Monday, October 24, 2011

Health Care and Medicare Advantage Plans

When you turn 65, you are eligible for Medicare. There are Parts A, B, C, and D. Each part acts on its own merit, but interact with each other to help reduce the cost of health care for seniors. According to, Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care. Part B helps cover medically-necessary services like doctors' services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Part D is for prescription drug coverage. For more details about Medicare in general, run by the CMS, visit this site:
What is a Medicare Advantage Plan (Part C)?

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year. This site from has more details:

Medicare Advantage plans are privately run versions of the government's Medicare program. They are subsidized by the government and offer basic Medicare coverage topped with extras or premiums lower than standard Medicare rates, according to the Chicago Business Journal. The Kaiser Family Foundation has a good overview at this site: .

What Does a Medicare Advantage Plan Cost?

Each month, Medicare pays your advantage plan a fixed amount of money to provide your care, according to About Health Insurance. The advantage plan is then responsible for paying your doctor, hospital, and other providers of care. Although your advantage plan must follow Medicare’s rules, it can charge you a premium and additional out-of-pocket expenses, such as a copayment for a doctor visit, coinsurance for durable medical equipment (such as a wheelchair), and an annual deductible for prescription medications. You also are responsible for your Medicare Part B monthly premium, which is taken out of your social security check.

How Do You Join a Medicare Advantage Plan?

Generally, you can join a Medicare Advantage Plan if you have Medicare Part A and Part B and you live in an area where there is an advantage plan that accepts new members. Some plans only cover certain counties within a state and you must live in one of those counties where the plan is offered. Some Medicare Advantage Plans hold local seminars to introduce their plans and you can get and complete a paper application at that time. You also can enroll by calling the plan, visiting the plan’s website, or on The Medicare site also lets you compare plans in your area. You also can join by calling Medicare at 800-633-4227.

If you are switching to a different advantage plan, all you have to do is join the new plan and you will automatically be disenrolled from your old plan. You will not have any lapse in your coverage. Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65. For example, if you turn 65 on April 28th, your eligibility period starts on January 1st and ends on July 30th. If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after your 25th month of disability. More details can be found at this site:

When you enroll in any Medicare Advantage plan, you will still get all Original Medicare covered services, but you may also obtain extra benefits and services not offered by Original Medicare, and/or you may be able to reduce your out-of-pocket costs. The extra benefits and services you receive and/or the amount of money you save will depend on which Medicare Advantage plan you choose, according to

Caution: Keep in mind, though, that because private insurance companies offer Medicare Advantage plans, they can change the extra benefits provided by the plan and decide (on an annual basis) whether they will continue participating in Medicare. Health care providers can also join or leave the plan at any time.

Caution: Depending on the Medicare Advantage plan you choose, you may decide to cancel an existing Medigap policy because you will no longer be able to use the additional coverage the policy provides. However, you should be aware that if you do so, you may be unable to get it back except in certain situations. If you've just become eligible for Medicare or if it is the first time you've enrolled in a Medicare Advantage plan, you may have special Medigap protections during your first year of coverage.

There are different types of Medicare Advantage plan, according to
•Health Maintenance Organization (HMO) Plans

•Preferred Provider Organization (PPO) Plans
•Private Fee-for-Service (PFFS) Plans
•Special Needs Plans (SNP)

Other, less common types of Medicare Advantage Plans include:
•HMO Point-of-Service (POS) Plans -- An HMO plan that may allow you to get some services out-of-network for a higher cost.
•Medical Savings Account (MSA) Plans -- An MSA plan combines a high deductible health plan with a bank account.

Tip: If you enroll in a Medicare Advantage private fee-for-service plan, you don't need a Medigap policy, and it generally isn't legal for any company to sell you one. However, you can keep an existing Medigap policy if you so choose, but your Medigap policy cannot reimburse you for any out-of-pocket costs you have under your Medicare Advantage plan.

Your out-of-pocket costs depend on:

•Whether the plan charges a monthly premium in addition to your Part B premium
•Whether the plan pays any of the monthly Part B premium (some plans offer this option, usually for an additional cost)
•Whether the plan has a yearly deductible or any additional deductibles
•How much you pay for each visit or service (copayments)
•The type of health care services you need and how often you get them
•Whether you follow the plan's rules, like using network providers
•Whether you need the additional benefits and if the plan charges for it
•The plan's yearly limit on your out-of-pocket costs for all medical services

There's a lot to consider when deciding which Medicare option is right for you, according to this site: Here are some questions to ask during the decision-making process:

•How much is the premium?
•Will you need to satisfy a deductible or pay copayment or coinsurance costs?
•Does the plan cover the additional benefits or services you need (such as coverage for vision, hearing, dental, or health and wellness programs)?
•Does the plan offer prescription drug coverage (most Medicare Advantage plans do)?
•Are you satisfied with your care? Medicare now ranks Medicare health plans from one to five stars.
•Do the healthcare providers you normally see participate in the plan?
•If your doctor leaves the plan, are you okay with changing doctors?
•Do you travel out of your service area a lot? If so, keep in mind that Medicare Advantage plans are only required to cover you for emergency care and urgently needed care outside your plan's service area.
•Are you okay with the fact that the plan's benefits and costs generally change each year?

According to, Medicare has a number of enrollment periods, including the initial enrollment period, general enrollment period, special enrollment period, and an Annual Election Period. The Medicare Annual Election Period is from October 15 until December 7, 2011, which is a month earlier than in previous years. During this enrollment period you can enroll in Medicare, add, drop, or change coverage. You need to consider all the aspects of your plan and compare it to other plans during this period. There might be a plan that works better for your medical needs. If you have Original Medicare and Medicare Part D Drug Plan there might be a Medicare Advantage Plan that would work better for you. Likewise if you have a Medicare Advantage Plan you might find that changing to Original Medicare works best.

Another thing you should be aware of with regard to a Medicare Advantage Plan is that no one should call or come to your home to sell you a Medicare plan. If someone does, do not give them any personal information. You should only give such information to doctors, health care providers, and plans approved by Medicare. Medicare plans are not allowed to ask you for financial information like credit card numbers or bank information over the phone or via email unless you are already a plan member. You cannot be enrolled in a plan over the phone unless you contact the company to enroll. If they call you, you should be suspicious. To fight fraud be sure to ask questions, educate yourself about Medicare, and beware of providers who discuss items that are not covered, but suggest they can get coverage for those items. Much more indepth material can be found at this site:

Medicare Advantage plans are critical for you to save money on medical expenses not covered by Parts A and B. When you consider the plethora of plans in the market place, make sure you do a lot of homework as the choices are multiple in price, scope, and included benefits. And, look for a plan with a high STAR rating from CMS. That way, even though you may pay more for the coverage, you are assured of getting a very good plan. Don't play games with Medicare Advantage plans, as a small mistake may cost you quite a bit later on if you have health care issues that require extra attention.

Until next time.


Anonymous said...
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rager4me said...

Medicare Part D Plans is a great benefit to senior citizens.

Ms Fisher said...

Such a great post about medicare advantage plans.Keep on posting!

Mike Marti said...

I was doing research online on Medicare Advantage plans and came across your blog. Very good information!

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