What is a Medicare advantage plan and should I get it?

Medicare is a private insurance plan. However, advantage plans are an alternative to private insurance. These plans are distinct from Medicare and have several pros and cons. 

Medicare Advantage plans may vary and can provide better care, flexible plans, and saving opportunities. On the other hand, some plans may be too expensive to afford, have fewer options to offer, and may require changes in your lifestyle. 

We will provide information on Medicare advantages in this article and also their procedure, advantages, and disadvantages so you can know whether they are suitable for you or not.

What is Medicare Advantage?

Medicare Advantage is an extension of Medicare’s original plans and is often known as Medicare Part C. Several private insurance companies offer these plans. The features of these plans are a combination of original plans (Part A and Part B) and with some modification and additional options, Part C is made. 

Most Medicare Advantage plans offer the following benefits:

  •  Hospitalization
  •  Hearing
  •  Some home healthcare services
  •  Vision
  •  Prescription drug coverage
  •  Hospice care
  •  Dental
  •  Doctor’s visits
  •  Preventive care

Types of Medicare Advantage plans

There are a variety of Medicare advantage plans that you can choose from depending upon your needs: 

  • Health Maintenance Organization (HMO). By opting for HMO plans, you will be provided in-network doctors for your service. However, for the appointment of doctors, you may need referrals.
  • Preferred Provider Organization (PPO). As opposed to HMO, PPO plans offer both in-network and out-of-network medical services but the cost for both of them is different. 
  • Private Fee-for-Service (PFFS). PFFS plans offer flexibility in terms of payment and can be designed depending upon your capability.
  • Special Needs Plans (SNPs). SNPs are designed for payment for chronic medical conditions and long-term. 
  • Medical Savings Account (MSA). MSA plans are opted in pair with costly health plans and help to save money from medical expenditures. 

Medicare Advantage Benefits 

Medicare advantage plans benefits and options are more than that of original Medicare plans. 

Convenient coverage options

Original Medicare plans offer limited coverage and options and you need to purchase other plans to cover additional expenditures. If you opt for Original Medicare, it will only provide hospital insurance and medical insurance. If your needs are not covered in these two coverage options, you will need Medicare Part D for covering the cost of prescription drugs and Medigap for supplemental coverage.

Contrary to Medicare plans, all your needs and additional coverage are covered in the Medicare Advantage plans.

Personalized plan structures

Medicare Advantage provides flexible plans for every distinct situation and needs. For example, as mentioned before HMO plans can offer in-network specialists and if you don’t prefer them you can opt for PPO plans and get your desired services. Similarly, the PFFS plan can also provide consumer freedom and lets you select your options freely. Apart from basic medical services, these plans also provide additional services like hearing, dental and preventive care, etc. 

Cost-saving opportunities

Most of the Advantage plans are quite affordable and offer little to no deductible cost and cover best services without purchasing premiums. If you can’t cover all your costs in these plans, you’ll have to pay out-of-pocket but Medicare Advantage plans set annual limits of such costs. Also, you can save more by opting Medicare Advantage plan in services like laboratory expenses and medical equipment. You’ll be able to see much more savings if you end up choosing a Medicare HMO plan. 

Coordinated medical care

Many Medicare Advantage plans have a coordinated care network. Your healthcare providers are constantly communicating to get you the best care possible through various healthcare services. The service provider does all the interactions for you and you can save the expenses of choosing a healthcare team and you can have a group of specialists ready at your disposal. According to researchers, this type of medical care results in better service for the patients which has been estimated by higher ratings and it also eases the work of medical staff and can avoid any unpleasant experiences.

Disadvantages of Medicare Advantage

With all the mentioned advantages of the Medicare Advantage plans, most of the people are quite content by choosing them. However, these plans also have some disadvantages which may trouble you. 

Limited service providers

If you opt for a Medicare Advantage plan instead of the original Medicare plans you may be limited to the health care providers. Such as HMO, it limits you to choose from only in-network specialists and you need to pay additionally if you plan to choose otherwise i.e out-of-network. Similarly, the plans, which do not pose such restrictions, are expensive and have high deductibles and copays. 

Complex plan offerings

Medicare provides a tool, find a plan, through which you can narrow down your search for plans. You’ll see that many Medicare Advantage plans limits their options in different ZIP codes. Some users might find it difficult not be able to access certain benefits due to different ZIP codes. 

