Learn about Medicare Advantage plans

4 parts of medicare

Medicare Parts coverage and cost in 2020

What do Medicare Parts cover and cost in 2020?

There are 4 parts of Medicare: Part A, Part B, Part C, and Part D.

  • Part A covers inpatient hospital services.
  • Part B covers outpatient medical services.
  • Part C is Medicare Advantage plan offered by private companies approved by Medicare.
  • Part D provides prescription drug coverage to lower the cost you pay for medications.

Before you receive any of the health benefits above, you must first pay Part A deductible of $1408 in 2020. However, you can avoid paying this cost by having a Medicare Supplement plan.

What does Medicare Part A cover and cost in 2020?

According to Medicare.gov, Part A covers the following:

  • Inpatient hospital care
  • Skilled Nursing Facility care
  • Long-term Care Hospitals
Medicare Part A - Hospital

Inpatient Hospitals Coverage and Cost in 2020

The first 60 days of inpatient care is covered by Medicare Part A. In other words, you pay $0 coinsurance for eash 60 day benefit period. For example, you can be a hospital inpatient multiple times per year and each hospital stay will cost you nothing so long as each stay is 60 days or less. However, hospital stays between 61 days and 90 days will cost you $352 coinsurance per day in 2020.

Skilled Nursing Facility

Skilled Nursing Facility Coverage and Cost in 2020

Medicare Part A also covers 20 days of care in a Skilled Nursing Facility (SNF). Specifically, you pay $0 coinsurance for each 20 day benefit period. Some of the benefits of SNF include physical therapy, meals, and dietary counseling. Therefore, you can get short-term skilled nursing care multiple times per year for no cost so long as each stay is 20 days or less. However, SNF stays between 21 days and 100 days will cost you $176 per day in 2020.

Long-term Care Hospital Coverage and Cost in 2020

Medicare Part A covers the first 60 days in a Long-term Care Hospital (LTCH). In particular, the cost of LTCH is $0 for each 60 day benefit period under the following conditions.

  • You are transferred to a LTCH directly from an acute care hospital.
  • You are admitted to a LTCH within 60 days of being discharged from a hospital.

If the above conditions do not apply, then you must pay $1364 deductible in 2020 before Medicare will pay anything. Furthermore, LTCH stays from 61 days to 90 days will cost you $341 coinsurance per day in 2020.

Medicare Part A - Long-Term Hospital Care

What does Medicare Part B cover and Cost in 2020?

Medicare Part B covers the following services:

  • Medical outpatient services for stays at any hospital or medical facility for less than 24 hours. For example, a stay that occurs overnight but for less than 24 hours is outpatient service.
  • Preventive services to prevent illness such as seasonal flu-shot and annual wellness visits.
first aid kit

Medicare Outpatient Coverage and Cost in 2020

Original Medicare covers 80% of medically necessary services and supplies. These Part B medical services include:

  • Ambulance Service  – transportation to a medical facility.
  • Doctor Visits – anytime to see your primary doctor or specialist.
  • Mental Health – psychotherapy and counseling to treat conditions such as anxiety and depression.
  • Durable Medical Equipment – devices that assist with your medical conditions. For example, blood sugar monitors, oxygen equipment, and wheelchairs.

Before Medicare pays for these medical services and supplies, you must first pay Part B deductible of $198 in 2020. Furthermore, you are responsible to pay the 20% that Medicare does not cover. However, Medicare Supplement Plan C and Plan F pay Part B deductible and your 20% coinsurance.

Medicare Preventive Coverage and Cost in 2020

Medicare preventive services cover screening tests that help detect health conditions at early stages when treatment is most effective. In the tables below, we list 31 preventive tests covered by Medicare Part B. 

Medicare Part B preventive screening table 1
Click to view larger table size
Medicare Part B preventive screening table 2
Click to view larger table size

In the tables above, 71% of these screening tests are free after you pay the $198 Part B deductible. Furthermore, 19% of tests require payment of Part B deductible and 20% coinsurance. Finally, 10% of tests you pay absolutely nothing: neither Part B deductible nor 20% coinsurance. These preventive screening tests are completely FREE:

  • Nutrition Therapy Service – you pay nothing if you have diabetes or kidney disease.
  • “Welcome to Medicare” preventive visit – you pay nothing as long as the doctor does not perform additional tests or services.
  • Yearly Wellness Visit – is free every 12 months as long as the doctor does not perform additional tests or services.

To receive Part B coverage you need to pay a monthly premium. In 2020, the standard premium for Part B is $144.60.

What does Medicare Part C cover and cost in 2020?

Part C Medicare Advantage network
MA plans have a network of doctors, hospitals, and other medical services.

Medicare Part C is an alternative to Original Medicare and covers Part A (Hospital Insurance) and Part B (Medical Insurance). Part C is also known as Medicare Advantage (MA) Plan.

Medicare Advantage (MA) Coverage

MA plans often include Medicare Part D prescription drug coverage. Moreover, many MA plans include extra benefits not covered by Original Medicare. For example, MA plans may include dental, vision, and hearing. Some MA plans even include gym memberships such as Silver Sneakers! MA plans are offered through a network of healthcare providers HMO or PPO.

Medicare Advantage (MA) Costs

To enroll in Medicare Advantage Plan (Part C) you must first be enrolled in Part A and Part B. Most Seniors pay no premium for Part A. However, you will have to pay Part B monthly premiums. In 2020, the standard premium for Part B is $144.66. Furthermore, you will need to pay a monthly Part C premium. According to The Kaiser Family Foundation, the average Medicare Advantage Plan premium is $36 in 2020.

When you add standard Part B and average MA premiums, the total monthly cost is $180.66 in 2020. Conversely, Original Medicare Part B and Part D premiums only cost $177.34 in 2020. However, you may be thrilled to get a gym membership for only a few extra dollars per month!

You can choose a lower premium MA plan. As a result, you may be excited to pay less every month. However, these MA plans will have higher deductibles, copays, and larger out-of-pocket limits. Consequently, the cost to use your health insurance will be much higher. You can avoid these excessive costs by choosing an MA premium of $40 or more.

What does Medicare Part D cover and cost in 2020?

Part D saves you money on prescription drugs. Specifically, it reduces your cost for brand-name and generic drugs. For example, rather than paying the full retail price for medications, you only pay small copayments with Part D. To join a Part D drug plan, you must be enrollment in certain parts of Medicare.

