Medicare Plans

Medicare Advantage (Part C)

Medicare Advantage, also known as Medicare Part C, is a type of health insurance plan offered by private insurance companies such as AARP, Humana, Wellcare, and Aetna. These plans provide an alternative to traditional Medicare and are designed to offer comprehensive healthcare coverage to beneficiaries. All Medicare Advantage plans cover all the services offered by Medicare Parts A and B and many times also provide additional benefits not given by original Medicare.

Additional Benefits:

1. Most Medicare Advantage plans offer additional benefits, such as dental, vision, hearing, and wellness programs, which are not covered by original Medicare.
2. Cost Savings: Medicare Advantage plans may have lower monthly premiums than Original Medicare and may also provide out-of-pocket cost savings.
3. Network Coverage: Medicare Advantage plans often have a network of providers, which may include doctors, hospitals, and specialists, which can help ensure continuity of care.
4. Care Coordination: Medicare Advantage plans may offer care coordination services to help ensure that all aspects of a patient’s care are being properly managed.
5. Prescription Drug Coverage (Part D): Most Medicare Advantage plans include prescription drug coverage, which can help reduce out-of-pocket costs for prescription medications.

Medicare Supplement

Medicare Supplement plans, also known as Medigap plans, are private health insurance policies designed to supplement Original Medicare coverage. These plans help fill the gaps in healthcare costs that are not covered by Medicare Part A and Part B, such as deductibles, copayments, and coinsurance.

Here are some key points to know about Medicare Supplement plans:

1. Coverage: Medicare Supplement plans are standardized and labeled with letters (e.g., Plan A, Plan B, etc.). Each plan offers a different set of benefits, although the coverage for each lettered plan is the same, regardless of the insurance company selling it. It’s essential to review and compare the available plans to choose the one that best suits your needs.
2. Compatibility: Medicare Supplement plans work alongside Original Medicare. This means you must be enrolled in Medicare Part A and Part B to be eligible for a Medicare Supplement plan. These plans do not cover prescription drugs, so you may want to consider enrolling in a separate Medicare Part D plan for prescription medication coverage.
3. Costs: While Medicare Supplement plans provide additional coverage, they come with a monthly premium. The cost of the plan may vary depending on factors such as your age, location, and the insurance company you choose. It’s important to compare prices and consider your budget when selecting a plan.
4. Guaranteed Issue Rights: There are specific periods, such as the six-month Medicare Supplement Open Enrollment Period, during which you have guaranteed issue rights. During these periods, insurance companies are generally not allowed to deny you coverage or charge higher premiums based on pre-existing conditions.
5. Portability: Medicare Supplement plans are portable, which means you can keep your coverage even if you move or travel within the United States. However, keep in mind that coverage benefits and costs may vary depending on your location.
6. Standardized Benefits: Although different insurance companies offer Medicare Supplement plans, the benefits within each lettered plan are standardized. For example, Plan F benefits will be the same regardless of the insurance company you choose. This makes it easier to compare plans based on price and customer service.

It’s important to note that Medicare Supplement plans are not the same as Medicare Advantage plans. Medicare Advantage plans are an alternative way to receive Medicare benefits through private insurance companies, while Medicare Supplement plans work alongside Original Medicare.

Before making a decision, it’s advisable to research and compare Medicare Supplement plans carefully. You can contact insurance companies, utilize online resources, or seek guidance from a licensed insurance agent to help you understand the available options and choose the plan that best meets your healthcare needs.

Stand Alone Prescription Drug Plans (Part D):

1. Part D provides access to prescription drugs at a lower cost than paying out of pocket.
2. Part D plans can offer cost savings through lower co-payments and deductibles.
3. Part D plans may also cover preventive care services, such as vaccinations and screenings, which can help prevent or manage health conditions.
4. Part D plans offer flexibility in choosing a plan that meets individual needs based on the medications taken.
5. Part D plans have an annual out-of-pocket maximum that limits the amount patients pay for covered medications.

Frequently Asked Questions

What is a Medicare Advantage Plan?
Medicare Advantage, also known as Medicare Part C, is not a separate benefit. Part C is a component of the Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs, HMO-POSs, and PPOs, PFFSs are known as Medicare Advantage Plans. You have the option to obtain your Medicare coverage through a Medicare Advantage Plan rather than through Original Medicare.

What are the 13 Things You Need to Know About Medicare Advantage?

1. You are still in the Medicare Program.

2. You still have Medicare rights and protections.

3. A Medicare Advantage Plan replaces your Part A and Part B coverage. It must be as “Good As” your Original Medicare and is often better, and usually offers more benefits than original Medicare.

4. You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year.

5. You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).

6. You can check with the plan before you get a service to find out if it’s covered and what your costs may be.

7. You must follow plan rules, like getting a referral to see a specialist to avoid higher costs if your plan requires it. The specialist you’re referred to must also be in the plan’s network. Check with the plan.

8. If you go to a doctor, other health care provider, facility, or supplier that doesn’t belong to the plan’s network, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.

9. Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.

10. If you join a clinical research study, some costs may be covered by your plan. Call your plan for more information. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name in the www.medicare.gov website..

11. Medicare Advantage Plans can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.

12. Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for all medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan.

13. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.

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