Why Doesn’t Bob’s Medicare Plan Require Copies While Mine Does?

Why Doesn’t Bob’s Medicare Plan Require Copies While Mine Does?

Before the Balanced Budget Act, Medicare beneficiaries had a much simpler variety of options. Because Medicare supplements have already been standardized, the recipient has two main options. You may choose to enroll only in original Medicare and risk dividing the deductibles and coinsurance costs that are required. On the other hand, you could choose one of the 10 standardized drug supplements that best fit your needs to help pay for this cost-sharing when medical services were accessed. However, after Medicare Advantage plans came into play, there was considerable confusion. In addition to the regular Medigap options, the beneficiary now had private Medicare health plans available, which generally have much lower monthly premiums, but require networks and also require more cost-sharing for medical services than a comprehensive supplement. Medicare would have provided.

However, all too often, the beneficiary makes a quick decision, either because there is too much confusing information or because he bases his initial choice on what a friend has chosen, even if he has a different set of health needs and conditions.  Still he is not well informed about the works plan. Let’s see an example:A beneficiary, say his name is Murphy, subscribes to a $0 Medicare Advantage plan based solely on price and then develops a significant health condition that requires a lot of treatment and co-payments according to the rules of the chosen plan. Murphy begins to feel the tension of many co-payments and coinsurance due to his plan. Naturally, he complains about this to some friends and neighbors.

A neighbor, let’s call him Bob, shares that his own plan doesn’t require co-payments. In fact, when Bob goes to the doctor, the hospital or the imaging center, he pays nothing. Murphy gets angry and suspects immediately. Why do you have to spend thirty dollars every time you see your specialist when Bob doesn’t? Why did Murphy MRI last week cost $250 when Bob said his MRI last year was completely covered by his plan? Murphy starts making some phone calls and finds out from an insurance agent why his plan is different.  The Medicare Advantage plans have a much lower premium from the beginning because the beneficiary agrees to.

1) comply with the network rules and restrictions and enrollment periods in the plan, and

2) share part of the cost of treatment in the form of co-payments and co-payments insurance for medical services as you receive them. Murphy did not question so soon when he enrolled in his plan because he was healthy at the time and did not want to pay anything for his coverage.