What is Medicare Advantage?

Information You Need If You’re Eligible for Medicaid

A lot of people have been asking, “What is Medicare Advantage?

Medicare Advantage Plans (Medicare Part C) are optional Medicare plans offered by Medicare-approved private companies and available to people already enrolled in Medicare Part A (hospital) and Medicare Part B (medical). If you enroll in a Medicare Advantage Plan, your plan will provide all of your Medicare Part A and Part B coverage. Medicare Advantage plans can provide also additional coverage in other areas of health including dental, vision, and hearing. Most Medicare Advantage plans also include prescription drug coverage.

Medicare will pay a fixed amount for your care every month to the company offering your Medicare Advantage Plan. Although every company offering Medicare Advantage Plans has to follow rules set by Medicare, companies retain a lot of flexibility when it comes to setting out-of-pocket costs and requirements concerning which doctors or facilities you can use and when. In these areas companies can set their own rules, and the rules can change from year to year.

If you’re looking for a Medicare Advantage Plan:

You need to be enrolled in both Medicare Part A and Medicare Part B. If you are, you can sign up for Medicare Advantage during your Medicare Initial Enrollment Period. You can also join a Medicare Advantage Plan, or make changes to an existing plan, during an annual Open Enrollment Period or during any Special Enrollment Period you may qualify for.

Although many people decide not to keep Part B coverage after enrolling in Medicare, you must not drop your Part B coverage if you want to enroll in a Medicare Advantage Plan.

Dropping Part B coverage will make you ineligible for enrollment in a Medicare Advantage plan.

What kind of plans are available through Medicare Advantage?

Medicare Private Fee-for-Service (PFFS) Plans

Which generally allow you to visit any doctor or hospital Original Medicare would allow you to visit, as long as the doctor or hospital agrees to treat you.

Health Maintenance Organization (HMO) Plans

Which normally require referrals from primary care physicians and treatment by specialists and hospitals within the plan’s network.

HMO Point of Service (HMOPOS) Plans

Which are HMO plans that may allow you to get some services out-of-network for a higher cost.

Medicare Preferred Provider Organization (PPO) Plans

Which allow you to use doctors, hospitals, and providers outside the plan’s network at additional cost.

Medicare Medical Savings Account (MSA) Plans,

Which deposit Medicare funds into an account used for paying your health care costs.

Medicare Special Needs Plans (SNPs)

Which provide focused, specialized health care for specific groups of people including beneficiaries of both Medicare and Medicaid, those in nursing homes, and those with certain chronic conditions.

You will normally pay a monthly premium for enrollment in a Medicare Advantage Plan. This is in addition to your Medicare Part B premium, although some Medicare Advantage Plans pay for all or part of your Part B premium.

All Medicare Advantage Plans cover emergency and urgent care, and all Medicare Advantage Plans are required to cover all services Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan.

Not all Medicare Advantage Plans work the same way, and Medicare Advantage costs can vary widely, so it’s important to investigate all the plans available in your area before making a choice. To learn what plans are available in your area, click here.

If you’d like to know more about how to join Medicare Advantage, contact MedicareMall now and one of our licensed, bonded representatives will be glad to give you the information you need and help you determine which Medicare Advantage Plan is right for you.

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