Top Carriers Dropping Medicare Advantage Private Fee-for-Service Plans

Top health insurance carriers are dropping their Medicare Advantage Private Fee-for-Service (PFFS) plans, according to recent announcements by some health insurance providers, including Coventry and WellCare. A PFFS is a Medicare Advantage (MA) plan that is available through a state licensed, risk-bearing entity, or a PFFS Medicare Advantage Organization (MAO).

As a result of PFFS coverage drops by Coventry and WellCare alone, more than 500,000 Medicare beneficiaries will have to find new coverage.

Currently, Medicare Advantage plans receive government subsidies so that they can offer beneficiaries more benefits than simple Medicare plans. Medicare Advantage plans are offered to Medicare-eligible individuals by private health insurers. However, analysts are expecting the reimbursement rates for these PFFS programs to fall by approximately five percent, making them less profitable for insurance carriers.

How PFFS Currently Work

PFFS are popular amongst consumers because they allow Medicare beneficiaries to choose their own healthcare providers, rather than having to select their providers from a limited number of in-network of Medicare-approved providers. Beneficiaries can see any provider, as long as the provider agrees to charge based on the PFFS fee schedule. This fee schedule is the same as the Medicare schedule.

PFFS MAOs have yearly contracts with the Centers for Medicare and Medicaid Services to provide Medicare beneficiaries with their Medicare benefits as well as additional benefits that a company opts to provide. Essentially, the PFFS provider pays for healthcare instead of Medicare when a beneficiary has such a plan.

The main benefit (which makes PFFS so popular) is that individuals who join PFFS MAOs are not required to use providers within a network and can, therefore, see any provider as long as the provider is able to receive payment from Medicare and the PFFS MAO.

More Changes to PFFS Plans

In addition to the decreased government reimbursement amount for PFFS plans, PFFS plans will be required to develop healthcare provider networks beginning in 2011. The change will force PFFS beneficiaries to select their healthcare providers from within the plan network, limiting their freedom to see providers that they prefer.

Experts predict that more healthcare insurance providers will follow Coventry and WellCare by dropping their PFFS plans in coming months. Individuals should contact their healthcare insurance providers if they are currently enrolled in a PFFS or are considering enrolling in a PFFS to get more information about how their provider will respond to the upcoming PFFS changes.

More Information About Medicare Advantage Plans

Medicare Advantage plans are specific types of Medicare plans that are in place to cover the cost of healthcare related expenses for Medicare participants. These plans are similar to traditional Medicare plans in that they provide financial support for individuals seeking medical or health-related services. However, the Advantage plans generally have more benefits and lower copayments than many other types of Medicare plans. In order to have a Advantage plan, Medicare participants need to have Medicare Part A and Medicare Part B plans.

One major difference between Medicare Advantage plans and other types of Medicare plans is that Medicare Advantage participants may need to see only doctors that are members of the Medicare Advantage provider plan. However, plans may allow participants to use a wide variety of services, including Medicare Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service providers, and Medicare Special Needs providers.

Medicare participants should also be aware that Medigap policies do not provide gap coverage for individuals that participate in the Medicare Advantage program.

South Carolina Medicare Advantage Plan Changes – Should I Stay Or Should I Go?

South Carolina Medicare Advantage plans, just like the Medicare Advantage program nationwide, are poised for some major changes in 2010 and beyond. Does this affect you and, if so, how? If you have a Medicare Advantage plan currently, should you keep the same plan, find a new MA plan or return to “original Medicare”?

The Advantage plan program is an alternative to “original Medicare”. With this program, Medicare beneficiaries enroll with a private company for the management and administration of their Medicare benefits. Since the program’s inception, it has been controversial in some circles, as the Federal Government pays the private companies a large amount of money per person, per year to manage each individual’s Medicare benefits through the private company.

In early 2009, the Obama administration, in conjunction with the Centers for Medicare & Medicaid Services (CMS), announced plans to overhaul the way these plans are handled. These changes will affect the companies that administer the private plans, as well as those enrolled in them. Some of the major changes include:

As a large part of an announced $316 billion Medicare funding cut, funding to the private Medicare Advantage plans will be reduced. To go along with this, there will be a competitive bidding process for these private plan contracts.
Annual out-of-pocket expenses will be required to be capped in 2010. The anticipated cap amount is $3,400.
Plans with 10 or fewer enrollees in a certain area, or county, will be required to not offer plans in that area.
CMS projects that 10 million Medicare Advantage customers will face monthly premium increases of $40-70 per person in 2010. To go along with the higher premiums, many of the South Carolina Medicare Advantage plans will also be reducing services/coverage to compensate for lower reimbursement rates from the Federal Government.
Starting in 2011, the private MA plans are required to develop networks for their coverage. Currently, the private-fee-for-service (PFFS) plans are not required to have networks. This elimination of the PFFS plans as they are now is already having an impact for 2010. Coventry Health Care, Well Care Health Plans and Health Net all have announced the end to their PFFS plans as of 1/1/2010 – between these three companies, this affects 428,000 people nationwide.
Without a doubt, it is apparent that the marketplace for South Carolina Medicare Advantage plans is changing. Each individual must look past any pre-existing notions of the differences in “original Medicare” and the MA program and re-examine how these plans are going to work for them moving forward. While some may find it advantageous to stay with the government’s Medicare Advantage program, even after all of the changes; however, others may find more reasonable and comprehensive Medicare Insurance coverage elsewhere.