 Part D drug plan
Part D drug plans save you money

How to Join a Drug Plan

You must have either Part A or Part B to join a stand-alone Part D drug plan with Original Medicare. However, you must have both Part A and Part B to join a Medicare Advantage plan. Since private health insurance companies such as Aetna, Mutual of Omaha, and AARP provide drug coverage, the price you pay will vary.

Part D Costs for Original Medicare and MA Plans

To enroll in Part D with Original Medicare you need to have either Part A or Part B. However, most people have both Part A and Part B coverage. Since private health insurance companies such as Aetna, Mutual of Omaha, and AARP provide drug coverage, the price you pay will vary.

Part D drug costs in 2020 

All Part D drug plans a monthly Part D premium. This amount will depend on the income reported on your 2018 tax return. Some Part D plans have an annual deductible which can not be more than $435 in 2020. However, other drug plans may have little or no deductible. 

After the out-of-pocket deductible, you pay either a copay or coinsurance for each prescription drug. For example, $10 copay for all drugs on a tier or 25% of the drug cost. Furthermore, after you and your drug plan spend a certain amount, you enter a coverage gap called the donut hole.

Donut Hole Costs in 2020

In 2020, you will enter the donut hole and pay 25% coinsurance for both brand-name and generic drugs when your drug plan spends $4,020. After total out-of-pocket drug costs are $6,350 in 2020, you exit the donut hole.

Want More Help with Medicare Parts?

You can speak with a licensed agent at 1-855-368-4717 and get more help with the 4 parts of Medicare: A, B, C, and D. Our team is very experienced at explaining Medicare parts and how they work. 


open enrollment for medicare

Medicare Open Enrollment Period

Medicare Open Enrollment Period

Once a year Medicare open enrollment period is October 15 to December 7 – also known as Annual Election Period or Annual Enrollment period – anyone with Medicare can make changes to their Medicare health plans and prescription drug coverage for the following year. For example, the next Medicare open enrollment is October 15, 2020 through December 7, 2020. Any changes you make to Medicare coverage during this open enrollment period will take effect in January 2021. Read more about what you can do during open enrollment period.

Medicare Advantage Open Enrollment

Likewise, Medicare Advantage open enrollment period occurs once a year between January 1 thru March 31. Anyone who has a Medicare Advantage Plan can switch to a different Medicare Advantage Plan. Alternatively, you can drop Medicare Advantage and return to Original Medicare. In addition, you can join a Medicare Part D prescription drug plan. For example, read the following story about George.

Why George Switched from Medicare Advantage to Original Medicare

open enrollment for medicare
George and Barbara excited about switching to Medicare Part D plan

George turned 65 last last year and enrolled in Medicare Advantage Plan. In 2020, George and his wife Barbara bought a recreation vehicle (RV). Together they plan to enjoy retirement by traveling across the United States in their new RV. However, George has an Advantage Plan and when he travels outside of his service area he pays higher out-of-network costs. Therefore, George makes a smart move and switches from his Advantage Plan to Medicare with Part D prescription drug plan.

Now, George and Barbara have peace of mind knowing their health costs will remain consistent whereever they travel in the United States. The good news is you can switch too! Medicare Advantage Open Enrollment Period (OEP) is January 1 to March 31. If you have a Medicare Advantage Plan, you can switch to another Medicare Advantage Plan. Otherwise, you can drop Medicare Advantage and enroll in Original Medicare and join Part D prescription drug plan. To shop and compare Medicare plans call Senior Healthcare Direct at 1-855-368-4717 or click the get quote button below.

get Medicare quote button

Common Questions About Medicare Open Enrollment

What is Medicare open enrollment?

Medicare open enrollment also called annual election period and annual enrollment period (AEP) is the annual period between October 15 and December 7 when people eligible for Medicare can change their Medicare plan.

When is Medicare open enrollment?

Annual Medicare open enrollment period is October 15 to December 7. Open enrollment for 2020 coverage ended on December 7, 2019. Next open enrollment will begin October 15, 2020 for coverage starting in January 2021.

What is Medicare Advantage open enrollment?

Medicare Advantage open enrollment only applies to people who have Medicare Advantage plans. During Medicare Advantage OEP you can switch to a different Medicare Advantage plan. Alternatively, you can switch from Medicare Advantage plan to Original Medicare including Part D prescription drug plan.

When is Medicare Advantage open enrollment?

Medicare Advantage open enrollment is January 1 to March 31.

What’s you can not switch in Medicare Advantage open enrollment?

During Medicare Advantage open enrollment period you can not switch from Original Medicare to Medicare Advantage Plan. In addition, you can not join Medicare Part D prescription drug plan. Furthermore, you can not switch from Medicare Part D drug plan to another Part D drug plan.

Silver Sneakers Medicare Plans

What is Silver Sneakers?

medicare plans silver sneakers

Silver Sneakers is a health and fitness program for Medicare beneficiaries 65 years or older. Thus, if your a senior Medicare Plans may pay for Silver Sneakers. Members of Silver Sneakers have access to thousands of gyms, community centers, and other participating fitness location across the nation. As a member you can take classes designed for seniors of all fitness levels led by trained instructors. In addition, you have access to on-demand video library of classes and workouts. You can even download the SilverSneakers GO app to get your digital membership card and workouts. The app is free and available on IOS and Android devices. Most important, Silver Sneakers is a place for seniors to find a friendly, supportive community in person and online.

Why Join Silver Sneakers?

Silver Sneakers helps you stay strong in body, mind, and spirit. Regular physical activity keeps your heart, brain, bones, muscles, and joints healthy. For instance, if you have a chronic condition like arthritis, diabetes, or osteoporosis, safe exercise can help you feel better. In addition, staying social in the Silver Sneakers community is vital to your good health.

Silver Sneakers Program

The Silver Sneakers program includes a basic membership at any participating gym. Facilities and amenities vary by location, however, many Medicare Silver Sneaker gyms include the following:

  • Cardio equipment, including treadmills and ellipticals
  • Strength training equipment, such as weights and strength machines
  • Amenities, such as pools and walking tracks

Unlike other senior gym memberships, you can go to all fitness locations in the Silver Sneakers network. You can visit over 17,0000 Medicare Silver Sneaker locations across the United States.

