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WHAT IS Medicare Advantage (MA)? MA
is a type of health insurance plan for individuals on Medicare. You must already have Medicare Part A (hospital insurance)
and Medicare Part B (medical insurance) in place to enroll in a MA plan. You must also be free of end-stage renal disease
(kidney failure). MA plans are approved by Medicare and offered by private insurance companies. Medicare pays
a monthly fixed amount to the private insurer to implement the plan. The MA plan then becomes your primary insurer, not Medicare.
MA plans are not Medigap or Medicare Supplement plans. MA plans are comprehensive in that they can cover all services (hospitals,
doctors, outpatient, and prescription drugs) depending upon the particular plan chosen. There are deductibles and co-pays.
The extent of the deductibles and co-pays varies with the plan. There are different types of MA plans such as a Health Maintenance Organization
(HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Medical Savings Account (MSA), and Special Needs
Plan (SNP). Some of these plans require that you choose a primary care doctor and that you get your health care from the plan’s
network of doctors and hospitals. Others do not have these stipulations.
Detailed descriptions of the various
types of MA plans can be found by obtaining a current Medicare Handbook at 1-800-Medicare (1-800-633-4227) or visiting www.medicare.gov. Like other health insurance plans, MA plans identify your rights and your right to appeal health plan decisions. For help in selecting the right MA plan for you Contact Us.
WHAT ARE SOME MA PLAN FEATURES? Medicare mandates that MA plan benefits must be equal to or better than traditional Medicare.
Consequently, in addition to varying degrees of hospital, medical, and prescription drug benefits, many MA plans, in order
to be competitive, offer extra coverage such as vision, hearing, dental, and/or health & wellness programs. Others have
value-added services like a Health Advice Line staffed by a registered nurse 24/7. Telephone counseling resources to help
with legal, financial, caregiving, or daily living challenges may also be provided.
It is important to consult
the plan’s Summary of Benefits for a given year. Read the plan materials before enrolling. It is wise to seek out a
knowledgeable, credible specialist who will work in your best interest to provide assistance with selection.
Once
you are enrolled, read all correspondence sent to you from the plan, especially any variations that might occur for subsequent
years. Be aware that plan details, including rules and regulations can, and often do, change from year to year. While not
all plans include prescription drug coverage, those that do, may have changes in their formularies (covered drugs) as well
as other benefit changes. For help in selecting the right MA plan for you
Contact Us.
WHAT DO MA PLANS COST?MA
plan premiums vary with the type of plan selected. A range can be anywhere from a “0” premium (without prescription
drug coverage) to $100+ per month. Generally, the premiums are significantly less than if an individual elects traditional
Medicare, a Medicare supplement, and an add-on prescription drug plan. Deductibles and co-pays contribute to out-of-pocket
costs.
If an individual has limited income and resources, help with paying various portions of the deductibles, co-payments,
and premiums may be available. You may call or visit your state’s medical assistance (Medicaid/welfare) office for details.
Contacting Medicare at 1-800-Medicare (1-800-633-4227) and saying “Medicaid” at the prompt, can get you the telephone
number for your state Medicaid office. For help selecting a quality health plan
at the best value Contact Us.
HOW DO I ENROLL IN A MA PLAN? Pre-requisites to enrolling in a MA plan are: * Enrollment in Medicare Part A (hospital insurance)
*
Enrollment in Medicare Part B (medical insurance)
* Free of end-stage renal disease (ESRD/kidney failure)
* Reside in the plan's service area You may initially join a
MA plan: - When you
first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65)
- If you get Medicare due to a
disability, you can join during the 3 months before to 3 months after your 25th month of disability.
The Annual Enrollment Period is between November 15-December
31 each year. Your coverage begins on January 1 of the following year. At this time you may join, switch, or drop a MA plan.
In most cases, you must stay enrolled for that calendar year starting the date your coverage begins. However, in certain situations,
you may be able to join, switch, or drop a MA plan at other times. These situations can include moving out of the plan's service
area, loosing group coverage, or becoming initially eligible for Medicare.
For more enrollment details and an application Contact Us.
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