatient mental health services, as well as chiropractic coverage. The plan also provides alternative acupuncture services at a $0 copay, with 25 treatments per year.

HUMANA ADVANTAGE PLANS IN KNOXVILLE

Original Medicare provides the retired citizens of 65 years and older health care services. The medicare includes both the hospital insurance as well as medicare insurance. Medicare Advantage plans have a benefit over the Original Medicare plans because of the added advantages the plans provide. The medicare advantage plans are offered by private organisations, which are approved by Medicare. One such private organisation is Humana Medicare health insurance company, which is one of the biggest in the United States.  the Humana Medicare Advantage plans in the city of Knoxville is discussed below.

 

  1. Humana Honor (HMO)

With an overall rating of 4, the Humana honor plan has a monthly premium of $0. The plan does not have an annual deductible and has an out of pocket maximum of $5900. Under this plan, you also have to pay a $0 copay for visiting your primary doctor, and a $35 copay for visiting a specialist. Humana Honor plan provides added services like dental coverage, oral exams, vision care, hearing services, and chiropractic services. You are also entitled to fitness, and over the counter benefits. However, the plan does not cover prescription drug services and you have to enrol in a Part D plan separately.

 

  1. Humana Gold Plus H4461-035 (HMO)

With an overall rating of 4.2, the plan is offered at a monthly premium of $0. The plan has no annual deductible and a maximum out of pocket expense of $6700 for in-network providers. You do not have to pay a copay of $5 while visiting your primary health care provider and a copay of $45 while visiting a specialist. The plan also covers prescription drug services as well, with no deductible. For generic and brand name drugs, you have to pay a coinsurance of 25%. The plan covers all of your urgently needed services as well as emergency ambulance services as well. The plan covers medicare covered dental services, oral exams, eye exams, eyewear, glaucoma screening, hearing exams, hearing aids, and over the counter benefits of $25 every three months.

 

  1. Humana Honor (Regional PPO)

With an overall rating of 4, the Humana honor plan has a monthly premium of $0. It is a regional preferred provider organisation plan, which lets you choose a healthcare provider of your choice. Since the plan is regional, you would have to choose one within your own region. The plan has an annual deductible of $500, and an out of pocket maximum of $3400. Under this plan, you also have to pay a $10 copay for visiting your primary doctor, and $30 for visiting a specialist. Humana Honour plan provides added services like dental coverage, oral exams, vision care, hearing services. You are also entitled to fitness, and over the counter benefits. However, the plan does not cover prescription drug services and you have to enrol in a Part D plan separately.

 

  1. Humana Gold Plus H4461-031 (HMO)

With an overall rating of 4, the plan is offered at a monthly premium of $40. This plan has no annual deductible, and an out of pocket maximum of $6700. While visiting a primary care doctor you have to pay a copay of $5 and for a specialist a copay of $40. The plan covers prescription drug services as well with no deductible. For generic or brand name drugs you have to pay a coinsurance of 25%. It provides Medicare-covered dental benefits, eye exams glaucoma screening, or hearing exams. Along with this it also provides various fitness benefits absolutely free of cost and covers your chiropractic services as well.

 

  1. Humana Choice H5216-099 (PPO)

With an overall rating of 4, the plan is offered at a monthly premium of $58. The plan has an annual deductible of $750 and an out of pocket maximum of $6700. While visiting your primary doctor you have to pay a copay of $15 and for a specialist, you have to pay a copay of $40. The plan includes prescription drug services as well with a deductible amount of $150.  The deductible is applicable to preferred brand, non-preferred drug, or specialty tier. For generic as well as brand name drugs you have to pay a 25% coinsurance. The emergency services are also covered in this plan at a copay of $90. The plan also provides skilled nursing facility for up to 100 days, with a $0 copay for the first twenty days. The plan covers preventive care and home health care services as well. The plan also covers fitness benefits as well as over the counter benefits without paying any copay or coinsurance.

 

  1. Humana Choice R7315-002 (Regional PPO)

With an overall rating of 3.3, the plan is offered at a monthly premium of $99. With an annual deductible of $1000, the plan has a maximum out of pocket expense of $6700. This regional PPO plan gives you the flexibility of choosing any health care provider of your choice, at a copay of $20, and a specialist at a copay of $45. Along with covering in-hospital stay for an acute disease, the plan also covers psychiatric hospital stay at a $0 copay after the fifth day. The prescription drugs are also covered under this plan, with a deductible of $400. It is applicable to generic, preferred brand, non-preferred drug, and specialty tier as well. Extra benefits include vision care, hearing services, over the counter benefits, dental care, and fitness benefits as well.

 

  1. Humana Gold Plus H4461-030 (HMO)

With an overall rating of 4.3, Humana Gold plus plan offers a monthly premium of $106. This Health Maintenance Organisation plan requires you to have a primary care provider, who would have the overall picture of your health at all given times. You can choose any doctor to be your primary care provider, provided he lies in the network of the plan. The plan does not have an annual deductible and an out of pocket expense of $3400. You do not have to pay any co-pay while visiting your primary provider and have to pay a $40 copay while visiting a specialist. It also provides prescription drug coverage, dental care, vision care, and over the counter benefits as well.

 

  1. Humana Gold Plus SNP-DE H4461-022 (HMO D-SNP)

With an overall rating of 4 stars, this plan is offered at a monthly premium of $0. This gold plus plan is Special needs Plan which is specially added for people with particular chronic diseases. Not everybody is allowed to enrol in such plans. If you have a chronic disease like heart failure or end-stage renal disease, you can enrol in this plan. The special needs plan is specifically designed to cater to your needs depending on your particular situation. You have to pay a $0 copay while visiting your primary or specialty doctor. The plan also covers in-hospital stay and several chiropractic services as well. Along with covering the transportation costs, dental services, vision services, hearing services, over-the-counter benefits and fitness benefits are also covered in this plan. The plan also covers all of your prescription drug cost as well, provided you use the in-network pharmacies. The plan also provides preventive and home health care services at $0 copay.