Medicare Advantage – Overview


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Medicare Advantage Plans and Important Points You Must Know

Medicare advantage plans, also known as Medicare Part C, help consumers pay for related services through private plan options chosen by the consumer. Advantage plans are available through private companies approved by Medicare. They are network plans featuring PPO and HMO service options.   There are different plans that offer different levels of coverage and they can include a wide range of services. Here is a list of points to help you understand Medicare advantage plans in further detail.

• This plan is available to those who enroll in Medicare.  It is used with Part A and Part B. When you use these plans you have the same protection and rights as a Medicare recipient.

• Enrollment for this coverage is done on an annual basis. There are specific times during the year to sign up for coverage.  This could occur prior to turning 65 years old, if you enroll at the beginning of the year for Part A or B, or if you have a disability while being under age 65.  If you have a preexisting condition you may still qualify for coverage.

• You can learn services covered with the plan before getting the service. This helps you save of costs and you have an idea of what you may be responsible for when the service is completed.

• Check your plan before seeing a specialist to ensure their services are part of network coverage.  You will be responsible for paying related costs not covered by your plan.  You plan may have rules in place you should follow regarding referrals.

• If you use an HMO (health maintenance organization) or PPO (preferred provider organization) your costs may be higher if related services are not covered in your plan.  This includes services through health care provider or doctor. You could pay more for services if they are not in network.

• Even though you can choose a provider part of your plan’s network, they can choose to leave the network anytime.  The plan can also make changes to providers offering care in your network. This means you will need to consider another provider when they decide to leave.

• Costs related to clinical research studies may be covered.  You will need to review plan details carefully or contact your plan for additional details on what, if anything, is covered.

• Certain costs related to Medicare Advantage Plans should not exceed costs found in Part A and Part B coverage.  This may include skilled nursing services and dialysis for example.

• The Advantage plan will pay for all medical costs after you satisfy out-of-pocket costs for the year.  The amount of out-of-pocket costs varies by plan and what you pay is based on your needs and income.

• You have the option to select another Medicare plan if the plan you select through the Advantage plans changes or is no longer part of Medicare.

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