Every year, Medicare Advantage plans of all types are approved by the Center for Medicare and Medicaid Services (CMS). Every plan must be at least as good as original Medicare, i.e. those plans which include prescription drug benefits needs to be at least as good as Medicare Part A, Part B and Part D.
"At Least As Good" Means....
Here is the issue. When the CMS approves plans, these plans must be at least as good as original Medicare, which is defined as the actuarial equivalent. What does that mean? It means that statistics are used to determine that the Medicare Advantage plan is at least as good as original Medicare, on average. That does NOT mean that your Medicare Advantage plan is better than original Medicare for each particular benefit. You can (rightfully) ask: What in the world does THIS mean?
Example: Skilled Nursing Facility Care
I am not going to point out insurance companies; it is not the point of the blog, or the book Maximize Your Medicare, to point out specific companies or specific policies. However, here is a real-world example.
Original Part A Skilled Nursing Facility Care:
0-20 days: $0. Medicare pays.
20-100 days: You pay the first $148 per day in 2013, Medicare pays the remainder.
100+ days: You pay 100%
Medicare Advantage Example:
0-20 days: $50/day copay.
20-100 days: $150/day copay.
This Happens
If you stay at a skilled nursing care facility for 100 days, it is entirely possible that you will pay $1160 more than under original Medicare.
Get Maximize Your Medicare, Get Informed
These small details seem insignificant, right? Tell that to the subscribers of this plan in 2013, who are admitted to a Skilled Nursing Facility. I cannot fix this, and neither can you, other than to become informed every year, to check every year, to protect yourself to the best of your ability.
You want $9.99 of value? There it is, free, and there are many, many more examples of this in Maximize Your Medicare.
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