What is Medicare Advantage?
Another perplexing area for individuals who are about to qualify for Medicare is the set of programs called Medicare Advantage Plans.
Often times these programs are referred to as Part C.
Medicare Advantage plans are approved by Medicare and provided by contract through private insurers.
Household names like Aetna, Anthem Blue Cross, Blue Shield, HealthNet, Secure Horizons, Kaiser, and United HealthCare are some of the companies that provide these types of plans.
When enrolling in an Advantage program, the Medicare beneficiary is actually trading their Original Medicare coverage for these plans.
They must also continue to pay their Part B Medical premiums.
What do these plans cover? Advantage Plans must provide your Part A (hospital insurance) and Part B (medical insurance) benefits, including emergency and urgent care.
The only major benefit area not covered by Advantage Plans would be hospice.
Hospice is still covered by Original Medicare and must be obtained through a Medicare certified hospice facility.
Many Advantage Plans do offer additional benefits which would include things like dental, vision, hearing, gym memberships as well as other health and wellness programs.
Most advantage plans do include prescription drug coverage (sometimes referred as Medicare Part D).
Advantage Plans generally fall under the generic category of managed care plans.
Usually they are HMO (health maintenance organizations) or PPO (preferred provider organizations).
There is also a third type of plan called a Preferred Fee for Service program (PFFS).
HMO's do require that the member select a primary care physician from those participating in the plan.
That primary care physician is then charged with supervising your medical care which would include referrals to a specialist and admission to the hospital.
With an HMO, an individual can only use doctors, hospitals, and other facilities that are contracted with the HMO.
The PPO offers participants more choice.
They can elect to use providers of medical care that are contracted with the health plan or any physician or hospital.
Normally, PPO's have deductibles, coinsurance and copays to pay for covered Medicare eligible services.
Private Fee for Service plans may allow the plan member to use any doctor or Medicare approved hospital.
You are not required to choose a primary care physician or wait for referrals to specialists.
However, unlike Original Medicare, you may find that some doctors or hospitals may decline to treat you based on the reimbursement the PFFS plan is willing to provide for covered services.
What does an Advantage Plan Cost? Each month the Medicare Advantage program receives a fixed amount from CMS (Centers for Medicare& Medicaid Services) to provide your care.
The Advantage plan is then responsible for paying your doctors, hospital, lab facilities, and other providers of care.
Even though the plan does receive a payment to provide you with care, they are permitted to charge you a monthly premium and additional out of pocket expenses.
The out of pocket expenses can take the form of copays for doctor's office visits, coinsurance for days in the hospital, or an annual deductible for prescription drugs.
As mentioned previously, the member is still responsible for paying their monthly Part B premiums.
How and when can I join an Advantage plan? An individual can enroll in an Advantage plan if they have both Part A and Part B of Medicare and live in an where a plan is available.
Many plans only cover certain geographic regions in a state and you must live in that area to enroll.
You can join a plan when you first become eligible for Medicare.
The initial enrollment period for a newly eligible individual is the three months prior to the month you turn age 65 and the three months following your birthday month.
Thereafter, there is an annual open enrollment period where an individual may change plans.
Historically, the annual open enrollment period commences on November 15th of each year with enrollment closing on December 31st.
Coverage in the new plan would be effective January 1st.
2010 is bringing some changes to the annual open enrollment period.
It will commence a bit earlier and close prior to the Christmas holidays.
Special open enrollment periods are available to individuals who move out of the plans service area or should the plan cease to offer benefits in your geographic region.
Medicare Advantage Plans and Health Reform Advantage Plans have cost the federal government more than traditional Medicare.
As part of the HealthCare Reform package signed into law on March 23, 2010, the federal will start to reduce the subsidies for these plans beginning in 2012.
This will probably result in higher premiums being charged or a reduction in the benefits offered.
However, these plans will not be able to reduce the benefits that an individual would normally received through Medicare.
