What is Medicare Advantage?
Medicare Advantage is Insurance offered by Medicare approved private companies to provide all the benefits of Part A and Part B plus additional benefits that Medicare does not cover. Many Medicare Advantage plans cover prescription drugs within their plans.
- Medicare Advantage plans are contracted through the centers for Medicare and Medicaid Services (CMS).
- Medicare Advantage plans are NOT Medicare Supplement Plans.
- Medicare Supplements are additional insurance products that can be purchased to work with Original Medicare.
- Still part of Medicare.
- Receive the same services, supplies, and benefits offered under Original Medicare.
- Private companies will pay for your healthcare services– not Medicare.
Are you eligible for Medicare Advantage?
You are eligible for Medicare Advantage if:
- You are entitled to Part A
- You are enrolled in Part B (premium may be required)
- You are a US Citizen or Lawful Resident
- You are a permanent resident of the plan’s service area
- You do not have End-Stage Renal Disease (ESRD)
How Does An HMO Plan Work?
- You choose a Primary Care Physician who will help navigate your healthcare needs.
- You choose network providers and facilities to receive your healthcaare services.
- Our network arrangements allow us to create savings that we share with you.
- If you need emergency or urgent services, go to the emergency room closest to you!
- You may need a referral to see specialists and receive certain services.
- Lower out-of-pocket costs
- You have the ability to select a different Primary Care Physician as needed.
How Does A PPO Plan Work?
- You have a network of doctors, specialist and facilities contracted with the plan to provide services.
- You can see providers out-of-network. Reminder– providers that do not contract with us are not obligated to treat you, except in emergency situations. Cost- sharing will be lower at in-network providers.
- You should expect to pay more if you choose to use out-of-network providers.
- Referrals are not necessary, but some Specialists require a doctor to doctor referral or the services may require plan authorization prior to receiving the service.
- Your Primary Care Physician will continue to help coordinate healthcare services.
- PPO plans may not impose prior authorization requirements for Out-of-Network services but member or provider can request an advance determination of coverage.
What to Expect When Joining a Medicare Advantage Plan
- You will continue to pay your Part B Premium.
- Your current plan may be affected if you join a Medicare Advantage plan.
- You will use your plan’s member ID card instead of your Medicare card.
- Medicare Supplement (Medigap policy) and Medicare Advantage Plans (Part C) are not the same thing.
- Using network providers will help keep your costs lower.
- Medicare Advantage plans offer a Maximum Out-Of-Pocket amount.
- If you enroll in Part D late, you may have to pay a penalty.
- A Medicare Advantage plan offers additional benefits in addition to what Original Medicare covers.
- If receiving assistance from a sales agent, broker, or other individual employed by or contracted with a Medicare Advantage plan, he/she may be paid a commission based on your enrollment in the plan.