We understand how confusing Medicare can be. There are many different types of Medicare insurance available, including Medicare Advantage, Supplements and Prescription Drug plans.
Steve Lineberry, General Manager of Emory Healthcare Network Advantage, and Chuck Chaput, Executive Vice President, Medicare Compare USA, join the show to discuss medicare Advantage and how to navigate the confusing world of medicare.
What is Medicare Advantage
Guest
: Steve Lineberry & Chuck Chaput
From the Show: Emory Healthcare Consumer
Transcription:
Bill Klaproth (Host): Is it Medicare time for you and are you trying to understand it? and what is Medicare Advantage? Well, we have got a podcast with answers for you. Here to give us a quick refresher on Medicare and explain Medicare Advantage is Steve Lineberry, General Manager of Emory Healthcare Network Advantage and Chuck Chaput, Executive Vice President of Medicare Compare USA.
Steve and Chuck, thank you for your time today. So, Chuck give us a quick refresher on Medicare and the different parts.
Chuck Chaput (Guest): It would be my pleasure. So, the basic components of Medicare would include Medicare parts A, B, C and D. Medicare part A refers to hospital services. Medicare part B refers to medical insurance which is including outpatient services as well as physician services. Medicare part C refers to all of the Medicare Advantage plans that we will talk about in more depth today. And then Medicare part D refers to Medicare prescription drug plans which are plans that cover a person’s prescription medications.
Bill: And Chuck, let me ask you this. What is the key difference then between original Medicare, sometimes called traditional Medicare and Medicare Advantage?
Chuck: Absolutely. So, original Medicare is comprised of two components. Medicare part A and Medicare part B as I mentioned a minute ago. So, part A is hospital and part B I medical. So, those two together represent original or traditional Medicare. A Medicare Advantage plan is a little bit different. A Medicare Advantage plan is offered by a private insurance company that has a contract with the Federal Medicare program known as CMS, the centers for Medicare and Medicaid Services. Medicare pays these private insurance companies a set fee per month to provide all of the care for their members. A Medicare Advantage plan must at a minimum provide the same level of coverage as original Medicare and then depending on the specific Medicare Advantage plan; they may or may not require an additional monthly plan premium. So, some Advantage plans have a zero-monthly plan premium, other plans have a premium that might be as high as maybe $100 or $150 per month. But it all varies by individual Medicare advantage plans.
The Medicare Advantage plans often include additional benefits that are not included or offered by original Medicare. So, some examples would be they include oftentimes a Medicare prescription drug plan at no additional cost. They may also include discount programs for durable medical equipment and other mail order healthcare supplies, gym memberships, as well as preventive dental or eye or hearing exams or prescription glasses, hearing aids, things of that nature. Now in the case with Emory Healthcare; there is an additional layer if you will of additional benefits that are available. All of the Medicare Advantage plans that Emory participates with and there’s a number of them; when a patient enrolls in one of these Advantage plans; they are then able to access the Emory Care Coordination Centers and these resources include additional programs geared around wellness or personalized health planning. And so, I’d like to ask Steve if he could provide a little more detail about the Emory Care Coordination Center benefits that are available.
Steve Lineberry (Guest): Yeah, thanks Chuck. We, here at Emory have put in place some additional resources for those that have Medicare Advantage. We have introduced what we call coordinated care centers, and these are really centers that our Medicare Advantage patients that have an Emory physician go to for comprehensive annual exams as well as ongoing evidence-based preventive care, education and counseling and control of chronic illnesses. We staff the centers with case management, with physicians and nurse practitioners as well as what we call a patient navigator who really helps a patient through their journey in the health system. And so through the centers, we are really taking full advantage of all of the resources that are available under the Medicare Advantage plan, but also working to tailor care for the patient to help them stay healthy and when they do have a chronic disease; such as diabetes or COPD or congestive heart failure; we are really focused on keeping them well, keeping them out of the hospital and helping them improve their conditions.
Bill: That’s great information Steve and Chuck. Let’s talk about enrollment then. How do the enrollment periods differ from Medicare Advantage versus traditional Medicare plans?
