MEDICARE ADVANTAGE OR PART C PLANS EXPLAINED
WHAT IS MEDICARE ADVANTAGE?
Medicare advantage is also referred to as Medicare Part C. In a nutshell, it gives you as a Medicare beneficiary, the opportunity to enroll in private health plans to receive your Medicare covered benefits, help lower your costs and of course other added benefits like dental, vision or preventive care services.
Traditional Medicare (A and B) pays for many healthcare services and supplies but doesn’t cover all your extra costs like Co-pays and deductibles. Medicare Advantage on the other hand gives you Medicare-approved health plan options (Offered through Private Insurance Companies like Fulmer Insurance) that cover the gaps of traditional Medicare by lowering such costs.
How Does Medicare Advantage Work?
When you join a Medicare Advantage Plan, you get your entire Medicare-covered healthcare through the private health plan with the use of the health insurance card that you get from that plan! Most Medicare Advantage Plans are managed care plans, i.e usually by a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see approved doctors that belong to the plan or go to certain hospitals to get the services. You still have your Medicare Membership!
To join a Medicare Advantage Plan, you must have an active Medicare Part A and Part B membership.
Why do you need Plans A and B to join Plan C?
The truth is that Medicare Advantage plans do not help with the cost of:
Hospice care
Original Medicare Part A pays for hospice care even when you get your benefits through a private Medicare Advantage plan. The Advantage plan continues to cover health care services not related to the hospice care.
Some Prescription Drugs
Some prescription drugs that might be covered under a standalone Medicare prescription drug plan. Each plan has a formulary that lists the drugs it covers.
While you still have to pay your monthly Medicare Part B premium to Medicare, it’s important to point out that you choose to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. This can only be authorized by you!
Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
In most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan’s list except in an emergency. You may also need to get a referral from your primary care doctor.
Preferred Provider Organizations (PPO) Plans
A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.
Medicare Special Needs Plans
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Medicare Private Fee-for-Service Plans
A Medicare PFFS Plan is a type of Automated Medicare Advantage Plan (Part C) offered by a private insurance company. Unlike Original Medicare, this plan determines how much it will pay doctors, health care providers, and hospitals, and how much you must pay when you get your desired care.
It is important to point out that if you choose a Medicare Advantage Plan, your Medigap policy won’t work. You will therefore receive no benefits from this plan such as deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, it is advisable to drop your Medigap policy if you join a Medicare Advantage Plan. However, you do have a legal right to keep the Medigap policy, if you choose to do so.
Are you enrolled in Medicare Advantage or just starting to think about signing up? You may be interested for yourself or you may be a caregiver. Whatever your situation, we’re here to help you understand Medicare Advantage and your choices. Get in touch with us!