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What is a Medicare Advantage Plan?
Medicare Advantage Plans (also known as Advantage Medicare) are health care options (like a HMO or PPO) for the Medicare program. These are programs that are approved by Medicare and run by private companies. They are sometimes referred to asMedicare Part C. With these options, you generally get all your Medicare-covered health care through one plan. They provide all your Part A and Part B-covered services. Generally, these plans offer extra benefits, and many include Medicare Part D (drug coverage). If you are enrolled in a Medicare Advantage Plan, your Medicare services are covered through this one plan, and are not paid for under Original Medicare.
Medicare Advantage Plan options may include:
How do I qualify for a Medicare Advantage Plan?
- Medicare Health Maintenance Organization (HMO) - An HMO plan must cover all Medicare Part A and Part B health care. Some HMOs also cover additional benefits, like additional days in the hospital. In most HMOs, you can only go to doctors, specialists, or hospitals on the plan's list, except in the case of an emergency. Your costs may be lower than in the Original Medicare Plan.
- Preferred Provider Organizations (PPO) - With this type of Medicare Advantage Plan, you use doctors, hospitals, and providers that belong to your designated PPO network. You may use doctors, hospitals, and providers outside of the network, but there will be an additional cost.
- Private Fee-for-Service Plans - In this type of plan, you can go to any Medicare-approved doctor or hospital that accepts the plan's payment. The insurance plan decides how much it will pay and what you pay for the services. You may pay more or less for Medicare-covered benefits. You may also have more benefits than the Original Medicare Plan.
- Medicare Medical Savings Account (MSA) Plans - A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. For more information about MSAs, visit http://go.usa.gov/irD to view the booklet, “Your Guide to Medicare Medical Savings Account Plans.”
- Medicare Special Needs Plans - This plan generally limits membership to people with specific diseases or conditions. They tailor their benefits, choose their providers, and create their list of covered drugs to best meet the specific needs of the groups they serve. Most Medicare Special Needs Plans are designed to serve people who have specific diseases or conditions, such asdiabetes, congestive heart failure, or HIV/AIDS. They always include Part D prescription drug coverage.
You can generally qualify for a Medicare Advantage Plan if you meet these conditions:
- You live in the service area of the plan you want to join. Contact the plans you're interested in to find out about their service area.
- You have Medicare Part A and Part B coverage.
- You do not have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
Choose your plan carefully; for the most part you will only be able to change plans once a year. In certain situations, you may be able to switch plans at other times.
How do I join a Medicare Advantage Plan?
Once you choose a Medicare Advantage Plan, you may be able to join by completing a paper application, calling the plan, enrolling online directly with the carrier, or you can Click Here to view options through Joppel.
When you join a Medicare Advantage Plan, you will have to provide your Medicare number from your Medicare card and the date your Medicare Part A and/or Part B coverage started.
What will a Medicare Advantage Plan cost?
The costs of a Medicare Advantage Plan depend on a number of factors. Here are some questions to consider when purchasing a Medicare Advantage Plan:
- Does the plan charge a monthly premium in addition to your Part B premium?
- Does the plan pay any of the Part B premiums?
- Does the plan have a yearly deductible?
- Does it charge any deductibles for any of the services?
- How much will you pay for each service or visit (copayments)?
- What type of health services do you need? How often?
- Will you be using network providers or out-of-network providers?
- Are there any additional benefits in the plan? Do you need them? What do these benefits cost?
Since private companies run the Medicare Advantage Plans, costs will vary. It's important to call any plan before joining to find out the rules, your costs, and to make sure the plan meets your needs. In some plans, if you see a provider who doesn't participate with the plan, your services may not be covered at all, or your costs will likely be higher.