What is Medicare Advantage?

Medicare Advantage is Insurance offered by Medicare approved private companies to provide all the benefits of Part A and Part B plus additional benefits that Medicare does not cover. Many Medicare Advantage plans cover prescription drugs within their plans.

Part C – Medicare Advantage
Are you eligible for Medicare Advantage?
Types of Medicare Advantage Plans, PPO & HMO
What to Expect When Joining a Medicare Advantage Plan

Medicare Advantage

Medicare Advantage plans are contracted through the centers for Medicare and Medicaid Services (CMS).
Medicare Advantage plans are NOT Medicare Supplement Plans.
Medicare Supplements are additional insurance products that can be purchased to work with Original Medicare.
Still part of Medicare.
Receive the same services, supplies, and benefits offered under Original Medicare.
Private companies will pay for your healthcare services– not Medicare.

Are you eligible for Medicare Advantage?

You are eligible for Medicare Advantage if:

You are entitled to Part A
You are enrolled in Part B (premium may be required)
You are a US Citizen or Lawful Resident
You are a permanent resident of the plan’s service area
You do not have End-Stage Renal Disease (ESRD)

Types of Medicare Advantage Plans, PPO & HMO

How Does An HMO Plan Work?

You choose a Primary Care Physician who will help navigate your healthcare needs.
You choose network providers and facilities to receive your healthcaare services.
Our network arrangements allow us to create savings that we share with you.
If you need emergency or urgent services, go to the emergency room closest to you!
You may need a referral to see specialists and receive certain services.
Lower out-of-pocket costs
You have the ability to select a different Primary Care Physician as needed.

How Does A PPO Plan Work?

You have a network of doctors, specialist and facilities contracted with the plan to provide services.
You can see providers out-of-network. Reminder– providers that do not contract with us are not obligated to treat you, except in emergency situations. Cost- sharing will be lower at in-network providers.
You should expect to pay more if you choose to use out-of-network providers.
Referrals are not necessary, but some services may require plan authorization prior to receiving the service.
Your Primary Care Physician will continue to help coordinate healthcare services.
PPO plans may not impose prior authorization requirements for Out-of-Network services but member or provider can request an advance determination of coverage.

What to Expect When Joining a Medicare Advantage Plan

You will continue to pay your Part B Premium.
Your current plan may be affected if you join a Medicare Advantage plan.
You will use your plan’s member ID card instead of your Medicare card.
Medicare Supplement (Medigap policy) and Medicare Advantage Plans (Part C) are not the same thing.
Using network providers will help keep your costs lower.
Medicare Advantage plans offer a Maximum Out-Of-Pocket amount.
If you enroll in Part D late, you may have to pay a penalty.
A Medicare Advantage plan offers additional benefits in addition to what Original Medicare covers.
If receiving assistance from a sales agent, broker, or other individual employed by or contracted with a Medicare Advantage plan, he/she may be paid a commission based on your enrollment in the plan.