Silver Sneaker program includes many types of exercise classes. You will find a variety of fun exercises classes designed for seniors of all fitness levels. Classes vary by location, but you will often find the following:

Silver Sneakers Program
  • Cardio and strength classes, which often include a chair for support
  • Water aerobics classesChair and standing yoga classes
  • Tai Chi, boot camp, and many other classes!

The instructors who lead Silver Sneaker classes are friendly and supportive. If you are new to a class, the instructor can help you learn how to do exercises safely. Furthermore, if you have limited mobility, instructors can adapt exercises for your needs.

Do you want to try something different from traditional gyms? You might like to try Silver Sneakers FLEX classes. The Silver Sneakers program offers more than 70 kinds of classes through its FLEX network. You can visit many different locations such as churches, community centers, or recreation centers. Some FLEX classes meet outdoors and many FLEX class sizes are smaller than gym classes.

Where to Find Silver Sneakers Locations and Classes?

You can find a Silver Sneakers locations and classes near you using the locator tool. You can go to any participating location or class you want in the Silver Sneakers network. For example, you can use weights in one location, go swimming at another location, and take a Silver Sneakers or FLEX class at a third location.

Medicare Plans with Silver Sneakers

You can find Silver Sneakers with Medicare Supplement Plans or Medicare Advantage Plans. However, you are less likely to find Silver Sneakers included in a Medicare Supplement Plans. A few of the Medicare insurance companies that may offer you Silver Sneakers Medigap Plans include:

  • AARP
  • Bankers Life aka Colonial Penn Life Insurance
  • Blue Cross Blue Shield

Depending on your location, Medicare plans with Silver Sneakers may be covered by Medicare Supplement Plan F or Plan G. However, more insurance companies offer Silver Sneakers with Medicare Advantage Plans including:

  • Aetna
  • Blue Cross Blue Shield
  • Humana
  • Mutual of Ohama
  • UnitedHealthcare
  • Well Care

You are more likely to find a Medicare Advantage Plan with Silver Sneakers than a Medicare Supplement Plan.

Silver sneakers enrollment

During Medicare Open Enrollment Period, you can switch to a Medicare Advantage Plan with Silver Sneakers between January 1 and March 31. To switch your Medicare Advantage Plan, you must be in a Medicare Advantage Plan now. Otherwise, you will need to wait until Annual Enrollment October 15 thru December 7. However, if you have Medicare Supplement Plan, you can shop a new Medigap Plan with Silver Sneakers anytime all year long. You can speak with a licensed agent about switching your Medicare Advantage Plan or Medicare Supplement Plan at Senior Healthcare Direct 1-855-368-4717. Otherwise, you can click the get quote button below.

medicare plans silver sneakers

Common Questions About silver sneakers

Does Medicare Cover Silver Sneakers?

Silver Sneakers is covered by many Medicare plans. For example, Silver Sneakers is covered by many Medicare Advantage Plans and Medicare Supplement Plans.

Does traditional Medicare cover Silver Sneakers?

Unfortunately, Original Medicare Part A and Part B does not offer or include Silver Sneakers.

Is Silver Sneakers available to anyone on Medicare?

To be eligible for Silver Sneakers you must be 65 years or older. Some people qualify for Medicare because of disability and are younger than 65.

Does Medicare Pay for Silver Sneakers?

If your Medicare Supplement Plan or Medicare Advantage Plan includes Silver Sneakers, then Medicare pays for Silver Sneakers.

Dental Plans For Seniors

Dental Plans For Seniors

Dental Plans For Seniors

Seniors can get dental care with a Medicare Advantage plan. These plans may include dental, vision, and hearing benefits that original Medicare does not cover.

Medicare Doesn’t Cover Dental Care

Original Medicare does not cover most dental care including dental procedures, supplies, and cleanings. Moreover, it does not cover tooth extractions, dentures, dental plates, and dental devices. However, Medicare Part A will pay for certain dental services while you are a hospital inpatient.

Medicare Advantage Plans

There are many private insurance carriers which offer Medicare Advantage Plans. Since these plans are not standardized, the coverage and benefits vary from plan to plan. Therefore, it’s best to shop advantage plans using a broker who can shop and compare a number of advantage plans. Senior Healthcare Direct is a nationwide Medicare Advantage insurance broker. Our licensed agents can shop Medicare Advantage plans so you can choose the plan that best suits your needs. You can speak directly with a licensed agents by calling 1-855-368-4717

In addition to dental care, Medicare Advantage plans may include other benefits such as routine vision and hearing.

Why Are Dental Checkups Important?

Regular dental checkups are essential to keeping your teeth clean and healthy. When you get dental checkups every 6 months, you reduce the chance of long-term dental problems. For example, professional dental cleanings help to get rid of hard-to-remove plaque or tarter which builds up even with regular at home brushing and flossing.

Dental Exams Decrease Your Risk of Disease

When a dentist catches dental issues early, they can be easier and less expensive to treat. However, letting dental problems linger can result in more complex and expensive procedures. Therefore, regular dental exams can save you money!

Furthermore, regular dental checkups helps prevent cavities and gum disease by removing tarter and plaque buildup. During your dental exam, the dentist checks for a number of issues:

Put a smile on your face with dental coverage
  • Oral cancer
  • Tooth decay
  • Gum Disease
  • Tooth grinding
  • Alignment problems

Moreover, your dentist can detect signs of more than 120 diseases including diabetes and heart disease.

Stand Alone Dental Plans

If you do not need vision or hearing plan, then you might consider a stand alone dental plan. These plans are network based like a PPO. So you get benefits for seeing providers in the network. You will usually pay a copay at the time of service and your insurance will pay a portion of the usual and customary fee for dental services.

What is the Best Dental Plan for Seniors?

Aetna dental plans for seniors is rated as the best overall plan according to The Senior List. Aetna offers a range of dental insurance policies to help keep your teeth in good condition.