Chuck: Absolutely. Well, the first thing to understand is that to be eligible for any form of Medicare health insurance; so that could include a Medicare Advantage plan or what’s referred to as a Medicare supplement or Medigap plan; to be eligible for any of those plans you must have Medicare parts A, and part B. And so, it is important that before somebody – when somebody is getting close to their Medicare eligibility, which generally happens when you turn 65 years old, you will need to contact your Social Security office well in advance. I would always suggest about four to six months before you reach 65, contact Social Security and determine when your Medicare part A and part B eligibility dates will be taking place. Generally speaking, they will be on the first day of the month you turn 65 and then once you are eligible, once you know you’re a and B effective dates; then you can sign up for a Medicare Advantage plan that meets your specific needs.
And so, the signing up for an Advantage plan, there are generally only a few types of questions that you really have to know. Number one is you need to know your A and B effective dates and number two, you have to live in the plan’s service area. So, what important is in the eyes of Medicare where do they consider your home zip code and county to be. Because where Medicare sees you as your residence; that’s what will determine which Medicare Advantage plans are available to you. And then lastly, a lot of people always ask “what are the health qualifications to go onto a Medicare Advantage plan?” And it’s a very simple process. The only disqualifier for an Advantage plan would be if you have ESRD which is end stage renal disease or kidney failure. So, other than that, if you live in the plan’s service area and you have Medicare A and B you cannot be declined based on your health status. So, you can sign up for any Advantage plan and then once you choose your coverage start date; the plan will begin in full force on that day.
Bill: Wow, there’s lot of information to sift through. So how can someone get help in choosing the right coverage in general and for Emory patients?
Chuck: Absolutely so to learn more; Emory Healthcare fully understands how confusing Medicare can be, so Emory Healthcare in partnership with my company Medicare Compare USA, offers an Emory Medicare insurance help line. This is a totally free service for patients and you can either call toll free 1-855-256-1501 or you can simply visit www.emoryhealthcare.org/medicare . And then lastly, you always should consider Medicare as a resource. You can call 1-800-MEDICARE or visit www.medicare.gov to learn more information about any components of the Medicare program.
Bill: Great information guys. There’s a lot to unpack there and thank you for sharing those resources. I’m going to give it to you once again. Just visit www.emoryhealthcare.org/medicare that’s www.emoryhealthcare.org/medicare . Or call 855-256-1501. Steve and Chuck, thank you so much for the great information today. We really appreciate it. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Is it Medicare time for you and are you trying to understand it? and what is Medicare Advantage? Well, we have got a podcast with answers for you. Here to give us a quick refresher on Medicare and explain Medicare Advantage is Steve Lineberry, General Manager of Emory Healthcare Network Advantage and Chuck Chaput, Executive Vice President of Medicare Compare USA.
Steve and Chuck, thank you for your time today. So, Chuck give us a quick refresher on Medicare and the different parts.
Chuck Chaput (Guest): It would be my pleasure. So, the basic components of Medicare would include Medicare parts A, B, C and D. Medicare part A refers to hospital services. Medicare part B refers to medical insurance which is including outpatient services as well as physician services. Medicare part C refers to all of the Medicare Advantage plans that we will talk about in more depth today. And then Medicare part D refers to Medicare prescription drug plans which are plans that cover a person’s prescription medications.
Bill: And Chuck, let me ask you this. What is the key difference then between original Medicare, sometimes called traditional Medicare and Medicare Advantage?
Chuck: Absolutely. So, original Medicare is comprised of two components. Medicare part A and Medicare part B as I mentioned a minute ago. So, part A is hospital and part B I medical. So, those two together represent original or traditional Medicare. A Medicare Advantage plan is a little bit different. A Medicare Advantage plan is offered by a private insurance company that has a contract with the Federal Medicare program known as CMS, the centers for Medicare and Medicaid Services. Medicare pays these private insurance companies a set fee per month to provide all of the care for their members. A Medicare Advantage plan must at a minimum provide the same level of coverage as original Medicare and then depending on the specific Medicare Advantage plan; they may or may not require an additional monthly plan premium. So, some Advantage plans have a zero-monthly plan premium, other plans have a premium that might be as high as maybe $100 or $150 per month. But it all varies by individual Medicare advantage plans.