Additional costs for coverage

Original Medicare plan only provides two coverage option and also have a high deductible, copays, and premium plans. In addition to this, you may need to pay for any Part D or Medigap for additional coverage.

Medicare Advantage plans provide a variety of options without these additional plans but their cost is more than Original Medicare plans. For example, many Medicare Advantage plans include drug deductibles and specialist visit copays.

State-specific coverage

Original Medicare’s services spread all across the United States. On the other hand, Medicare Advantage plans extend their special services in selected areas. So, if you are currently utilizing the Medicare Advantage plan, and you change your residence, your current plan may not be functional anymore.

The takeaway

As mentioned above, Medicare Advantage has many advantages over the Original Medicare plan such as better care, flexible plans, and saving opportunities. But these plans pose more restrictions, limit services and are more costly.



Maximize Your Health Insurance in 2021

The circumstances of 2020, caught every off guard. It was a continuous task of catching up with the new research studies and following preventive measures. With the circumstances getting worse, a lot more issues evolved, and with adapting to a new lifestyle, health care was primarily neglected by most of us.

Luckily with initial doses of vaccines being out in the market, there does seem to be a newfound hope of going back to our previous way of life. 2021 has begun with new hopes of better days coming. With these extraordinary times going by it’s time that you start focusing again on your and your family’s health care. Starting from setting healthier habits to maximizing your health insurance benefits to be prepared for any unforeseen health challenges.

Health insurances if planed correctly can easily become your best asset during difficult times. They can make your money work harder for you so you can get paid off your hard work when. there are difficult times ahead of you.

Have a look at the six of to top tips to maximize your health insurance in 2021

1. Consider choosing a plan that includes an HSA or FSA

Based on your family needs, you must work opening a health financial account like HSA or FSA. It is one of the best ways to make your money work harder for you. These both are saving accounts that one can utilize for out-of-pocket medical expenses and health care needs. For example life-saving drugs and eyesight care.

Before you decide on choosing any one of these. You must understand who these both are different from one another and how they would offer to you. For instance, In the case of HSA accounts, you have possession of the account. You have the freedom to utilize the funds. You can use them if you have recently switched from one job to another. You can invest in mutual funds, bonds, or stocks according to your choice. You can even save it up to your retirement time

On the other FSA have more restrictions. Because they’re owned by your employer, you can’t take an FSA with you if you leave, and any leftover money gets forfeited at the end of your insurance year.

If you go for HSA, you should consider your doctor visits and keep a check on how many times you visit them. You can only avail HSAs if have chosen a federally qualified high-deductible health plan. These plans have higher limits for out-of-pocket expenditures. Some employers that offer a health plan with an HSA will partially fund the account on behalf of their employees to help offset these out-of-pocket costs throughout the plan year. You can contact your employer to check the possibilities he offers. 


2. Understand your employer’s benefits before taking the job

We change our jobs very often due to upgrades and nicer salary. However, when looking for jobs we consider every other feature except the health plans they offer. Insurances are an important part of our life and if the provided plan does not fulfill our needs, out-of-pocket costs may use all your savings and leave you with nothing. It is important to pay attention to the health packages while choosing a job and you need to discuss this with your employer before making a final decision. 

3. Plan for any elective procedures you or your family will need

The pandemic since the last year has made things difficult for everyone and has also brought changes in the health plans as they are most needed now more than ever. Some new elective procedures have also emerged as things have started to settle. It is hard to select the perfect health care for you and your family and you never know when you will come across additional medical expenditures. You should research about different plans which cover all your costs and additional expenses and choose the most suitable one. The members of Harvard Pilgrim have a service tool called Estimate My Cost to estimate the cost of your plan in your area. Also, Reduce My Costs helps the members to save money by searching for inexpensive medical services and diagnostic facilities. 

Expenses increase considerably when you are a parent or are expecting a child. Parents now need to save more to give their child a brighter future and if you are already a parent of grown children, the responsibility is now double due to increased expenditures with age. There are some things you need to consider before choosing a family health insurance:

Make time for mental health

In troubled times like now, it is important to take care of your mental health and maintain your high spirits. Always check on your family and friends. Consider the mental health services and benefits your plan might include. As a member of Harvard Pilgrim, you have round-the-clock customer service, professional behavioral health treatment options (both in-person and virtually), online service, and programs for the care of their customers. Sanvello is also a tool available to keep your daily mood in check, therapists, support centers, coping tools, and guided journeys. 