The Best Dental, Vision, and Hearing Plan

Manhattan Life Assurance is a stand alone plan that combines dental, vision, and hearing coverage. This plan has no network restrictions. So you can receive care from your favorite dental, vision, and hearing provider. You choose you own dentist, optometrist, and audiologist. Since you can use this plan at any provider’s office, it is the best dental, vision, and hearing plan. In addition, Manhattan Life Assurance plans also include the following benefits:

dental plans for seniors
Get a stand alone dental, vision, and hearing plan
  • Affordable Guarantee issue for all ages 18 – 85
  • Guaranteed renewable for life
  • Family rates includes up to 3 children

Manhattan Life Assurance plan has no waiting period for preventive services. For example, you can get a dental cleaning and x-ray right away. Thereafter, you can receive dental cleanings every 6 months. In addition, there is no waiting time for tooth fillings and extensions.

However, you will need to wait 12 months for major dental work. For example, bridges, crown work, partials, and root canals.

Vision Care

Manhattan Life Assurance vision coverage pays for eye exams immediately. In addition, the plan pays for eye glasses, contact lenses, and frames after 6 months. Since there is no network you choose the optometrist you want.

Plan Costs and Coverage

You only pay $100 annual deductible. Plan coverage improves over time. For example, the plan pays 60% in first year, 70% in second year, and 80% after 24 months. Annual benefit coverage of $1,000 and $1,500 is available. In addition, fully insured hearing benefits are a part of all plans.

Learn More about Dental Vision and Hearing Plans

You can buy a dental plan for seniors today and use it tomorrow! You have the option of choosing from a Medicare Advantage Plan or Stand Alone Plan. Find out which plans are available in your state by calling Senior Healthcare Direct at 1-855-368-4717. Otherwise, you can get a quote by clicking the button below.

dental plans quote

Medicare Drug Plan

Change Your Medicare 2020 Drug Plan Today

medicare 2020 drug plan

You can get the Medicare drug plan you want in 2020! Here’s the big Medicare Part D and Medicare.gov update: During the last 2019 Annual Enrollment you may have used the new Medicare.gov Plan Finder which was rolled out in October 2019. Unfortunately, there were a lot of errors with this new Plan Finder. Our agents at Senior Healthcare Direct were one of the first to realize that a lot of data from Medicare.gov plan finder was not adding up. For example, the Medicare.gov Plan Finder did not match up with the carriers.

Helping You Get The Right Drug Plan

To help our clients, we cross referenced Medicare.gov and the carrier information. As a result, we helped our clients get the right drug plan. However, other Medicare agencies or individuals who did not know ended up enrolling in the wrong plan. Consequently, there have been a lot of complaints to Medicare. Because there were enough complaints, Medicare opened up a new Special Enrollment Period. So if you used plan finder in 2019 and chose the wrong 2020 drug plan because the information provided was inaccurate, you can change your drug plan. Therefore, you do not have to wait until October 2020. You can get a new drug plan today! Watch the video below for more details.

You Can Change Your Medicare 2020 Drug Plan

MedicareBob, owner of Senior Healthcare Direct, breaks the news about Medicare Plan Finder inaccurate information and how you can change your drug plan today. Watch the video to get more details and learn what to say when you call Medicare to change your drug plan.

MedicareBob’s Big 2020 Announcement

How to Change Your Drug Plan

You can make changes to your Medicare Advantage or Medicare Part D plan. If you made the wrong plan choice because of inaccurate information on the Plan Finder, call 1-800-MEDICARE and explain your situation. For other special circumstances, such as you move or lose other insurance coverage, visit Medicare.gov

medicare 2020

Medicare 2020: Medicare Advantage vs. Supplement Plan, which is better?

Compare Advantage Vs. Medicare Supplement

In the Medicare 2020 chart below, the red letters are disadvantages and green letters are advantages. The chart gives you a side by side comparison of Medicare Advantage verses Medicre Supplement.

2020 Medicare Advantage vs Medicare Supplement

Medicare Advantage has a smaller, local network of providers. While Medicare Supplement network has over 800,000 providers nationwide. You must have Medicare Part B and pay $198 deductible for a Medicare Advantage plan. However, a Medicare Supplement plan pays the 20% co-insurance expense of Medicare Part B and the deductible of Part A ($1408 in 2020). Medicare Advantage has set co-payments. While Medicare Supplement covers your co-pays for hospital stays, skilled nursing facility care, hospice and home health care. Essentially, Medicare Supplement fills the holes in Medicare so you don’t have any surprise bills. That’s why it is also called Medigap. For example, when you go to the hospital, the Supplement plan pays your $1408 deductible. However, Medicare Advantage charges you around $300 per day each day for days 1-7. As a result, spending a week in the hospital with Medicare Advantage will cost you $2,100.

Referrals and Underwriting

Medicare Supplement plans have consistent benefits from year to year. On the other hand, Medicare Advantage plans may change their benefits. So you will have more homework to review upcoming Advantage plans. Medicare Supplement plan require no referrals. So you can quickly go to any doctor or hospital without a referral or prior authorization. However, HMO Advantage plan requires you to get referrals. There is no medicare underwriting requirements for Supplement plan as long as you apply within your initial 6 month enrollment period (get more details on Medicare Supplement plan). Likewise, all health conditions are accepted except End-Stage Renal Disease (ESRD).


Medicare Advantage plans have lower monthly premiums. However, you will pay extra every time you use your benefits by paying fixed co-payments and co-insurance. Moreover, you will continue to pay for benefits until your reach your maximum out-of-pocket limit of about $7,000. On the other hand, Medicare Supplement plans have higher monthly premiums. However, the plan pays all copays and co-insurance costs for Medicare covered services. In other words, you total out-of-pocket equals your annual premium amount. Therefore, you get a predictable monthly expense.

Prescription Drugs

Medicare Supplement require you to add Medicare Part D plan to cover prescription drugs. To avoid late enrollment penalty, you want to enroll in Medicare Part D during your initial open enrollment period October 15 – December 7. If you missed open enrollment, the new open enrollment is January 1 – March 31, 2020. Click here for details on Medicare New Enrollment 2020. Most HMO Medicare Advantage plans cover prescription drugs. Likewise, PPO and PFFS plans may also cover prescription drugs.

2020 Medicare Supplement Plan and 2020 Medicare Advantage Plan

Medicare Zero Premium Plan – Zero Premium Supplement – Medicare Myths

Medigap Monday: When Can I Upgrade From A Medicare Advantage Plan To A Medicare Supplement

2018 Medicare Advantage Plan Finder

Medicare Advantage or Medicare Supplement Plan, which is better?