The Medicare Advantage plans often include additional benefits that are not included or offered by original Medicare. So, some examples would be they include oftentimes a Medicare prescription drug plan at no additional cost. They may also include discount programs for durable medical equipment and other mail order healthcare supplies, gym memberships, as well as preventive dental or eye or hearing exams or prescription glasses, hearing aids, things of that nature. Now in the case with Emory Healthcare; there is an additional layer if you will of additional benefits that are available. All of the Medicare Advantage plans that Emory participates with and there’s a number of them; when a patient enrolls in one of these Advantage plans; they are then able to access the Emory Care Coordination Centers and these resources include additional programs geared around wellness or personalized health planning. And so, I’d like to ask Steve if he could provide a little more detail about the Emory Care Coordination Center benefits that are available.
Steve Lineberry (Guest): Yeah, thanks Chuck. We, here at Emory have put in place some additional resources for those that have Medicare Advantage. We have introduced what we call coordinated care centers, and these are really centers that our Medicare Advantage patients that have an Emory physician go to for comprehensive annual exams as well as ongoing evidence-based preventive care, education and counseling and control of chronic illnesses. We staff the centers with case management, with physicians and nurse practitioners as well as what we call a patient navigator who really helps a patient through their journey in the health system. And so through the centers, we are really taking full advantage of all of the resources that are available under the Medicare Advantage plan, but also working to tailor care for the patient to help them stay healthy and when they do have a chronic disease; such as diabetes or COPD or congestive heart failure; we are really focused on keeping them well, keeping them out of the hospital and helping them improve their conditions.
Bill: That’s great information Steve and Chuck. Let’s talk about enrollment then. How do the enrollment periods differ from Medicare Advantage versus traditional Medicare plans?
Chuck: Absolutely. Well, the first thing to understand is that to be eligible for any form of Medicare health insurance; so that could include a Medicare Advantage plan or what’s referred to as a Medicare supplement or Medigap plan; to be eligible for any of those plans you must have Medicare parts A, and part B. And so, it is important that before somebody – when somebody is getting close to their Medicare eligibility, which generally happens when you turn 65 years old, you will need to contact your Social Security office well in advance. I would always suggest about four to six months before you reach 65, contact Social Security and determine when your Medicare part A and part B eligibility dates will be taking place. Generally speaking, they will be on the first day of the month you turn 65 and then once you are eligible, once you know you’re a and B effective dates; then you can sign up for a Medicare Advantage plan that meets your specific needs.
And so, the signing up for an Advantage plan, there are generally only a few types of questions that you really have to know. Number one is you need to know your A and B effective dates and number two, you have to live in the plan’s service area. So, what important is in the eyes of Medicare where do they consider your home zip code and county to be. Because where Medicare sees you as your residence; that’s what will determine which Medicare Advantage plans are available to you. And then lastly, a lot of people always ask “what are the health qualifications to go onto a Medicare Advantage plan?” And it’s a very simple process. The only disqualifier for an Advantage plan would be if you have ESRD which is end stage renal disease or kidney failure. So, other than that, if you live in the plan’s service area and you have Medicare A and B you cannot be declined based on your health status. So, you can sign up for any Advantage plan and then once you choose your coverage start date; the plan will begin in full force on that day.
Bill: Wow, there’s lot of information to sift through. So how can someone get help in choosing the right coverage in general and for Emory patients?
Chuck: Absolutely so to learn more; Emory Healthcare fully understands how confusing Medicare can be, so Emory Healthcare in partnership with my company Medicare Compare USA, offers an Emory Medicare insurance help line. This is a totally free service for patients and you can either call toll free 1-855-256-1501 or you can simply visit www.emoryhealthcare.org/medicare . And then lastly, you always should consider Medicare as a resource. You can call 1-800-MEDICARE or visit www.medicare.gov to learn more information about any components of the Medicare program.
Bill: Great information guys. There’s a lot to unpack there and thank you for sharing those resources. I’m going to give it to you once again. Just visit www.emoryhealthcare.org/medicare that’s www.emoryhealthcare.org/medicare . Or call 855-256-1501. Steve and Chuck, thank you so much for the great information today. We really appreciate it. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
