Medicare Advantage Broken Down & Explained

Our company is a Texas based company that provides services to our senior citizen population that includes: Medicare Advantage, Medicare Insurance, Medicare Part D & Medicare Supplement. So, although we may reference Texas Medicare Advantage information, this article can be used universally & is an excellent source of information for those seeking to be informed and educated.

Understanding Medicare Advantage

Some senior citizens and others enrolled in two of Blue Cross Blue Shield of Michigan’s Medicare Advantage plans will have to make a switch before the end of the year.

“What’s happening is that those plans, nationally, are ending,” said Blue Cross Blue Shield of Michigan spokeswoman Helen Stojic. The plans are "sunsetting (being phased out) because they don’t have provider networks,” she said.

She said such plans will continue to be offered by Blue Cross Blue Shield, “but they will have provider networks as required beginning in 2011. The previous plans did not have provider networks.”

In their place, Blue Cross Blue Shield is offering an array of products that have service provider networks, she said.

Blue Cross Blue Shield members affected should have started receiving letters early this week from the nonprofit corporation, and they can expect to receive second letters later this week with information about the new plans to which they can switch.

The plans ending this year are called Medicare Advantage Option A and Medicare Advantage Option B. Those 2-year-old plans are, in general terms, combinations the Original Medicare Plan (the government-backed health insurance program that looks to provide affordable coverage to people over 65 and qualified individuals who have disabilities), along with other options.

Medicare has two main categories, as explained on the BC/BS website: the Original Medicare Plan and the Medicare Advantage Plan. Each has four sub-categories related to: hospital insurance coverage (Part A); coverage for medical services and supplies (Part B); and coverage for prescription drugs (Part D).

Medicare Advantage plans are considered Part C. In very simple terms, those private fee-for-service plans are combinations of Parts A and B, provided through private insurance companies.

The replacement plans are preferred provider organization plans being called Medicare Plus Blue PPO Vitality and Medicare Plus Blue PPO Assure. Blue Cross also will continue to offer its current PPO Plan, which is now being called Medicare Plus Blue PPO Signature. Members will have to consider them during the annual election period for Medicare beneficiaries, Stojic said. That enrollment period starts Nov. 15 and ends Dec. 31.

Medicare beneficiaries can also opt to choose from four products offered by Blue Care Network, the Blue Cross-affiliated health maintenance organization. Included is a new HMO Medicare Advantage product for 2011.

Stojic said she did not know how many of Blue Cross’ 4 million members statewide are affected, but she said, “We’re working with seniors. We’re working with insurance agents. We have information on our website. ... We’re trying to help seniors navigate the changes.”