How to choose your Medicare Advantage Plan:

Medicare Advantage Plans Merging:

CMS finalizes 2016 payment and policy updates for Medicare Health and Drug Plans


April 6, 2015

Contact: CMS Media Relations

(202) 690-6145 | go.cms.gov/media

CMS finalizes 2016 payment and policy updates for Medicare Health and Drug Plans

Rate Announcement Details Plan Payments and Other Program Updates for 2016


The Centers for Medicare & Medicaid Services (CMS) today released final Medicare Advantage (MA) and Part D Prescription Drug program changes for 2016 that provide fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations.


“These policies strengthen Medicare Advantage for current and future consumers by encouraging higher quality care,” said Andy Slavitt, acting CMS Administrator. “As the Medicare Advantage marketplace continues to grow, consumers are getting access to better care through more choice and competition. Seniors and people with disabilities, including the dual-eligible population, will continue to have an extensive choice of plans, affordable premiums, and better and more transparent information about provider networks and pharmacies.”


The Medicare Advantage and the Part D Prescription Drug programs’ enrollments and quality continue to grow and improve since the Affordable Care Act became law. Medicare Advantage has reached record high enrollment each year since 2010, a trend continuing in 2015 with a cumulative increase of more than 40 percent since 2010. At the same time, premiums have fallen by nearly 6 percent from 2010 to 2015. And, more than 90 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.


The finalized policies fully consider the many comments received during the public comment period. Particular care is being taken to ensure that plan sponsors have the right incentives to care for dual eligible populations over the long term. The Rate Announcement finalizes changes in payments that will affect plans differently depending on the characteristics of those plans. On average, the expected revenue change is 1.25 percent without accounting for the expected growth in coding acuity that has typically added another 2 percent.  The final revenue increase is larger than the February advance notice largely because the Medicare actuaries recently updated Medicare per capita spending estimates for 2014 and 2015. Medicare per capita spending in 2014, 2015 and 2016 is still expected to be below historical standards.


Today’s announcement drives important improvements to the star rating system, additional accuracy and transparency of provider networks, and continues to promote improvements in quality of care for beneficiaries. The policies in the Rate Announcement and final Call Letter reflect Secretary Burwell’s commitment to a Medicare program – including Medicare Advantage – that delivers better care, spends health care dollars more wisely and results in healthier people. In the Final Call Letter, CMS continues to update the Star Ratings measures to drive improved quality for Medicare Advantage and Part D enrollees. To enhance program integrity and payment accuracy, Medicare Advantage plans will continue to be provided stringent oversight for improper payments, just like other providers in the Medicare program.


Lastly, the final policies will provide enrollees with greater information to make informed and timely decisions about their care and their coverage. The Final Call Letter takes steps to require Medicare Advantage plans to maintain accurate provider directories in a timely manner and make those directories widely available. These steps will help enrollees better understand the providers and choices available to them. In addition, CMS will ensure that Part D sponsors provide clear and accurate access to information on preferred cost sharing pharmacies in their networks so that all beneficiaries have access to affordable coverage.


To view a fact sheet on the 2016 Rate Announcement and final Call Letter, please visit: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-06.html

# # #

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgov

Shared by: Robert Bache

Twitter @MedicareBob






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United Healthcare / AARP is offering 3 PPO Medicare Advantage Plans in Pinellas County Florida for 2015:

United Healthcare / AARP is offering 3 PPO Medicare Advantage Plans in Pinellas County Florida for 2015:

(Call 1-855-368-4717 to enroll)

Insurance Plan Summary
InsurerUnitedHealthcare/Medicare CompleteUnitedHealthcare/Medicare CompleteUnitedHealthcare/Medicare Complete
PlanAARP MedicareComplete Choice Plan 2 R5287-001AARP MedicareComplete Choice H5532-001AARP MedicareComplete H1080-004
Monthly Premium$0.00$29.00$0.00
Medical Coverage
Primary CareIn Network $15 copay; Out-of-Network $45 copayIn Network $15 copay; Out-of-Network $45 copay$5 copay
Specialist VisitsIn Network $50 copay; Out-of-Network $70 copayIn Network $50 copay; Out-of-Network $70 copay$45 copay
Routine Annual Physical$0 copay$0 copay$0 copay
Routine Annual Eye$50 copay (for up to 1 every year)$50 copay (for up to 1 every year)$45 copay (for up to 1 every year)
Inpatient Hospital CareIn Network $395 copay per day, days 1-4; Out-of-Network 40% of the costIn Network $395 copay per day, days 1-4; Out-of-Network 40% of the cost$335 copay per day, days 1-5
Diagnostic Tests, X-rays, & Lab Services$22 to $25 copay (or 20% of the cost)$13 to $16 copay (or 20% of the cost)$13 to $16 copay (or 20% of the cost)
Outpatient SurgeryIn Network 20% of the cost; Out-of-Network 40% of the costIn Network 20% of the cost; Out-of-Network 40% of the cost20% of the cost
Emergency Care$65 copay, waived if admitted$65 copay, waived if admitted$65 copay, waived if admitted
Urgent Care$30 to $40 copay$30 to $40 copay$30 to $40 copay
Ambulance$300 copay$250 copay$250 copay
Home Health Care$0 copay$0 copay$0 copay
Skilled Nursing$0 copay per day, days 1-20; $155 copay per day, days 21-64; $0 copay per day, days 65-100$0 copay per day, days 1-20; $155 copay per day, days 21-59; $0 copay per day, days 60-100$0 copay per day, days 1-20; $155 copay per day, days 21-59; $0 copay per day, days 60-100
Annual DeductibleN/AN/AN/A
Out-of-Pocket Maximum$6,700 to $10,000$5,900 to $10,000$5,900.00
Out-of-Network CoverageIt may cost more to get care from out-of-network providers, except in an emergency. See Plan Details for additional information.It may cost more to get care from out-of-network providers, except in an emergency. See Plan Details for additional information.It may cost more to get care from out-of-network providers, except in an emergency. See Plan Details for additional information.
Prescription Drug Coverage
Amount you pay for prescriptions up to $2,960
Pharmacy Deductible$200 for Tiers 3 and 4 only$250 for Tiers 3 and 4 only$220 for Tiers 3 and 4 only
Retail (one month)$2/$8/$45/$95/33%$2/$8/$45/$95/33%$2/$8/$45/$95/33%
Mail (three month)$4/$16/$125/$275/33%$4/$16/$125/$275/33%$4/$16/$125/$275/33%

What is a Medicare Advantage Plan?

