Get more from Medicare without paying more

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Medicare Advantage plans are also referred to as Medicare Part C plans. These plans are offered by private insurance companies and allow you to access all the coverage & benefits Original Medicare provides, plus additional benefits and services all in a single plan.

Many Medicare Advantage plans include prescription

drug coverage (Part D), usually at no additional premium.

Some plans also include extra benefits such as:

• Routine vision, hearing, and dental care

• Health & Wellness programs

• 24/7 Nurse phone line

 

Pros

  • Additional benefits not covered by Original Medicare included at no additional costs

  • Protected by annual out-of-pocket maximums

  • You have your own, local, licensed agent to assist you with your Medicare healthcare services & needs

  • Prescription Drug Plan may be included in your plan

Cons

  • Some plans limited to a network of local hospitals & physicians

  • May need a referral to see a specialists

When can I enroll in a Medicare Advantage plan?

Before you can enroll in Medicare a Medicare Advantage plan...

  • You must sign up for Original Medicare Part A & Part B

  • Your Initial Enrollment Period, which is a seven-month time span that includes the 3 months before the month you turn 65, your birthday month, and the 3 months after your birthday

  • If you don't enroll during your initial enrollment period, you may have to wait to enroll during Medicare Open Enrollment, which is October 15 - December 7. If you enroll later, your premiums could be higher.

 

How do I enroll in a Medicare Advantage Plan

Once you have enrolled in Original Medicare (Parts A and B), you can enroll in a Medicare Advantage plan.

  • Each private insurance company that offers a Medicare Advantage plan manages its own enrollment

  • Medicare Advantage companies offer options to enroll over the phone, online, or through a licensed agent.

  • To learn about available Medicare Advantage plans in your area, contact a local, licensed agent, the company directly, or visit Medicare.gov

 

Do I need to enroll in Medicare Advantage every year?

Once you have enrolled in Original Medicare (Parts A and B), you can enroll in a Medicare Advantage plan.

  • Your Medicare Advantage plan renews automatically each year as long as you pay the premium and plan is still available in your service area

  • You do not have to do anything to continue your coverage, but make sure that the plan is meeting your healthcare needs

 

Glossary of Key Terms to Understand

 

Co-Insurance

  • The costs that  you and the health insurance plan pay are split on a percentage basis. For example, you might pay 20% of the total allowed cost of a service and the plan would pay the remaining 80%

 

Co-Pay

  • The fixed amount you pay at the time your receive a covered service. For example, you might pay $20 when you see the doctor or $12 when you buy a prescription.

Deductible

  • A set amount you pay out of pocket for covered services each year before your plan begins to pay

Out-of-pocket maximum

  • The maximum amount you pay during a policy period (1 year). This amount does not incllude your premium or the cost of any services that are not covered by your plan.

  • After you reach your out-of-pocket maxium, your plan pays 100% of the allowed amount of covered services fo rthe remainder of the policy period.

Premium

  • The fixed amount you pay your health insurance plan for Medicare coverage. You may pay your premium to Medicare, to a private insurance company, or both, depending on your coverage. Most premiums are charged monthly.

 

Your Share of Medicare Advantage Costs

With Medicare Advantage plans, the insurance company that offers the plan sets the monthly premium and decides on the cost-sharing amounts. Look at the details of each plan you are considering to what your share of the cost could be.

How does cost sharing work with Medicare Advantage plans?

  • Most Medicare Advantage plans use a combination of deductibles, co-insurance, and co-pays to share the costs of your care with you. Before you choose a plan, be sure it is a good fit for you and your budget.

Is there a limit to what I pay out-of-pocket?

  • Yes, limits on your cost sharing is another way that Medicare Advantage plans differ from Original Medicare (Part A and Part B). Many Medicare Advantage plans offer a benefit that caps your out-of-pocket spending for cost sharing expenses like co-pays and deductibles. This provides financial protection in case of a catastrophic or medical emergency.

Is there a deductible for prescription drug coverage?

  • Some Medicare Advantage plans have a deductible for prescription drug coverage, while others do not. Look at the specific plan for details.

 

Your Choice of Providers Depends on Your

Medicare Advantage Plan

Most Medicare Advantage plans have service areas, limiting your care to a geographic boundary. All Medicare Advantage plans offer nationwide coverage for  emergency room visits, urgent care, and renal dialysis.

With some Medicare Advantage plans you must choose your doctor from a network. The primary care provider (PCP) will manage  our care, including if you need to see a specialist or go the hospital. this is often called coordinated care.

Other, Fee-For-Service Medicare Advantage plans allow you to get care from any Medicare-eligible provider who accepts teh terms, conditions, and payments of the plan. These plans do not offer coordinated care.

COORDINATED CARE PLANS

  • Coordinated care plans use a network of doctors and hospitals working together to provide care. Each plan creates its own network. In most cases, you will pay most or all costs if you see a provider outside of the network.

Health Maintenance Organization (HMO) plans

  • HMO plans require you to seek care from providers in your network. Many require  you to get a referral from your primary care physician to see a specialist.

Preferred Provider Organization (PPO) plans

  • PPO plans usually don't require a referral to see a specialist and allow  you to see providers outside the network without having to pay the entire cost yourself.

Point of Service (POS)

  • A type of HMO plan that allows you to see doctors and hospitals outside the network for covered services, usually for a higher co-pay or co-insurance.

Special Needs Plans (SNPs)

  • SNPs are designed for people with a range of special needs, including those with chronic diseases, nursing home residents, an people who are eligible for both Medicare and Medicaid.

PLANS WITHOUT COORDINATED CARE

Private Fee-For-Service (PFFS)

  • PFFS plans allow enrollees to see any providers in the U.S. who accept Medicare's payment terms and conditions.

Medical Savings Account (MSA) Plans

  • MSA plans combine Medicare Advantage plan coverage with a special savings account you can use to pay for covered expenses tax-free.

 

How do I begin choosing a plan?

Reach out to a licensed agent in your area and let him/her know you are interested in choosing a Medicare Advantage plan. Ask any questions you may have and after meeting with the agent, determine you are comfortable with him/her.

Visit Medicare.gov

  • Review which plans are available in your area. You can also call the Medicare Helpline for more information about plans and policies in your area. Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-202248, 24 hours a day, 7 days a week.

Compare Costs

  • Review the premium amount (if any) you will pay each month. Then estimate your total cost sharing for services.

Look at the network

  • If the plan has a network of care providers, make sure you will have access to the doctors you want to see.

Decide if  you want prescription drug coverage.

  • Many Medicare Advantage plans include prescription drug coverage.

  • For help with questions about buying insurance, choosing a health plan, buying a stand-alone prescription drug plan or a Medicare Supplement insurance plan, and your rights and protection under Medicare, call your State Health Insurance Assistance Program (SHIP). Find your local resource at shiptacenter.org

 

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