Bottom line

The above-mentioned tips can be used to design and choose a perfect health plan for you and your family. There are several counselors to guide you to make the right choice. Also, every company has customer service that is always available, and also apps are also available for these purposes. 

Hopefully, these tips will help you make the best decision for you and your family in regards to health care. Follow these tips to maximize your health benefits. Maximizing the health benefits is essential for yourself and your family‘s longterm security. It will help you stay secures during the hard times and gives you the protection that you want to avoid unwanted circumstances. So plan well for your future and maximize your health insurance according to your requirements and budget.

ClaimLinx helps auto dealer save money

It doesn’t matter what type of business it is. ClaimLinx can help owners and their employees save on health insurance.

The New Hampshire Auto Dealers Association found out just that when some of its members started working with ClaimLinx. On average, businesses that use ClaimLinx’s Solution save between 20 to 40 percent on their health plan within the first year.

ClaimLinx focuses on savings

Tom Quigley, Co-Owner of Claimlinx, said all it takes for business owners to start saving is a willingness to look at their health insurance differently. His company’s Solution combines traditional group insurance with a self-funded plan. That way employers can save money while providing great benefits.

“We have developed a solution on health insurance,” he said. “The main focus of our business is showing business owners how to use tax laws to greatly reduce the cost of health insurance for both the employer and the employees.”

A real example of savings for a small business

AutoServ Dealerships in Tilton, NH are members of the New Hampshire Auto Dealers Association who became clients of ClaimLinx two years ago. In the first year, they saved almost $100,000 on their health insurance. What’s more is they were able to pass that savings onto their employees as well. Their workers saved about 5 percent year over year while keeping deductibles lower than with the group’s previous plan.

Donna Gaudet Hosmer, General Counsel at AutoServ, said they turned to ClaimLinx because they needed a better option for health insurance at their company.

“The reason we chose ClaimLinx was primarily cost,” she said. “We needed an affordable option that reached a diverse array of employee needs in terms of benefits and affordability.”

How to start saving on health insurance

ClaimLinx works with businesses of all sizes. Qualified consultants are always available to start a consultation. They start by identifying each clients needs and balancing them with the costs of the health plan.

By taking the health plan out of the hands of traditional insurance companies, there is an amazing opportunity for savings while still providing great benefits. That means low deductibles and copays at a low cost to the employer.

Tom Quigley said for most companies this all comes down to setting up a plan that balances risk with savings.

“Really what the ClaimLinx solution boils down to is a math problem,” he said. “It’s really is as simple as putting a couple of keystrokes on your calculator. And to literally figure out the risk and the savings. What most people find is that the savings generated is greater than the actual risk associated. Meaning that every single person could go into the hospital or hit their deductible and the company still saves. That’s happening about 90-95 percent of the time.”

ClaimLinx focuses on education

This new way of buying health insurance isn’t just about the plan, though. It’s about educating employees on the best way to use the plan to get affordable healthcare. ClaimLinx turns its members into educated consumers so they no longer feel lost while navigating the health insurance industry.

Donna Gaudet Hosmer said the Solution was “definitely a departure from traditional insurance” but the people at ClaimLinx were there to help with educating members and providers on the new system. She said these resources were invaluable to members at the company. They were able to save money and still get the most out of the plan.

“The cost benefit far outweighs the learning curve to understand how to use it properly and maximize it,” she said. “So it’s been a huge win for us and I would highly recommend other dealers take a look at this.”

Contact ClaimLinx today to schedule a consultation.

Risk pools and small business medical insurance

Risk Pools and Small Business Medical Insurance

Small Business Insurance

Whilst starting a small business, there are many risk pools for which the insurance company offers various solutions. The primary focus of medical insurance is to achieve what is best for clients and to satisfy their clients, they offer them multiple options.

Health insurance policies are costly. Many investors do not invest in health insurance because it is challenging. There are risk pools and selection can be difficult when it comes to choosing a health insurance policy. We must choose which policy and company would be best for our interests and matches our requirements perfectly.