What is the difference between Medicare Advantage Plans and Medicare Supplement Plans?

Physicians United Plan

The State of Florida is seeking to dissolve Physicians United Plan (PUP).

Florida is looking to dissolve the local Medicare Advantage health insurance company.

Health News Florida is reporting, The Florida Department of Financial Services filed a petition in Leon County Circuit Court to place the Orland-based plan into receivership because it is insolvent. The company’s May financial statement reported assets of $92.4 million while liabilities amounted to $105.3 million.

Florida’s commissioner of insurance regulation, “PUP’s insolvency poses a serious danger to the financial safety of the policyholders, subscribers, claimants, creditors and citizens of the state of Florida.”

Physician’s United is a Private health insurance company offering Medicare Advantage Plans to Medicare Beneficiaries in the following Florida Counties: Brevard, Broward, Hillsborough, Lake, Marion, Miami-Dade, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, Sumter, St. Lucie and Volusia.

This news is in line with a Blog / Video that I posted last year, “Is Obamacare going to destroy Medicare Advantage Plans?”. Click here to watch video:

The Affordable Healthcare Act is cutting funding to Medicare Advantage Plans, as mentioned in last years blog I wrote, “I believe that the smaller insurance companies will either be purchased by a larger insurance company, or go out of business”, Robert Bache.

PUP is an example of  a Company going out of business because it ran out of money. It is reported that in April, PUP’s leaders acknowledged that the company needed $30 million in capital by June 3rd to avoid liquidation. Obviously, they were not successful in getting the capital and now that State of Florida has asked for automatic liquidation on July 1.

What does this mean to PUP Policyholders?

We are not sure, however the most likely scenario that will occur is:

Policyholders will receive a letter from CMS (Centers of Medicare Services) stating that they are losing their Plan and will have 63 days to find a new Plan. To see what Plans are available please call Senior Healthcare Direct toll free, 1-855-368-4717.

Robert W. Bache aka “MedicareBob™”

President / Producer

Senior Healthcare Direct

Direct Toll Free: 1-800-525-0299

Company Toll Free: 1-855-368-4717


Learn more about Robert aka “MedicareBob™”



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Medicare Advantage Cuts Proposed for 2015

(MedicareBob™) – The U.S. government on Friday proposed a cut in payments to private health insurers for 2015 Medicare Advantage plans, a move Republican lawmakers said would hurt benefits for the elderly and disabled.

The proposal, released in a document by a division of the U.S. Department of Health and Human Services, appeared to cut payments by more than the 6 to 7 percent the insurance industry had expected, one Wall Street analyst said.

“Now the lobbying begins: can the plans get Congress to help make the cut less severe?” CRT Capital analyst Sheryl Skolnick said, adding that her assessment of the hundreds of pages of information was preliminary.

Friday’s notice of proposed rates opens a window for negotiations on the final ruling, due April 7.

Insurers and lawmakers have said cuts will mean smaller networks of doctors and hospitals and higher out-of-pocket costs. Insurers have said they could only maintain benefits if there was no change in payments for 2015 from 2014.

Many factors go into determining the government’s total reimbursement to insurers. These payments are based in part on the assumption that Medicare Advantage spending per person will fall 3.55 percent in 2015. Total reimbursement to insurers, however, is influenced by factors such as payments for patients who are sicker than average.

An executive at one company that manages Medicare Advantage plans said that insurers are facing cuts in the 8 percent to 10 percent range when factoring in the per capita spending decline and other planned reductions. These include a new health insurance tax under President Barack Obama’s healthcare law as well as other risk adjustments.

Other industry officials said they were still reviewing the Medicare notice to determine its full impact. Republican lawmakers said any additional cuts to the program were unacceptable.

“These Medicare Advantage cuts are misguided, threaten a successful program for seniors, and must be overturned,” Republican Senator Orrin Hatch said in a statement.

“Medicare Advantage is extremely popular for a reason – run through the private market, seniors gain access to high-quality and coordinated care with additional benefits that they otherwise wouldn’t get,” he said.

The criticism from Hatch and other leading Republicans adds to pressure from the party over Obama’s signature domestic policy achievement. The Patient Protection and Affordable Care Act, which aims to extend health coverage to millions of uninsured Americans, includes provisions to cut Medicare spending.

UnitedHealth Group Inc, Humana Inc and Aetna Inc are among the insurers who manage private Medicare plans for about 15 million of the 50 million Americans eligible for Medicare.

The shares of insurers fell in after-hours trading. Humana posted the biggest loss with a 4 percent decline.


The proposed payment rates are a key factor in how insurance companies plan theirbusiness for the coming year, including in which markets they will offer health plans, what their medical and administrative costs will be and at what level to set premiums and doctor visit co-payments.

Insurers have said that 2014 was a difficult year for Medicare Advantage because of cuts to payments estimated at about 6 percent overall by the industry group, called America’s Health Insurance Plans (AHIP).

“As 2015 payment rates are finalized, we urge the Medicare agency to protect seniors from facing higher costs and fewer benefits by keeping Medicare Advantage payment rates flat,” AHIP Chief Executive Karen Ignagni said in a statement.

The Centers for Medicare and Medicaid Services said in a statement that the proposed changes for 2015 are smaller than those implemented in 2014.

It also said in the statement that it planned to calculate risk scores in 2015 with the same methodology as in 2014. It said it would change a part of its risk payment formula to account for the increasing proportion of baby boomers entering Medicare, who tend to have better health.

It was not immediately clear how these and other formula changes in the document would affect the industry overall or specific insurers.

Medicare Advantage and other government paid-healthcare services like Medicaid are among the insurers’ fastest growing businesses.

But if the costs to insurers of providing the healthcare services outpace the payments from the government, the difference is paid by the insurers, undermining their ability to profit from these plans.

“Medicare Advantage plans are fully at risk under this program. So if their estimate is off, for better or for worse, they are at risk for that,” said Anne Hance, a lawyer at McDermott Will & Emery in Washington, D.C. who focuses on regulation.