For more details on Medicare Advantage plans, visit Medicare's website or consult with your local insurance agent.
Often times these programs are referred to as Part C.
Medicare Advantage plans are approved by Medicare and provided by contract through private insurers.
Household names like Aetna, Anthem Blue Cross, Blue Shield, HealthNet, Secure Horizons, Kaiser, and United HealthCare are some of the companies that provide these types of plans.
When enrolling in an Advantage program, the Medicare beneficiary is actually trading their Original Medicare coverage for these plans.
They must also continue to pay their Part B Medical premiums.
What do these plans cover? Advantage Plans must provide your Part A (hospital insurance) and Part B (medical insurance) benefits, including emergency and urgent care.
The only major benefit area not covered by Advantage Plans would be hospice.
Hospice is still covered by Original Medicare and must be obtained through a Medicare certified hospice facility.
Many Advantage Plans do offer additional benefits which would include things like dental, vision, hearing, gym memberships as well as other health and wellness programs.
Most advantage plans do include prescription drug coverage (sometimes referred as Medicare Part D).
Advantage Plans generally fall under the generic category of managed care plans.
Usually they are HMO (health maintenance organizations) or PPO (preferred provider organizations).
There is also a third type of plan called a Preferred Fee for Service program (PFFS).
HMO's do require that the member select a primary care physician from those participating in the plan.
That primary care physician is then charged with supervising your medical care which would include referrals to a specialist and admission to the hospital.
With an HMO, an individual can only use doctors, hospitals, and other facilities that are contracted with the HMO.
The PPO offers participants more choice.
They can elect to use providers of medical care that are contracted with the health plan or any physician or hospital.
Normally, PPO's have deductibles, coinsurance and copays to pay for covered Medicare eligible services.
Private Fee for Service plans may allow the plan member to use any doctor or Medicare approved hospital.
You are not required to choose a primary care physician or wait for referrals to specialists.
However, unlike Original Medicare, you may find that some doctors or hospitals may decline to treat you based on the reimbursement the PFFS plan is willing to provide for covered services.
What does an Advantage Plan Cost? Each month the Medicare Advantage program receives a fixed amount from CMS (Centers for Medicare& Medicaid Services) to provide your care.
The Advantage plan is then responsible for paying your doctors, hospital, lab facilities, and other providers of care.
Even though the plan does receive a payment to provide you with care, they are permitted to charge you a monthly premium and additional out of pocket expenses.
The out of pocket expenses can take the form of copays for doctor's office visits, coinsurance for days in the hospital, or an annual deductible for prescription drugs.
As mentioned previously, the member is still responsible for paying their monthly Part B premiums.
How and when can I join an Advantage plan? An individual can enroll in an Advantage plan if they have both Part A and Part B of Medicare and live in an where a plan is available.
Many plans only cover certain geographic regions in a state and you must live in that area to enroll.
You can join a plan when you first become eligible for Medicare.
The initial enrollment period for a newly eligible individual is the three months prior to the month you turn age 65 and the three months following your birthday month.
Thereafter, there is an annual open enrollment period where an individual may change plans.
Historically, the annual open enrollment period commences on November 15th of each year with enrollment closing on December 31st.
Coverage in the new plan would be effective January 1st.
2010 is bringing some changes to the annual open enrollment period.
It will commence a bit earlier and close prior to the Christmas holidays.
Special open enrollment periods are available to individuals who move out of the plans service area or should the plan cease to offer benefits in your geographic region.
Medicare Advantage Plans and Health Reform Advantage Plans have cost the federal government more than traditional Medicare.
As part of the HealthCare Reform package signed into law on March 23, 2010, the federal will start to reduce the subsidies for these plans beginning in 2012.
This will probably result in higher premiums being charged or a reduction in the benefits offered.
However, these plans will not be able to reduce the benefits that an individual would normally received through Medicare.
For more details on Medicare Advantage plans, visit Medicare's website or consult with your local insurance agent.
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