Risk pools

It is a group of persons whose medical expenditure would be pooled in order to analyze their premium. We must encounter risk pools in insurance. There are premium policies. One may balance between what is relative of low charge. A person with a complicated medical situation would prefer to select a scheme or policy which will serve him best i.e. higher premium policy. On another hand, a person who is healthier less likely to catch any disease will go for options that will serve him best i.e. a low premium policy.

The structure of health insurance policies was structured on less risk pooling in order for a more efficient and rational health facility scheme. In a system that includes less or little risk pooling, the citizens are accountable for costs. If money is not revolved between people then there would be less reasonable care in treatments due to low money. Thus, if there is totally no risk pooling then society would be burdened

There is a health risk after the retirement of people. The expenses that are revolving are limited. Thus if all the savings or the funds you had provided in past are consumed then there’s calamitous healthcare; limited resources.


Understanding Adverse Selection

The attraction of a disproportionate share of unhealthy people towards an insurer is known as adverse selection according to the American Academy of Actuaries. This problem arises due to the reason that the people with higher health care needs, when given the chance, are likely to purchase health insurance and to purchase health insurance with richer benefits than individuals with fewer health care needs. It creates problems for both insurance companies and insurance takers.

This causes a hike in premiums and not only this, due to this reason more healthy individuals opt for the coverage and cause an additional hike in the premiums. These changes in the premiums are usually referred to as a “premium spiral” in the industry.

To counter the effect of adverse selection risk pools are set up and to attract a broader range of healthy individuals. Not only this, but it also allows to equally divide the cost of sick or less healthy people. This is achieved by giving insurances to younger adults and healthy people from all age groups. It keeps the premiums at affordable prices for all members of the risk pool.


Small business:

Is it necessary to give employees of the USA their health insurance? Well, it depends there is a risk of offering a health insurance policy to workers. They can go for a new job for better remuneration. The immigrants go for private insurance if their boss doesn’t provide in contact.

Insurance for small businesses as a whole is very important. Small businesses are important and must be secured and insured. There are plans which cover the insurance of the company or small business you have started; to whatever level you want to achieve.

Insurers must opt for a single risk pool when they are going for premiums. It can be said, that the insurers should pool all their entity’s marketplace enrollees altogether when they are opting for the cost of their artifact. In other words, the cost of sick enrollees would be spread entirely enrollees i.e. the people who have signed up for the policy.


Small Business Options

The Department of Labor (DOL) increased the range to less expensive insurance plans for small business and their workers through Association Health Plans (AHP) as a result of Executive orders of President Trump “Promoting Healthcare Choice and Competition Across the United States.” on 19th June 2018.

This executive order allows small businesses and people who are self-employed to get together by the region or the industry they work for and get the insurance policy as one employer.

AHP’s improve the negotiating power with insurance companies by leveraging larger risk pools and greater economies of scale.

Despite the fact that becoming a part of large risk pool results in price reduction due to the size of the risk pool, there are various reasons these plans tend to be a lot cheaper.

Due to the fact that AHPs do not lie under the rules of the Affordable Care Act (ACA), they are not liable to provide 10 compulsory benefits provided by AHP.

SHOP, The small business health options program. Is a program for an employer that provides a marketplace to buy bulk health insurance in case they get on the merits of small business tax credits. It is necessary to have fewer than 25 full-time employees and pay under $50,000 average incomes per year and are able to pay 50 percent of employees premiums at the least.

More requirements include, at least 70% of eligible employees get the health plan except when they are an eligible waiver by getting insurance through their life partner or employer-based coverage.








Health Insurance USA

Health Insurance USA for Foreigners

Leaving your homeland to live abroad is quite a difficult thing to do. Residing in the USA especially as a foreigner is challenging. It can be a huge difference in the environment and lifestyle. This transition is not very easy to adjust to. One thing you need is to secure yourself heath wise in a stranger country as well in other countries you may travel to. We aim to provide you with a complete guide for when you travel to the United States. We have given top health insurance USA for foreigners with reasonable premiums and options.


