Medicare Part C
Medicare Advantage Plans are healthcare policies written by private insurance companies. They must be approved by Medicare and include all benefits in Original Medicare Parts A and B. These plans are similar to employer health plans, and vary by state and county.
Medicare Advantage Programs
All Medicare Advantage Plans require participation in Medicare Parts A and B. One obvious strength of a Medicare Advantage Plan (MA) is their network. MA plans offer HMOs, HMO-POS, EPOs, PPOs. An important part of selecting an MA plan is to confirm doctors and prescriptions are within its network. Otherwise, you may not be able to see your doctor or pay a higher cost while out of network.
Medicare Advantage Plans never have underwriting “health questions” at any age or stage of an illness, including ESRD (end stage renal disease).
Features of Medicare Advantage Plans
- The plans have low to no monthly premiums.
- Plans are offered with and without Prescription Drug Coverage (PDP).
- Plans include Part C. Things like some dental, vision, hearing aids, gym membership, over-the-counter items.
- Special Needs Plans – some insurance carriers offer Special Needs Plans for chronic medical conditions like diabetes, heart disease, COPD, and blood clotting disorders. These plans typically include Prescription Drug Plans, and the benefits are designed to bring cost sharing down in the services that someone with a chronic illness will need care.
- Dual Eligibles – also Medicare Advantage Plans for those with low or limited incomes. In addition to Medicare, these individuals need to be enrolled in the Medicaid/Medicare Savings Program. The plan’s benefits are designed with case management, low to no cost sharing, strong benefits in Part C that may include a food card.
Medicare Advantage Plan vs Medigap
Finding the right fit for your medical and financial needs is an important part of choosing any supplement to Original Medicare.
Bayside Health Benefits offers a Certified Medicare Insurance Planner® to find the right fit for your needs. We work with ELEVEN insurance companies to diligently search for a health plan that meets your needs. In addition to the insurance company, we are available all year to service your policy by helping you understand its benefits and know how to use them.
Do I pay you for your services? Why should I use a broker/agent?
- No. We are paid by the insurance company.
- Access to knowledgeable, Certified Medicare Insurance Planner®
- Guide to enrollment timeline and penalty avoidance
- Help finding the right plan for your medical/financial needs
- Saves confusion and research time of doctors and RX
- Knowledge about multiple carriers, not just one
- Navigation of policy benefits
- Agent/broker services your policy in addition to the carrier
Option 1 - Medigap
- No Networks
- No Referrals
- Part B Deductible, $226
- No Copays
- International Travel
- RX coverage SEPARATE
Option 2 - Medicare Advantage
- PPO, HMO Networks
- Referrals required on most HMO’s
- Similar to Employer Coverage
- Copays, OPM
- Dental, Vision, Hearing, OTC, Gym, DSNP, CSNP, Givebacks
- RX coverage INCLUDED
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