(Reporting by Caroline Humer; Editing by Michele GershbergJonathan Oatis, G Crosse,David Gregorio and Andre Grenon)

Robert Bache’s thoughts:

This is the trend that we have seen over the past 6 years, and it will continue. I anticipate less and less Medicare Advantage Plan options every year for at least the next 3 years.

How is Obamacare effecting Medicare Advantage Plans?

Medicare, Dental, Vision, Hearing

Medicare Advantage Plan HMO-POS

Medicare Advantage Plan HMO

Medicare Advantage Explanation

What are the Benefits to Advantage Plans?

Robert Bache

Medicare Advantage vs Medicare Supplement

Is Obamacare Destroying Medicare Advantage Plans?

What is a Medicare Advantage Plan

Aetna Medicare Advantage Plan 2014 HMO Preview:

Aetna Medicare Advantage Plan 2014 HMO Preview:

Aetna is offering two types of Medicare HMO Plans in 2014:
1. The Aetna Medicare Traditional HMO
2. The Aetna Medicare Open Access HMO

The Aetna MedicareTraditional HMO:
Referrals are not needed for certain services that are considered “direct access”:

  •   ER and urgent care
  •   Routine eye exams
  •   Flu and pneumonia shots
  •   Annual mammograms

The Aetna Medicare Traditional HMO requires a member select and use a primary care physician (PCP).
The PCP coordinates care and provides referrals to other health care providers in the Aetna Medicare Plan (HMO) network.
Getting a referral is easy. If the PCP cannot treat the condition, the doctor can issue a referral to an Aetna Medicare Plan (HMO) network specialist.

The Aetna Medicare Open Access HMO:

  •  It allows members to go to any Aetna Medicare Plan (HMO) network provider they choose for covered services without a primary care provider (PCP) referral.
  •   PCP selection is not required, but is recommended.
  •   Members receive the same benefits as the Traditional HMO plan.

ALL 2014 Aetna Medicare HMO Plans include:

  •   Routine physicals
  •   Annual Wellness exams
  •   Mammograms
  •   Routine gynecology exams
  •   Prostate cancer screenings
  •   Flue and pneumonia vaccines
  •   Colorectal screenings
  •   Bone density exams (bone mass measurement)
  •   All Plans have a maximum out of pocket amount
  • Aetna Health ConnectionsSM Disease Management
  • Healthy Outlook Program
  • National Medical Excellence Program
  • Case Management Services
  • Annual Preventative Reminders
  • Numbers to know
  • Informed Health Line
  • Doc Find

Here is a partial list of benefits covered in the plans:

  •   Primary care
  •   Specialty care
  •   Inpatient hospitalization
  •   Surgery
  •   Home health care
  •   Skilled nursing care
  •   Outpatient services
  •   Ambulance services
  •   Urgently needed care
  •   Hearing aid and/or eyewear reimbursements are covered in some plans.


All plan include a monthly health club membership that includes two options:
o Tier 1 clubs – no copay
o Tier 2 clubs – nominal annual copay

  •   Members are covered for urgent and emergency medical care 24 hours a day, seven days a week, anywhere in the world.
  •   Optional Supplemental Benefits that provide coverage for dental, hearing, and/or vision are available for an extra cost with some HMO Plans.

Some plans include a Transportation benefit (24 one-way trips) per year that can be used for travel for defined health care needs.

MedicareBob™’s Favorite Benefit for Aetna’s 2014 Medicare Advantage HMO Plans:
I really like “Aetna’s Travel Advantage Program” that is included in Aetna 2014 Medicare HMO Advantage Plans.

The Travel Advantage Program Fact Sheet:
o It covers members who are temporarily traveling to another Medicare HMO service area for up to 12 consecutive months.
o It provides access to the same benefits that members receive in their home service area.
o Member must contact Member Services to elect the Travel Advantage Program.
o Members must contact Member Services when they return to their home service area.
o Members must use Aetna Medicare HMO network Providers.

TO LEARN MORE CALL ME, 1-800-525-0299.

Robert Bache aka “MedicareBob™”
President / Producer
Senior Healthcare Direct
Direct Toll Free: 1-800-525-0299
Company Toll Free: 1-855-368-4717

Learn more about Robert aka “MedicareBob™”


Please “Like” Senior Healthcare Direct on Facebook:

Robert Bache

About Medicare Advantage Plans / Medicare Part C

About Medicare Advantage Plans / Medicare Part C

What Is Medicare Advantage (Part C)?

As a Medicare recipient, you are eligible for additional health plan choices, such as Medicare Advantage. This type of plan, sometimes referred to as “Part C”, combines health insurance with health services. The benefits include all of Part A (hospital insurance) and Part B (medical insurance), and certain plans may also include Part D (prescription drug coverage).

Medicare coverage is broken up into parts and cover specific services.

Medicare Part A (hospital insurance) includes:

  • Hospital and inpatient care
  • Nursing facilities, hospice, and home health care

Medicare Part B (medical insurance) includes:

  • Doctors’ services, hospital outpatient care, and home health care
  • Preventive services

Medicare Part D (prescription drug coverage) includes:

  • Prescription drug coverage through Medicare-approved insurance companies
  • Discounts on prescription drugs

Each health insurance company must follow the guidelines set by Medicare. However, there are no set rules regarding out-of-pocket costs or how a member receives services (referrals, in-network vs. out-of-network). These rules vary according to health insurance carrier and may change each year.

I would love the opportunity of assisting you in understanding the available Medicare Advantage Plans in your County, please call me toll free: 1-800-525-0299.

-Robert Bache, “MedicareBob”

What is an HMO Medicare Advantage Plan?

Robert Bache

Medicare Supplement OR Medicare Advantage Plan, which is better?

Medicare Supplement vs. Medicare Advantage Plan, which offers better coverage?
A Medicare Supplement Plan works with Medicare to pay the out of pocket costs that Medicare does not pay for. When you have a Medicare Supplement Plan, you will continue to use your Medicare red, white, and blue card, as well as your Medicare Supplement Card.

