Category: Medicare

What is the difference between a Medicare HMO and PPO plan? Well an HMO stands for Health Maintenance Organization and PPO stands for Preferred Provider Organization. Let’s go over some of the major differences between these two plans.

HMO :

1. You will need to choose a primary care doctor
2. If you need to see a specialist, you will need to go to your primary care doctor first to get a referral.
3. Generally will have co pays for your doctor visits and services you use
4. You will need to use the network of hospitals and doctors to obtain your medical care. If you choose to go outside of that network, your HMO plan may not cover the costs of your visit.
5. Tends to be more affordable with lower premiums and deductibles

PPO:

1. You do not need to choose a primary care doctor.
2. You may see a specialist without the need of a referral from your primary care doctor
3. May likely also have co pays for doctors visits and other services.
4. You may see any doctor within the insurance company’s network without need of a referral.
5. Will likely have an annual deductible and larger premiums
6. Can generally see doctors and obtain services out of network, though you will likely pay for more of the cost of the services compared to in-network doctors and hospitals.

It is important to understand what your current healthcare needs are, as well as, what your future costs may be to help decide which type of plan may be right for you. If you choose an HMO, you will need to make certain that your list of doctors are included in that HMO plan.

You will have choices to make when it comes to choosing the type of Medicare plan that is right for you. To help make sure you are choosing the right plan for you, contact me so we can go over your options and help you make the best decision. As always, there is no cost to sit down and discuss your options.

Do these sound familiar? They stand for Pharmaceutical Assistance Contract for the Elderly and Pharmaceutical Assistance Contract for the Elderly Needs Enhancement Tier. These are Pennsylvania’s prescription assistance programs for older adults.

There are some requirements you will need to meet and your eligibility for these programs is determined by your prior year’s income. Some of the requirements are:

1)You must be 65 years of age or older

2)Be a Pennsylvania resident for at least 90 days prior to applying

3)You cannot be enrolled in Medicaid’s prescription benefit

Income eligibility for PACE is as follows: Income for PACENET is as follows:

Single person: Total income $14,500 or less Income between $14,500 and $27,500

Married: Combined income under $17,700 Combined income $17,700 and $35,500

While you are not required to have Part D coverage, you are encouraged to purchase a Part D plan as it could help you save even more money on your prescriptions. If you have PACE, then the PACE program will pay the Part D premiums for a plan that has a premium assistance agreement. If you have PACENET, then you will pay for the premium at the pharmacy when you are getting your medications. For 2019, the PACENET premium is $37.03. Also under PACENET, if you do purchase a Part D plan, you will pay the premium for the plan and not pay the PACENET premium.

There is no “donut hole” with PACE or PACENET.

For more information, you can go to the PACE/PACENET website here.

If you need help understanding how the program works just call me at 814-242-3389 or contact me here.

More information can be found below.

https://pace.now.site/

Medicare Part D otherwise known as a Prescription Drug Plan is a part of Medicare. Sometimes this is part of your Medicare Insurance, for example, if you chose a Medicare Advantage Plan. However, if you have Original Medicare, you will need to sign up for Part D.

When you first turn 65, you enter your Initial Enrollment period. This is a 7 month period of time(3 months prior to your birthday, the month of your birthday and three months after your birthday). If you will not have employer coverage, you will need to sign up for Medicare. If you just choose Part A and Part B you must sign up for Part D, otherwise you will be subject to a penalty. In 2019 that penalty is 1% of the national base premium($33.19) times the number of months you went without Part D coverage. Now this penalty is added to your monthly premium and continues every month.

So don’t forget that you will need credible Prescription Drug coverage, otherwise you will be subject to a penalty.

If you have questions, please reach out to me and I’ll help guide you through the process.

Do you know the different parts of Medicare? There are 4 main parts. Let’s go over them very briefly here.

Part A: This is your hospital insurance. It helps to pay for things such as the cost of a semi-private room, nursing care, meals, home health, hospice and skilled nursing facility stays.

Part B: This helps to pay for things outside of the hospital such as doctor’s visits, outpatient procedures, diagnostic tests, bloodwork, chemotherapy and radiation. You will pay a premium in order to have Part B. In 2019, the premium will cost you $135.50/month.

Together, Part A and B are referred to as Original Medicare.

Part C: This is where you can purchase a Medicare Advantage Plan. These plans are private health plans that will cover your Part A, B, and sometimes Part D, all in one “bundle.” You will still pay your Part B premium if you purchase one of these plans. These Advantage Plans may also offer additional benefits such as vision, dental and hearing coverage. There are usually different options you have when choosing one of these plans so it is important to look at all of your options before deciding on one. There is much more to talk about with these Advantage Plans which will be covered in future posts.

Part D: This is for your prescription drugs. You will need to choose a plan offered by a private insurance carrier. You will also pay a premium for Part D. You may have to pay a penalty if you do not sign up when you are first eligible. Keep in mind that a prescription drug plan may be included in your Medicare Advantage plan. Again, there is much more here to cover, which will be done in future posts.

This is a brief overview of the parts of Medicare. Putting it all together can take some time to understand. If you are getting ready to turn 65, reach out, and I can help guide you through the process to help you understand what choices you have.