Foreigner Health Insurance Plans in the USA

Foreigners in the United States can choose from two recommended choices. Cigna Global provides services worldwide with multiple options and services. It has adjustable plans that fit your budget and needs simultaneously. People with any price range can contact them and request and quote. GeoBlue Xplorer is also a versatile insurer with the same quality of service and benefits as Cigna. GeoBlue Xplorer works in collaboration with Blue Cross and Blue Shield of America and provides you best medical staff and hospitals of Blue Cross and Blue Shield of America.


Medical Coverage for Expatriates in the USA

Before moving to America, you need to know that you don’t need to get health insurance as a foreigner or even as a citizen. But if you don’t get insurance, you will not be able to afford medical expenses and medical care. Some visa types make health insurance for foreigners compulsory.

The health care expenses in America are higher than in other countries. This is due to high medical inflation and the doctors demand repeated tests and scans for confirmation. Due to this, it not only increases the cost but also makes the service quality better.

Private hospitals and clinics offer health care at a minimum cost. But this service is only provided if you have healthcare insurance. Employees are facilitated by employers in respect of insurance policies for them and their families. Medicare provides an insurance program for retired employees. But unfortunately, Medicare does not offer these plans for immigrants and foreigners. So instead of local insurance plans, they are forced to pay for international services.

The USA demands the immigrants and foreigners to make arrangements for their healthcare i.e employer-based or approved insurer within a month of arrival unless they are capable of affording regular medical costs in America.


How Much Does Health Insurance Cost in the USA?

You may think of the average insurance cost in the United States. But these are not fixed plans and the cost of such plans depends upon your region, age, history of illnesses and severity of the medical condition, etc. You need to narrow down the plan that covers all your need because spending on medical care is very costly and you can’t even afford to miss it because it is impossible to survive without it on your own. The scans, tests, and medication are often too expensive to be afforded by a layman.


Cost of Health Insurance for Non-US citizens in the USA

Here are some of the international insurers that provide services in various regions and are suitable for immigrants and foreigners in America. The costs can be adjusted by using by adding or removing options and benefits accordingly.

Cigna offers global service with affordable platinum and more affordable silver plan for foreigners. You may need some guidance from an agent about the plans and what best suits your needs. The total payable cost is figured out after $750 base deductibles amount and $1000 for other deductibles like dental, vision, and other evacuation modules. The cost can be varied by certain factors. You can always request a custom quote and estimate your pricing.

The Affordable Care Act, widely known as Obamacare or the ACA includes a provision for shared responsibility. This act ensures that US citizens and residents have access to quality health care. Whereas immigrants and foreigners on any type of visa are not legally bound to obtain health care insurance in the first five years of their stay in America. While J visa candidates are not bound for this service for two years after their arrival.

Some individuals who are foreign nationals but have become a resident are exempted from federal income tax list. These individuals are:

  • Nonresident aliens;
  • Individuals who file a Form 1040NR or Form 1040NR-EZ (including a dual-status tax return for their last year of U.S. residency);
  • dual-status aliens in their first year of U.S. residency;
  • Individuals who are claimed as a personal exemption on Form 1040NR or Form 1040NR-EZ.
  • Nonresident aliens or dual-status aliens who elect to file a joint return with a U.S. spouse;

Besides this, all U.S citizens residing in the US and all foreign nationals who are qualified as resident aliens are under the individual shared responsibility provision. Non-resident aliens need to meet certain requirements to be elected and become resident aliens.


Determining the International Health Coverage Amount Needed

You can estimate the expenses of health care insurance by the duration of your stay and your affordable range if you are not provided services. The longer your stay is, the more is the cost of the insurance policy. If you have to return soon and want to avail of the services of your homeland only, you can opt for a minimum cost coverage plan. But if you have to stay longer for a job or studies, go for a high-cost premium plan to avoid any issues in your stay.


Most Popular Health Insurance for Non-US citizens in the USA

  • The Cigna Global Medical plan is suitable if you have a limited budget and want to get services and multiple options at a minimum price.
  • The GeoBlue Xplorer plan administers services under BlueCross and gives you access to a wide network of doctors. Their services are not only excellent but they also maintain their standard throughout the period.
  • An affordable plan that we recommend to younger clients is The IMG Global Medical It helps to have a plan that is on their budget. You can only get limited benefits and emergency care by adopting Silver and Bronze programs. You can cover more benefits and options with Gold and Platinum plans.