A Medicare Advantage Plan works in replace of Medicare. Medicare pays a private insurance company to insure you, with the requirement that the benefits are at least as good as what Medicare offers. If you choose a Medicare Advantage Plan, you can put away your Medicare red, white, and blue card because you will only be required to present your Medicare Advantage Plan card to use the insurance.
So which is better?
Good news, there is no wrong answer, they both are good, and both probably offer better coverage than you are used too. Below are the good and the bad for each type of insurance, I hope this helps:

 Medicare Supplement:

The Good:

Flexibility- choice of Doctor and/or Hospital

Predictability- very little out of pocket expense

Pays all hospital bills

You and your Doctor decide your care

Easy to shop and compare the different prices

No referrals are required, no HMO or PPO

Travels with you, same coverage all over the US

Electronic Billing

The Bad:

An additional Monthly Premium ($75-$180)

No dental or vision coverage

Monthly premium increases every year

No prescription drug coverage, you will need Part D


In summary, a Medicare Supplement Plan is going to cost an additional monthly premium, but it provides coverage that allows you to choose your own Healthcare Providers, and it is easy to budget because as long as you pay the monthly premium, you will rarely get a bill.

Medicare Advantage Plan

The Good:

Very low monthly premium, sometimes $0.00

Insurance Company helps manage your care

Some dental and/or vision

Includes prescription drug coverage

The Bad:

High out of pocket costs up to $3,500 to $7,500

Doctor / Hospital Network: HMO or PPO

Requires referrals

Annual Contracts, can only change 10/15-12/07

Coverage is limited to your County

Insurance Company decides your care

In summary, a Medicare Advantage Plan operates like group health insurance that most of us have had our whole life, and has a low monthly premium. However, if you are retiring and your income is being reduced, it may be more difficult to have health insurance that is impossible to budget for because you do not know how much you will use the Plan each year.

Candid MedicareBob™: I assist roughly 100 people per month with choosing which Medicare Coverage is the best for them, and 70% of the time, the choice is a Medicare Supplement Plan. This does not mean that I do not like Medicare Advantage Plans, to me it really comes down to the pricing that is available for the Medicare Supplement Plans in your area. If a Medicare Supplement Plan F, G, or Plan N is $100 or less per month, than a Medicare Supplement makes a lot of sense for most people. This being said, I do have clients that cannot afford a Medicare Supplement, this is when I assist them in choosing the right Medicare Advantage Plan for them. As I mentioned previously, both Medicare Supplement Insurance and Medicare Advantage Plans typically offer better insurance than you have had while you were working.


You should know: The only time that you are guaranteed approval for any Medicare Supplement Plan is when you first turn 65 years old, or within 6 months of when you start Medicare Part B.

How do I, a licensed insurance agent/broker that sells Medicare Supplements and/or Medicare Advantage Plans make money?

This is a fair question, and I am happy to share this information with you. My services; Medicare education, telephonic enrollment, and customer service, has no additional cost to you. I get paid by the insurance company, not by you.

CLICK HERE TO WATCH A SHORT VIDEO: Medicare Advantage or Medicare Supplement, which is better?

Medicare insurance question? What quotes from 20+ Medicare Supplement Companies? What a chart of the available Medicare Advantage Plans in you County? Call me, Robert W. Bache aka MedicareBob™: 1-800-525-0299.

Robert W. Bache aka “MedicareBob™”
President / Producer
Senior Healthcare Direct
Direct Toll Free: 1-800-525-0299
Company Toll Free: 1-855-368-4717
Learn more about Robert aka “MedicareBob™”


Please “Like” Senior Healthcare Direct on Facebook:

Robert Bache

Which is Better, Medicare Supplement Insurance or Medicare Advantage Plans?

Medicare Supplement vs Medicare Advantage

Robert Bache aka MedicareBob™ explains the fundamental differences between Medicare Supplement Plans and Medicare Advantage Plans.

Robert Bache, “Are you a person that would rather pay now or pay later? Medicare Supplement is for people who would rather pay now, a Medicare Advantage Plan is for people that would rather pay later…”

Cigna to begin co-branding marketing with recently acquired HealthSpring

Cigna to begin co-branding marketing with recently acquired HealthSpring:

Back in 2012 Cigna Cop. purchased HealthSpring of Nashville. Tenn for $3.8 billion for a larger share of the Medicare market. Cigna has recently announced that they are starting a new marketing campaign branding the two companies together.

This is a good sign if you have a HealthSpring Medicare Advantage Plan, this is an indication that Cigna is going to continue to fund the Plans properly. I do not think that Cigna would co-brand if they thought the HealthSpring Plans were not going to be around for the future.

This really goes along with my previous articles and videos. The smaller Medicare Advantage companies are either going to be purchased by one of the insurance jugernauts, or they are gong to disconinue their Plans.

Robert Bache aka “MedicareBob™”





Medicare Advantage Plans are Changing

Medicare Advantage Plans are Changing

Obamacare includes some changes to the Medicare Advantage program:

  • Starting January 2014, Medicare Advantage plans will be held to a minimum loss ratio of 85%
  • Requires restructuring the funding levels to Medicare Advantage plans in order to reduce payments closer to traditional Medicare (i.e. remove the 14% “overpayment” to Medicare Advantage)

            1)  Congressional Budget Office estimates this will cut $145 billion over 10 years

           2)  The payment restructuring was designed to be implemented in 2011.

  • However, in 2012 CMS expanded “quality” payments to Medicare Advantage plans through a demonstration program (outside of Obamacare) that effectively mitigated most of the impact of the Medicare Advantage funding cuts from Obamacare.  The demonstration program is targeted to continue through 2014, at which time the additional bonus payments will end unless other measures are put in place.

MedicareBob™’s explanation:

Medicare Advantage Plans are receiving less money from the Government, therefore the insurance companies are going to have to do better with less money. I look for the smaller Medicare Advantage companies to either go out of business, or be purchased by one of the bigger insurance companies.

Examples: Care Improvement Plus has been purchased by United Healthcare, and Coventry has been purchased by Aetna.

What does this mean to people one Medicare Advantage Plans?

·         Less options

·         Less benefits

·         Maybe more of a monthly premium

The days of paying a $0.00 premium and receiving a rich Medicare Advantage Plan are ending soon. However, when you compare the benefits and premium of a Medicare Advantage Plan to an Employer or Private insurance Plan, Medicare Advantage Plans are still typically going to offer better coverage. Medicare Advantage Plans over the next few years should still offer good benefits for a low monthly premium.

 Robert Bache aka “MedicareBob™”

Cell Phone:1-800-525-0299