Posted by J. Garrett Ball, Medicare specialist on January 18, 2011 under Uncategorized | 
Recently, the Medicare Advantage company, Guardian Healthcare, filed for bankruptcy. Because Guardian is, as of 2010, one of the top three Medicare Advantage plans in SC, this filing affects many individuals in the state who have this Guardian Medicare Advantage plan, as well as providers and agents who are owed money by the company.
Regarding the Guardian Healthcare members, the most important thing to note is that the Centers for Medicare and Medicaid Services (CMS) has declared a special election period for many affected members of this health plan in most counties in the state. For those people who have been granted this “SEP”, they will be (or have recently been), notified by a letter from Medicare. Make sure you hold on to this letter. This “SEP” allows those who have Guardian Healthcare’s plan the opportunity to chose either an actual Medicare Supplement plan (also called Medigap) or another plan.
Although health care reform and other changes have greatly affected the number and quality of Advantage plans that are available, there are still a few Medicare Advantage plan options in the state (3 companies that are operating Advantage plans in the whole state). However, as an independent agency, our recommendation would be to use this one-time special enrollment period to choose a Medigap plan. The advantages of a Medigap plan (vs. an Advantage plan) are listed below:
- First of all, Medicare Supplement plans don’t change each year, like Advantage plans do. The plans are Federally-standardized, so each company offers the same outline of coverage for their plans - the only variation is price and company reputation.
- Secondly, Medigap plans, unlike all Advantage plans (as of 1/1/2011), do NOT have networks. Someone who has a Medigap plan can go to any doctor or hospital nationwide that takes Medicare.
- Lastly, Medicare Supplement plans offer a “Guaranteed Issue” into a Medicare Supplement when you are involuntarily losing your Medicare Advantage plan (i.e. Guardian Healthcare). If you have any pending health issues or history of medications or health problems, you have this one-time opportunity to qualify for a Medicare Supplement without medical underwriting or pre-existing condition restrictions.
Overall, the bankruptcy of Guardian Healthcare has been, and will continue to be, a problem for many affected members, providers, and other affected groups. However, for members, because Medicare has granted this SEP, which allows you to choose a new plan without penalty or underwriting, you can take advantage of this one-time opportunity to either select the more comprehensive coverage of a Medicare Supplement plan or find a new Advantage plan.
To get more information about either, please visit South Carolina Medicare Supplements or call us at 877.506.3378.
Posted by J. Garrett Ball, Medicare specialist on November 4, 2009 under 2010 plans, South Carolina Medicare Advantage plans |
Although it may make things more difficult for those who are on Medicare Advantage plans and those who work with them, the annual 45-day enrollment period is what we have to work with. And, this year’s AEP is nearly here.
The 2009 period (for the 2010 plans) is expected to be especially interesting, as there are at least 4 major Medicare Advantage companies pulling out of the Medicare Advantage marketplace completely. This represents hundreds of thousands of customers nationwide that have to find a new company/plan. These individuals also have a special right to purchase a Medigap plan, if they so choose, which they would otherwise have to qualfiy for medically by answering medical questions. However, due to the involuntary loss of their current Medicare Advantage plan, these individuals can choose either a Medicare Advantage or Medigap plan of their choice, with no pre-existing condition exclusions or ability to be turned down.
There are some very good Medicare Advantage plans still in South Carolina for 2010, despite many changes overall to the plans, which has led the aforementioned plans to drop out completely and other plans to raise premiums and/or reduce benefits.
To get information about the 2010 South Carolina Medicare Advantage plans or get quotes, visit South Carolina Medicare Quotes.
Posted by J. Garrett Ball, Medicare specialist on July 22, 2009 under Medicare News, Medicare insurance news, Part D, South Carolina Medicare Advantage plans, South Carolina Medicare Supplements |
Even if you wanted to, you cannot escape the talk of health care reform these days. It is everywhere in printed, online and television media. As a leading, independent resource for Medicare and Medicare insurance news, Secure Medicare Solutions has closely examined both sides of how the proposed bill will affect those on Medicare. Our goal is to give you an unbiased look at how some of the proposed changes will affect you and your Medicare and/or Medicare insurance.