A Little Guide On Sauna Products And Usages!

Sauna is a sort of bathroom or building made for a special purpose of the steam bath. The steam bath is the main activity of a Sauna Bath. Sauna causes sweating which gives many health benefits. Sauna detoxifies the body and promotes immunity of the body. However, Saunas should be avoided by blood pressure patients.

Currently, steam baths or saunas are used all over the world. Till recently, saunas were generally commercial, but now so many people prefer to install the saunas for their residences for personal use, which shows the increasing popularity of the Saunas. And also they prefer to install the best sauna heaters in their pre-installed bathrooms.

Although outdoor saunas are also employed, yet Indoor Saunas are more popular. If you build your personal/residential sauna, build it near your bathroom, this will be more convenient to use both facilities. But you have to make sure before installing the electric sauna heater in your sauna that the floor is plain and proper electricity supply of 120 V. or 240 V. is available for sauna installation.

Commercial Saunas:
If you are going to build a commercial Sauna, then before investment, you may consider all its business aspects, although Sauna installation does not involve higher investment. Most of the gyms and health clubs have sauna installation in their business establishments.

Sauna Heaters:
It should be known well that the sauna heater and stoves can be bought in Gas, wood burning or electric sauna heater. But since this is a consumer society, Electricity and gas are preferred fuels for the saunas. Recently Infra-red saunas are also available in the market. But they need more precautions in their use. Choose freestanding heaters mounted on the floor if you plan to build a larger sauna bath; otherwise compact saunas mounted on walls are installed in average sauna installments. 110 Volts electric current is sufficient for them. They are meant for 1 to 3 persons. For larger sauna heaters ignited with 220 V. are required. Their size may vary from 2 KW to 18 KW. For a space of every 45 to 50 cubic feet, One KW electric energy for its heater is required.

Sauna Installation is not a costly affair. Radium Sauna for 4 persons costs from US$ 3300 to US$ 7000 which is a moderate amount as per USA standards or even as per standards of other countries of the world.

Saunas in hot countries and regions:
You will be glad to know that Saunas are also used even in hot countries including the countries of South Asia. However, Sauna bath is generally in more demand in cool countries.

Infrared saunas versus traditional saunas:
Both of these types can have a few advantages as well as side effects. Persons with high blood pressures should avoid sauna bath. More care should be taken in the use of radiant saunas as they have infra-red rays, so more care in using them.

Coventry Health Plans – Federal Healthcare Reform Compliance

Coventry health plans, like all plans offered in the United States, are required to meet the new federal guidelines for healthcare reform. These reforms change benefits, exclusions, and limitations for all healthcare plans offered in the U.S. with few exceptions. Such reforms include coverage for dependents until age 26 under certain criteria, changes in preventative care coverage, as well as changes to medical spending accounts like health savings and flexible spending accounts. Likewise, the new federal reforms have also created changes to Medicare including Advantage Plans and Part D Plans, as well as changes to other health insurance plans, terms, and coverage amounts.

Unlike many insurance companies, those participating in Coventry health plans have access to simple explanations of the changes to their plans. Rather than simply creating an additional page on their website, Coventry has produced downloadable PDF files that explain the changes to specific policies and healthcare plans. These informative fact sheets are categorized by healthcare plan type, then further categorized based on specific areas of health care. This makes finding the specific information consumers need easier and less time consuming. Insured customers can easily find the area of most interest to them in terms of the federally-mandated changes and how those changes will impact their particular policy.

The new federal regulations regarding healthcare reform were passed into law in the Spring of 2010. September 2010 saw the first of these reforms beginning to take effect. Coventry health plans along with hundreds of other health insurance policies and plans must now conform to these new insurance industry standards which are intended to better protect consumers. For example, annual and lifetime benefit limitations will gradually come to an end. Additionally, preventative care takes on a more important role as federal regulations put an end to cost sharing. That means insurance companies must now pay for preventative healthcare without charging co-pays or in some cases, meeting deductible requirements.

One thing to note with the new federal healthcare reform laws, they do not mean instant changes to your Coventry health plans or any other health insurance policy currently in effect. Rather, the reforms apply to new policies taken out after the law was passed. Old policies and healthcare plans must meet these new regulatory requirements as they are renewed. Therefore, if you have a healthcare plan that was in place prior to September 2010 (or later, as more regulations begin to take effect) you may have to wait until your plan renews before you can enjoy the increased benefits.

If you need assistance in locating particular coverages at a pre-determined price, we can help you obtain a health insurance [] quote, and save up to 50% on your monthly premium.