Medicare Advantage

If you are a member of the Medicare Advantage Plan, original Medicare does not cover your expenses but this plan does. Usually, the Advantage Plan will cover prescription costs, a Medicare Part D feature. Medicare Part A & B benefits are covered under the Advantage program. The program is streamlined in that it provides all your Medicare health coverage in this one plan. Sometimes referred to as Medicare Part C, these programs are administered by private firms but approved by Medicare. Being approved by Medicare, these options are similar to PPO’s and HMO’s and are known as Medicare Advantage Plans as well as (“Advantage Medicare”).

The program options for Medicare Advantage Plans:

* (HMO) Medicare Health Maintenance Organization: This provides for less expenses than the Original Medicare Plan. In the instance of an emergency you can go to any available facility, however you will otherwise be required to select from the plans list to obtain approved hospitals, specialists, or physicians for most HMOs. Options such as extra time in the hospital are sometimes provided by some HMOs. Health care items such as Part A and Part B must be included in HMO coverage.

* (PPO) Preferred Provider Organizations: With this alternative service, there will be additional expenses if you decide to go outside the PPO network to hospitals, physicians and other providers. Normally you would use providers, hospitals and physicians within the PPO network in this Medicare Advantage Plan.

* Medicare Special Needs Plans: Prescription drug coverage under Medicare Part D is always covered in this alternative. HIV/AIDS, congestive heart failure and diabetes are a few of the conditions that people have who are covered by most all of the Medicare Special Needs Plans. Catering to the needs of those they serve they provide a list of available drugs, choose of the providers to be approved, and otherwise create their benefits. People with special illnesses or diseases are those who are allowed to join these plans.

* Private Fee for Service Plans: This program may provide more benefits than the Original Medicare Program. Medicare covered benefits may cost you more or less in this plan. The cost which you pay and the services they pay for are determined by the plan. The primary benefit of this plan is that you may go to any Medicare approved hospital or physician who accepts the programs payment.

* (MSA) Medicare Medical Savings Account: Medicare Part D prescriptions are not included in these plans. Medicare accepted services are paid by the plan after you have payed up to the high deductible. Paying a variety of expenses with the proceeds in your account are decided by you. Any Medicare approved procedure’s costs are your responsibility.
Although, you are not required to pay the regular Medicare Part B premium. This plan does not require that you pay a regular premium because it has a very high deductible. Medicare Part A and B protection is covered by Medicare Advantage Plans.

Medicare Advantage Plan: How To Qualify

If you satisfy the following conditions you should generally qualify for a Medicare Advantage Plan:

  • You are not suffering from any End Stage Renal Disease (kidney transplant or permanent kidney failure which requires dialysis)
  • You presently have active Medicare Part A and B protection.
  • Determine the service location in which you are most interested and contact the plans about their areas. The service which you want to join must be where you live.

Medicare Advantage Plan: How To Join

Sometimes you may be able to change plans at times other than the standard one time per year. This is the reason for you to choose your plan carefully.

You must provide the date of joining Medicare Part A and/or Part B coverage, and you must provide your Medicare number from your Medicare card when you are ready to join a Medicare Advantage Plan. You may enroll online, call a Plan or by completing a paper application when you have chosen an Advantage Medicare Plan.

Medicare Advantage Plans: What is the cost?

A large number of aspects will determine the cost of an Advantage Medicare Plan. When purchasing a Medicare Advantage Plan you should consider the following questions:

  • What do any extra benefits cost? Are they required for you? Does the plan carry this extra benefits?
  • Will out of network providers or network providers be your preference?
  • Do you need a certain specialist in health care? Will you need them immediately and frequently?
  • When considering co-pays, what will each visit or procedure cost you?
  • In addition to your Part B premium, are there any other monthly premium costs?
  • Do any of the procedures or services have any deductibles?
  • Are there any Part B premiums and does the Plan pay any of these?
  • Are there any annual deductibles that the Plan charges?

Benefit Costs: What Are They?

Your services may not be covered at all and they may be higher if you see a provider who does not participate in the Plan. To assure that the plan satisfies your needs, learn your costs and find out the rules by calling the plan prior to joining.