Proposed Reform: Better Pricing for Part D Drugs
How it Affects You: This is a proposed change to assist in regulating the pharmaceutical industry and controlling drug prices. Medicare Part D aims to do this by negotiating better overall prices for Part D drugs, which should, over time, reduce the Part D premiums and co-pays that Medicare-eligible individuals have to pay. Some headway has been made on this already, with the pharmaceutical industry agreeing to a 50% cut for those that reach the dreaded “donut hole” (details for this are still pending).
Proposed Reform: Reduce Medicare Payments to Private Insurers (Medicare Advantage)
How it Affects You: If you have been paying much attention to the health care debate, you have heard the Medicare Advantage program mentioned numerous times. The projected change is to base the payments to these private insurers on an average of the plans’ bids, rather than the system now which is a standardized government-set amount. For those on Medicare Advantage, this reduced funding will, most likely, lead to an increase in premium and/or reduced benefits. For everyone on Medicare, it should lead to the ability to reduce the Medicare Part B premium.
Proposed Reform: Link Payments to Hospitals to Hospital Performance
How it Affects You: The idea to link hospital payments for Medicare patients to hospital performance has been around for a while, and it is a major part of the proposed health care reform. It’s intention is to increase overall hospital efficiency and give hospitals an economic incentive to “do right” by the patient. Some feel that this will lead to greater efficiency at hospitals, while others believe it will lead to greater dishonesty and fraud within the system. If it is a part of any legislation that is passed, we’ll find out for sure!
Proposed Reform: Standardization of Payments to Skilled Nursing Facilities/Long-term Care Facilities
How it Affects You: This provision of proposed legislation is intended to cut waste in the current Medicare system by measuring actual costs to come up with a more uniform system for reimbursing these facilities through Medicare. It remains to be seen if this will affect the quality of care received if in one of these facilities; however, the overall goal is to reduce waste in this part of the system and reduce the cost of Medicare to all Medicare-eligible individuals.
Proposed Reform: Reduce/Regulate Fraud, Waste and Abuse in the Medicare System
How it Affects You: This is the proposed reform that most everyone can agree upon. There have been many ideas tossed around as to how to do this. One of the primary ways that this is projected to be accomplished is higher scrutiny of health care providers and hospitals. Additional pre-payment reviews will be implemented, particularly on doctors/hospitals that order a significant amount of high-risk or high-cost procedures. Over time, this is intended to reduce the cost of Medicare (Part B premium, etc) to the individual.
Regardless of which side of the debate you come down on, it is obviously important to keep an eye on how it will all play out and how it will affect you. At Secure Medicare Solutions, we will do our part to keep you updated on any changes. You can always get updated information and follow along with us at Secure Medicare Solutions: An informative Medicare Insurance and Medicare Supplement Blog.
Posted by J. Garrett Ball, Medicare specialist on June 26, 2009 under Medicare News, Medicare insurance news |
As you have probably heard, Medicare Advantage plans also are in for many changes in the upcoming year(s). While it remains to be seen exactly how far the changes will go, some of the changes have already had significant effects.
First of all, changes are coming in the Private Fee for Service (PFFS) plans. Tighter regulations and lower doctor reimbursements for these plans have led to three major players in the PFFS plans to announce they are dropping their PFFS contracts for 2010 (WellCare, HealthNet and Coventry). These companies will still be active in other aspects of Medicare Insurance, but the dropping of the PFFS plans from these three companies affects approximately 500,000 insured individuals.
As always, SMS will keep you informed of additional MA changes as they are announced. It is anticipated that other companies will also make changes in the PFFS marketplace. If you have a Medicare Supplement, this does not affect you directly; however, most agree that those with Medicare Advantage plans should be prepared to re-evaluate their options during this year’s annual open enrollment period (Nov-Dec).
