Medicare Advantage & Medicare Supplement Plans

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MEDICARE ADVANTAGE PLANS

Medicare Advantage plans offer an alternative way to receive your Medicare benefits through a private, Medicare-approved insurance company. They must include all your Medicare Part A and Part B coverage (except hospice care, which is covered under Medicare Part A), but may offer additional benefits not included in Original Medicare.

Medicare Advantage Plans (also known as Medicare Part C) provide your Medicare Part A and Part B benefits (Parts A & B), along with additional medical coverage, all in one convenient private insurance plan. The additional coverage helps limit, and helps pay for, your out-of-pocket medical expenses.

Unlike Medicare Part A and Part B, many Medicare Advantage plans may also include coverage for prescription drugs (also known as Part D). Medicare Advantage plans may also include dental, vision, and other benefits. Since every plan varies, it is important to understand what your plan covers before signing up.

Most Medicare Advantage Plans tend to be either HMOs or PPOs. HMOs involve using a set of in-network doctors, specialists and hospitals. They typically require you to coordinate your care through a primary care physician, who can refer you to specialists when needed. PPOs tend to have larger networks and do not typically require referrals for specialists. Since Medicare Advantage HMOs and PPOs provide most of your health coverage in a single plan, they can seem similar to the insurance you may have had through an employer.

Medicare Advantage plans can help to reduce the amount you pay out-of-pocket for health care. Medicare Part A and Part B requires you pay for 20% of medical costs when needing outpatient care. It also requires you to pay a set fee per day when hospitalized for 60 days or more, which can vary depending your plan. Further, there is no cap on your out-of-pocket costs. There also is no coverage for prescription drugs, meaning you pay for 100% of costs at the pharmacy.

Medicare Advantage plans can help pay for all of these out-of-pocket costs, with many plans including prescription drug coverage. They also place a “worst-case” maximum limit on your out-of-pocket costs. These limits vary from plan to plan, but can be very affordable. Medicare Advantage maximum out-of-pocket limits can keep your costs both affordable and predictable.

Some people may prefer Medicare Advantage over Medigap because they enjoy the convenience of having one plan. Medigap plans work on top of, or in addition to, Medicare Part A and Part B. Medicare Advantage plans replace Medicare Part A and Part B, and often include additional benefits.

SUMMARY
  • Medicare Advantage allows you to receive Medicare benefits through a provide Medicare-approved insurance company
  • Medicare Advantage is also known as Part C.
  • Medicare Advantage also provides Part A & Part B benefits along with additional medical coverage
  • Some Medicare Advantage plans also include prescription drug plans which is also known as Part D
  • Medicare Advantage plans can help reduce the amount you pay out-of-pocket

MEDICARE PART A & B

Medicare Part A and Part B is the health insurance coverage provided by the government. Part A is for inpatient or hospital coverage and Part B is for outpatient or doctor’s office coverage. To be eligible, you must be 65 years old, and have paid federal taxes for at least 10 of your working years,or under 65 years old with certain disabilities. You can enroll in Medicare Part A and Part B during the Initial Enrollment Period. The Initial Enrollment Period is the 7 months surrounding your 65th birthday (3 months before you turn 65 years old, the month you turn 65 years old, and 3 months after you turn 65 years old). If you miss the Initial Enrollment Period, you can sign up during the General Enrollment Period, which is between January 1 and March 31. Unfortunately, you have to wait until July 1 for your coverage to begin. Additionally, you could pay higher premiums when you purchase supplemental coverage from a private insurer. If you or your spouse are currently over 65 and have health coverage through your employer, you may be eligible to get Medicare Part A and Part B during the Special Enrollment Period. The Special Enrollment Period will begin once your employer-based coverage expires.

SUMMARY
  • Medicare Part A and Part B is the health insurance coverage provided by the government
  •  To be eligible, you must be 65 years old
Medicare Website Link (Government)

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