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What is a Medicare Advantage Plan
There are different types of Medicare Advantage Plans (MA) available:
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Health Maintenance Organization (HMO):
In most HMOs, you can only go to doctors, health care providers or hospitals that are in the plan's network, except for emergencies. You may need to get a referral from your Primary Care Provider (PCP) for testing or to see a specialist.
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Preferred Provider Organization (PPO):
In a PPO, you pay less if you use doctors, hospitals and other health care providers that belong to the plan's network.
You usually pay more if you use doctors, hospitals and providers that are outside of the PPO network.
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Private Fee-for-Service (PFFS):
PFFS plans are similiar to Original Medicare because you can generally go to any doctor, hospital or other provider, as long as that provider accepts the payment terms set by the plan. The plan will determine how much it will pay
the providers and how much you must pay when you receive care.
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Special Needs Plans (SNP's):
SNP's provide focused and specialized health care for specific groups of people. Those groups consist of people who have both Medicare and Medicaid, reside in a nursing home or have certain chronic medical conditions.
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Medical Savings Account (MSA):
This plan combines a high deductible health plan with a bank account. Medicare deposits money into the account,
then you can use the money from that account to pay for your health care services during the year. MSA plans do not offer Medicare drug coverage.
Who can join a Medicare Advantage (MA) Plan?
* You must have Medicare Parts A and B, and live in the plan's service area to be eligible to join. People with End-Stage
Renal Disease (ESRD-permanent kidney failure) generally can not join a Medicare Advantage Plan.
What do Medicare Advantage (MA) Plans cover?
* Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original
Medicare covers hospice care even if you are in a MA Plan. In all types of MA Plans, you are always covered for emergency and urgent care. MA plans must offer emergency coverage outside of the plan's area (but not outside the United States). Many MA Plans offer extra benefits such as dental, vision and wellness plans. Most MA Plans include Medicare prescription drug coverage. MA Plan benefits can change from year to year. Make sure you understand how a plan works before you join.
Please consult your Senior Healthcare Specialist to learn which plan option is best for you.
How much do Medicare Advantage (MA) Plans cost?
* In addition to your Part B premium, you usually pay a monthly premium for the covered services in a MA plan. Each MA
Plan has different premiums and costs for covered services, so it is important to compare plans offered in your area
to understand plan costs and benefits before you join.
Please consult your Senior Healthcare Specialist to learn which plan option is best for you.
What is a Medicare Supplement Plan
How does a Medicare Supplement work?
A Medicare Supplement policy, also known as a Medigap policy, is private insurance that assists to supplement Original Medicare.
This means that these policies help pay some of the health care costs that Original Medicare does not cover; like copays, coinsurance and deductibles. If you have Original Medicare and a Medicare Supplement policy, Medicare will pay its share of the
Medicare approved amounts for covered costs then the Medicare Supplement policy will pay it's share of the remaining expenses.
Each standardized Medicare Supplement policy must offer the same basic benefits, no matter which Insurance company sells it.
Medicare Supplement polices can be used in any state or territory within the United States. All Medicare Supplement policies offer the same base benefits, with some offering additional benefits. These policies are standardized and identified by the letters A,B,C,D,F,G,K,L,M and N. Each state offers their own letter plans.
The best time to purchase a Medicare Supplement policy is during one's Open Enrollment Period which is triggered by your birth month when you turn age 65.
How much do Medicare Supplement (Medigap) polices cost?
* You pay a monthly premium to the private insurance company once you select the plan that is best for you. Each insurance
company has a different premium for every plan that they offer, so make sure to pick the plan and compnay that best suites
your budget and coverage options.
Do Medicare Supplement policies cover prescription drugs?
* Medicare Supplement policies do NOT offer prescription drug coverage. If you want precription drug coverage you will need to
get a stand alone Medicare Prescription Drug Plan (Part D).
PLEASE CONTACT YOUR SENIOR HEALTHCARE SPECIALIST FOR MORE DETAILS
For more information about Medicare go to
Veteran's Program
First Step is to determine your eligibility for VA benefits
* Where do I go to get that information?
* What options do I have?
Option 1: Enroll in both the VA and Medicare
Option 2: Enroll in the VA only
Option 3: Enroll in Medicare only
* How does CHAMPVA work for me?
* How does TRICARE for Life work for me?
These are tough questions that are posed to veterans when it comes to trying to find out what benefits they are eligible for and how each benefit covers them and their family.
To answer these questions and more, please contact Senior Healthcare Specialsits for assistance.
1-888-412-9990
