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Many seniors and people with disabilities who are on traditional Medicare find themselves searching for additional coverage to cover for medical expenses that Medicare does not already cover. More and more of these beneficiaries find the help through private health coverage of Medicare Advantage plans.

Seniors choose to enroll in Medicare Advantage plans because these plans provide comprehensive medical coverage, higher-quality care, better services, and additional benefits, reports The Coalition for Medicare Choices, a national grassroots organization who sole purpose is to protect and improve Medicare Advantage.

Who’s covered? According to CMC’s website MedicareChoices.org, Medicare Advantage covers over 14 million people nationwide. Out of those 14 million, 41% are blue-collar workers who earn less than $20,000 year, 1 in 5 being minorities.

In February 15, 2013, the Centers for Medicare & Medicaid Service enrollment data showed Hawaii, Oregon, Arizona, Pennsylvania, California, Florida, Ohio, Rhode Island, New York, Nevada and Utah as having the highest traditional Medicare beneficiaries enrolled in Medicare Advantage.

Does Medicare Advantage have high satisfaction and better quality care? In a new survey from The North Star Opinion Research firm commissioned by America’s Health Insurance Plans (AHIP), found 9 out of 10 seniors are satisfied with their Medicare Advantage coverage.

It has also been reported that 13 out of 20% of beneficiaries with Medicare Advantage had fewer patient readmissions into hospitals than Medicare fee-for-service, according to the American Journal of Managed Care. The quality of care for seniors under the Medicare Advantage program has improved as well, outperforming Medicare fee-for-service in 9 out of 11 quality measures.

Source: MedicareChoices.org

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The Affordable Care Act rollout last week was not all smooth sailing. It faced multitudes of glitches and hiccups online; as well as, offline. Despite its rocky start, the Affordable Care Act aims to reduce the Medicare coverage gap, also known as the "doughnut hole," by 2014 and completely close it by 2020, according to Medicare.gov.

Before the Affordable Care Act, benefactors would have to pay their insurance yearly deductible in out-of-pocket cost until their medical expense limit reached the copay of $4500.00, before any coverage premiums would kick in.

In 2014, with the Affordable Care Act, beneficiaries begin with the monthly Part D premiums and pays 100% of the drug cost until satisfying the $310 deductible. Then the plan pays for the rest of the cost of the medicine until hitting the expenses cap of $2850.00; a 25% out-of-pocket drop in copay. That’s when seniors are faced with the doughnut hole, once more.

The dreaded “doughnut hole” – is the difference seniors out-of-pocket drug expenses begins, after their Part D premiums coverage cap has been exceeded, and before they are eligible for the amount the government pays for "catastrophic" drug coverage.

Since 2010, the Medicare gap has been slowly closing through steady drug discounts. This is largely due to the government reaching out to pharmaceutical industry and bargaining for drug discounts. Discounts for brand name drugs and generic will continue. By next year, were expected to pay 47.5% for premium brand pharmaceuticals names and 72% for generic ones.

By 2020, Medicare Part D enrollees will save 75% on both premium and generic medication, according to the Centers for Medicare & Medicaid Service.

Source: LifeHealthPro & Centers for Medicare & Medicaid Service

• 2014 Medicare Advantage and Part D Certifications are now available! Learn More

It’s no big secret that the government was looking for a way to pave the way for an entirely new health reform. A cost control measure, which would save over $132 billion within a 10 year span. The government found it through the budget cuts changes they made to Medicare Advantage.

In 2014, the Medicare Advantage plans available will decrease from to 2,664 plans in 2013 to 2,522,, a difference 5.3 percent, according to Avalere Health analyst.

Further driving the decline of Medicare Advantage plans is the Affordable Care Act payment cuts. Beginning 2014, Medicare Advantage plans are required by law, to lower cost and use 85 percent of their revenue on medical care and quality improvement efforts. Any Medicare Advantage participants who fail to meet the requirements will be prohibited from accepting new enrollees, and their plans will be terminated after five years of non compliance. Not all news is bad for Medicare Advantage plans. Quality bonus programs have been developed to reward plans that are higher in quality and more efficient than their counterparts, reports Centers for Medicare and Medicaid.

According to Peter Kongstvedt, MD, a noted insurance industry consultant and a member of MANAGED CARE’s editorial advisory board, the Medicare Advantage HMOs will do well because their rates are often below the fee-for-service equivalents and they have a track record of doing well in the past. He also believes Medicare Advantage PPOs will fare well.

Source: LifeHealthPro & Managed Care Magazine

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