| A Medicare Advantage program is essentially an HMO paid for by Medicare but administered by a private insurance company. There are hundreds of them and they get more money(I think 17% more)than Medicare does and are able to offer more benefits than straight Medicare insurance. Congress has been been trying to reduce that amount for the last 3 years or so but the insurance lobbies have been working very hard to prevent it. I belong to an Advantage program called Mediblue which is administered by Empire (Blue Cross,Blue Shield) and is the only one made available to me by my company. My prescriptions are included (with copay)and there are several other goodies like a hearing aid allowance of $500. I am currently paying about $150 a month for my wife and me. The previous 2 years I paid absolutely nothing....my company's allowance was enough to cover employees in this county. As it is with Medicare and other HMO's, all doctors are not in their net but I can tell you that all the largest and best hospitals in NYC are... HMO's usually require a referral from your primary physician to see a specialist. My Mediblue does not. I pay $0 copay for a primary care physician and $10 copay for a specialist. Drugs have copays depending on whether they are brand names, how expensive they are, and whether they are generic. For drugs there is a maximum annual out of pocket cost of about $4500. Chiropractors,minimum vision care, and minimum dental care are included. There is no copay for almost all diagnostic tests including: mammogram, prostate, colon,cardio, paps, kidney dialysis, physical exams, xrays, most immunizations, etc....and a lot more. |
