Medicare Advantage Benefits, Coverage, and Plan information

 Medicare Advantage    

Download the Medicare Advantage Guide (Part C) and Prescription Drug Plans (Part D) to find coverage options from your local Blue Cross Blue Shield company. If you are a private Medicare fee-for-service plan holder, you can get Medicare prescription drug coverage from that plan (if provided), or if drug coverage is not provided, you can join a separate Medicare prescription drug plan to increase prescription drug coverage. According to the plan. Under traditional state health insurance, Part D drug coverage and Medigap may need to be purchased separately. There's also Medigap, a private health insurance plan that helps bridge "gaps" in traditional health insurance coverage, such as copays, coinsurance, and deductibles. [Sources: 3, 4, 9]     

You can add a drug plan (Part D) or buy a Medigap policy to pay for costs that Original Medicare does not cover. Remember that people with Original Medicare who want Part D coverage also subscribe to a separate Part D plan. These plans are offered by private insurance companies that contract with Medicare to provide Part A and B benefits, and sometimes Part D (requirements). MA plans combine Medicare Parts A and B, Part B, and often Part D into one plan so that the entire benefit package is provided by the private insurance company. [Sources: 0, 1, 3, 6]     

A Medicare Advantage plan combines Medicare Part A (hospital insurance), Medicare Part B (health insurance), and usually Medicare Part D (prescription drug coverage) into one plan. Medicare Advantage (sometimes called Medicare Part C or MA) is a type of health plan in the United States that provides Medicare benefits through a private sector insurance company. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow Medicare rules. Public health plans Part C, including Medicare Advantage plans, not only cover the same health care services as Original Medicare Parts A and B, but also typically include an annual physical exam and some kind of eye coverage and/or teeth, none of which are covered by Medicare Parts A and B. [Sources: 1, 7, 8]     

These plans cover all Medicare services, and some offer additional coverage for vision, hearing, and teeth. Most plans have network doctors and pharmacies that can offer discounts to plan members. [Sources: 1, 5]     

If you go to see a doctor, hospital, or other provider (independent or non-preferred) that is not part of the plan, you will usually pay more. HMO plans generally only pay for doctors and providers in the plan's network. If you use doctors and network-managed care providers, you will generally pay less out-of-pocket for your care. [Sources: 5, 9]     

Private Fee-for-Service (PFFS) Plans PFFS may or may not have a network of doctors/providers, but they cover any doctor or provider who accepts Original Medicare. Medicare Part B (health insurance) helps pay for doctors and other health care providers, outpatient care, home care, durable medical equipment, and some preventive services. Special Needs Plans (SNPs) Special Needs Plans offer benefits that cover special medical or financial needs. [Sources: 5, 6] 


The MA plan must provide members of this plan with coverage for all services covered by Medicare Parts A and B, as well as additional benefits beyond those covered by Medicare. To enroll in a plan, you must live in an area covered by the plan, and plan coverage and costs may vary by plan and location. Enrollment in plans is subject to renewal of the plan's contract with Medicare. If you have health insurance from your union or employer (current or former), when you become eligible for Medicare, you may automatically enroll in their sponsored MA plan. [Sources: 0, 2, 3, 5] 


Like other traditional Medicare plans, employer and union plans typically offer additional benefits and/or lower cost-sharing than traditional Medicare and are eligible for bonuses. Employers or unions (and sometimes pensioners) may also pay extra for these extra benefits. [Sources: 10] 


For each person who chooses to enroll in a Medicare Advantage Part C plan or another Part C plan, Medicare pays the plan sponsor a fixed amount (“per capita”) each month. Medicare gives the plan a certain amount each year to pay for your health care, and the plan puts some of that money into a bank account. [Sources: 7, 9] 


You can go to any Medicare-approved doctor or hospital that accepts your plan's payment terms. If you want prescription drug coverage and choose a Medicare Advantage HMO or PPO plan, it's important to choose a plan that includes prescription drug coverage (most do) because that's not possible. ) if you have an HMO or PPO Advantage plan. MSA does not include prescription coverage, but you can purchase a Part D plan in addition to your MSA plan. [Sources: 9, 11] 


Please note that under Original Medicare and Medigap you will still need Part D prescription drug coverage and if you do not buy it when you first become eligible and you are not covered by the drug plan through your work or spouse, you will be charged a lifetime penalty if you try to purchase it later. Original Medicare offers much greater access to health care providers nationwide, and when combined with a Medigap plan, Original Medicare can also offer lower out-of-pocket costs than Medicare Advantage plans (albeit with potentially higher total monthly premiums). If a person is unable to enroll in a Medigap plan, the 20% unlimited co-insurance for Medicare Part B can result in out-of-pocket expenses if extensive and ongoing medical care is needed. [Sources: 1, 11] 


In addition, the Medicare Advantage special open enrollment period runs from January through March of each year, during which more than 20,000,000 people with Medicare Advantage services (but not other Part C members) can change or end their plans. This period begins three months immediately before a newly eligible AIC becomes first eligible for both parts of Medicare, Parts A and B, and Part B, and ends at the end of the last day of the month preceding both Part A and Part B eligibility. A. or, on the last day for Part B individuals, the first enrollment period. [Sources: 3, 7] 





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