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What you need to know about Medicare Advantage Plans

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What you need to know about Medicare Advantage Plans

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What you need to know about Medicare Advantage Plans

After the Medicare Moderation Act of 2003 and the establishment of Medicare Advantage Plans, senior health insurance (specifically for people over the age of 65) has gone for a toss. There have been developments and there have been downfalls. The most recent low in the senior health insurance industry is perhaps the way Medicare Advantage Plans have been slammed. With experts raising questions about the advantages of these Advantage plans, it is left to be seen how the actually fare in terms of benefits offerings. For your information, the sole reason why Medicare Advantage Plans came into the picture in the first place was the view to offer something more than what was listed on Medicare Part A and B. Now when these plans are seen doing less than their fair share, their advantageousness is obviously being questioned.

So what exactly is the problem with Medicare Advantage Plans? According to the recent controversy, only those Medicare Advantage plans are at fault that are Private Fee for Service in nature. These plans offer maximum freedom to members as far as provider services are concerned. As per rule, whenever a member avails any service he has to get it billed from the provider (be it doctors and hospitals). Ironically, many Advantage plans are not available to providers, which is why they are not in a position to get the bill made. Under such circumstances the only option left for is to get the billing done from the insurance company in question. This practice often leads to unnecessary expenditure on the part of the members.

The problem, though, is not so acute when it comes to Preferred Provider Organization (PPO) and Health Maintenance Organizations (HMO). In these cases, members do not lose out on anything because there is a fixed provider network they can depend upon. Doctors, hospitals and medical centers within the folds of this network have already entered into an agreement with the insurance company to participate in the plan. The reason why PPO’s and HMO’s serve better is clear. While on one hand they have to ward off competition from other companies and their networks, on the other they can see federal incentives coming their way as reward to better performance. Once upon a time though the network system of health coverage was not considered a winner, today it is with most Medicare Advantage plan networks also offering prescription drug benefits.

Good or bad, Medicare Advantage plans actually work for a niche section of people. That segment of people is decided by both their financial condition and health condition. Usually persons with moderate income prefer Medicare Advantage plans, primarily because other options like Medigap coverage turns out a tad too expensive. These plans also work for individuals with chronic illness. Plans are directed towards different conditions and you’re sure to find one that will suit your budget and health condition.

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