Medicare

Medicare Advantage Plan

 Did you know clients enrolled in a Medicare Advantage plan report better care and higher levels of satisfaction? More than one-third or 17 million Americans are currently enrolled in a Medicare Advantage plan. Seniors Medicare Advantage plans cover more than original Medicare Parts A & B for comprehensive coverage. MA plans also provide values services like care coordination programs, nurse hotlines, and prescription drug management. Medicare Advantage plans seek to be a 360 health management team to the beneficiaries.

Medicare Advantage Plans

What is Medicare Advantage (Part C)? A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

Medicare Advantage Plans cover all Medicare services

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care and some care in qualifying clinical research studies. Original Medicare covers hospice care and some costs for clinical research studies even if you’re in a Medicare Advantage Plan.

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you may pay a monthly premium for the Medicare Advantage Plan.

Medicare Advantage Plans must follow Medicare’s rules. Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out‑of‑pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year.

You usually get prescription drug coverage (Part D) through the Medicare Advantage Plan. In some types of plans that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan. If your Medicare Advantage Plan includes prescription drug coverage and you join a Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

What is a Medicare Supplement policy?

A “Medicare Supplement Insurance” policy (also called Medigap) is private health insurance that’s designed to supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like co payments, coinsurance, and deductibles). These are "gaps" in Medicare coverage. If you have Original Medicare and a Medicare Supplement policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medicare Supplement policy pays its share. A Medicare Supplement policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits. Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.

Every Medicare Supplement policy must follow federal and state laws designed to protect you, and the policy must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy, identified by letters A through N. Each standardized Medicare Supplement policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medicare Supplement policies with the same letter sold by different insurance companies.

 
Eva Montes is an independent expert insurance advisor who will put your needs first and provide multiple policy options to get you the best coverage for the best price. Call me today at 704.968.1515