Medicare Advantage

 

Medicare Advantage Plans are private health insurance plans that are approved and regulated by Medicare. These plans are designed to provide the same benefits as Original Medicare (Part A and Part B) but are offered through private insurance companies.

Here are some key points about Medicare Advantage Plans:

  • Names and Variants: These plans are also known as Medicare Health Plans, Medicare Part C Plans, and MAs/MA-PDs. Previously, they were called Medicare+Choice plans.
  • Coverage: A Medicare Advantage Plan combines both Medicare Hospitalization (Part A) and Medical insurance (Part B) into a single health plan. It covers all the medically necessary services provided by Original Medicare.
  • Regulation: Medicare sets the rules for these plans and oversees the private companies that offer them to ensure compliance and quality of service.

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What are the types of Medicare Advantage Plans?

Medicare Advantage Plans come in several primary types, each with its own features and network structures. Most of these plans may also offer prescription drug coverage:

  • Health Maintenance Organization (HMO): This type of plan provides access to a network of doctors and hospitals that coordinate your care, with a focus on preventive services. You generally need to use the network for most care and obtain a referral from your primary care doctor to see specialists.

  • Health Maintenance Organization with a Point of Service Option (HMO POS): Similar to the HMO, but with added flexibility. You can seek care outside of the HMO network in certain situations or for specific treatments, though it may cost more.

  • Preferred Provider Organization (PPO): Offers access to a network of doctors and hospitals. You have the option to receive care from providers outside the network, although it typically involves higher out-of-pocket costs compared to using in-network providers.

  • Private Fee-For-Service (PFFS): This plan allows you to visit any Medicare-approved doctor or hospital that agrees to the plan’s payment terms. You are not required to use a specific network of providers.

  • Medicare Special Needs Plans (SNPs): Designed for beneficiaries with specific health conditions or needs, such as chronic diseases like diabetes. These plans offer specialized coverage tailored to the particular needs of the enrollees.

  • Medicare Medical Savings Account (MSA): Combines a high-deductible health plan with a bank account. The plan deposits a set amount into your account each year to help cover medical expenses, with the deductible typically being higher than other types of plans.

Each plan type offers different benefits and flexibility, so it’s important to review your options and select the one that best meets your health care needs and preferences.

How does a person choose a Medicare Advantage Plan?

When evaluating whether to switch to a Medicare Advantage Plan, it’s crucial to thoroughly compare it with your current coverage. Here are key factors to consider:

  1. Doctor Network: Check if your current doctors are part of the plan’s network. If not, determine if you’re willing to change doctors or if there are other options available.

  2. Prescription Drug Coverage: If the plan includes drug coverage, verify that your medications are listed on the plan’s formulary. This ensures that your prescriptions will be covered at a reasonable cost.

  3. Monthly Premium: Compare the plan’s monthly premium to what you currently pay. This can significantly impact your overall expenses.

  4. Coverage Costs: Review the plan’s Summary of Benefits to understand co-payments, co-insurance, and other costs associated with coverage. Be aware of how these costs compare to your current plan.

  5. Additional Services: Look into additional benefits offered, such as preventive care, vision, dental coverage, and health club memberships. These extras can add value to your plan.

  6. Coverage Gaps: Identify any treatments or services you need that might not be covered by the plan. Ensure that the plan meets all your healthcare needs.

  7. Network Restrictions: Consider how the plan’s network restrictions might affect you, particularly if you need to see out-of-network providers and are willing to pay extra for it.

For more personalized advice and to explore the best options available for you and your clients, feel free to give us a call. We can help you navigate through various products and carriers to find the right fit.

Medicare Advantage Carriers

Frequently Asked Questions

What is Medicare and who can get it?

Medicare is primarily used by individuals aged 65 and older, though some younger people may also qualify, including those with disabilities, permanent kidney failure, or amyotrophic lateral sclerosis (Lou Gehrig’s disease). While Medicare helps cover various healthcare costs, it does not fully cover all medical expenses or most long-term care costs.

Yes, you can adjust your Medicare coverage during specific enrollment periods, including the Annual Enrollment Period (AEP) and the Medicare Advantage Open Enrollment Period (MA OEP). Outside of these times, you may qualify for a Special Enrollment Period (SEP) if you experience certain life events, such as moving, losing other coverage, or becoming eligible for Medicaid.

 

Medicare is divided into four parts:

  • Part A: Hospital Insurance
  • Part B: Medical Insurance
  • Part C: Medicare Advantage Plans
  • Part D: Prescription Drug Coverage

For more information about Medicare, you can visit the official website at www.medicare.gov, contact the Medicare hotline at 1-800-MEDICARE (1-800-633-4227).

We’re here to help you explore the options that best fit your needs. Contact us today for a free consultation, and let us guide you through your choices. Call us at 417-218-0088 or click “Call Now” below to get started!