medicare advantage - plan details
TRANSCRIPT
What Is the Medicare Advantage Plan?
•An additional health plan for those eligible for Original Medicare
•Also known as Medicare Part C or MA Plan
•Theses plans do not offer supplemental coverage, such as Medigap insurance
What Is the Medicare Advantage Plan?
•The Medicare Advantage Plan is offered by private companies that are approved by Medicare
•It is a private insurance alternative to Original Medicare
•It is necessary to pay monthly part B premium, as patients are still deemed to be in the Medicare program
The 4 Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNP)
What Is Covered?
•Patient receives Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage from Medicare Advantage Plan, NOT Original Medicare
•Hospice care is provided by Original Medicare, NOT the Medicare Advantage Plan
•Extra coverage such as hearing, vision, and dental may be available
What Is Covered?
•Most plans are Managed Care Plans using a HMO or PPO
•Patient may be required to choose a primary care physician (PCP) and get a referral to see a specialist
•Patients may only be allowed to use approved facilities, hospitals, and physicians
How Much Does It Cost?
•The cost of the Medicare Advantage Plan depends on a number of factors such as the type of services that are needed and the frequency of the treatment
•Patients pay for Medicare monthly, and the Advantage Plan is responsible for paying the providers of care
•Average monthly premium is $32.59 in 2012, according to U.S. Department of Health and Human Services
How Much Does It Cost?
•A premium and out-of-pocket expenses can be charged
•Patient must also pay monthly premium for Medicare Part B from Social Security check
•Extra premiums possible for additional services and prescription drugs
How Much Does It Cost?
•Patients are sent an Evidence of Coverage (EOC) and Annual Notice of Change (ANC) by plan
•EOC provides details of what is covered by the plan
•ANC has details of forthcoming changes to costs, coverage, or service area
How to Join
•Medicare Part A and B required; patient must also live in an area where an existing Advantage Plan accepts new members
•Certain plans only cover specific counties within a state
•Advantage Plans should never ask for financial information over the phone
•Patients are advised to compare plans in their area before choosing
Joining, Switching, and Dropping Medicare Advantage Plans
•When patients join a new Medicare Advantage Plan, they are automatically disenrolled from their old plan
•Patients must call 1-844-839-0813 or contact their current plan to switch back to Original Medicare
•Patients may only be allowed to switch at certain times of the year
Joining, Switching, and Dropping Medicare Advantage Plans
•Patients are allowed to join the Medicare Advantage Plan from three months before to three months after their 65th birthday
•Those with Social Security Disability Insurance can join three months before to three months after their 25th month of disability
•Switching and dropping of plans is allowed during enrollment period: Nov. 15-Dec.31 annually
What If the Plan Stops Participating in Medicare?
•A plan can decide to leave Medicare at the end of each year
•A plan will get returned to the Original Medicare if another Medicare Advantage Plan is not chosen
•A patient has the right to purchase supplement insurance called Medigap
•Patients are still in Medicare program and will receive all Medicare-covered services no matter which option is chosen
Prescription Drug Coverage
•Many Medicare Advantage Plans include the Medicare Prescription Drug Plan (Part D)
•Patients that disenroll from the Advantage Plan and go back to Original Medicare need to join a Part D program for coverage
•Patients in an Advantage Plan with Part D coverage that join a Medicare Prescription Drug Service will be automatically disenrolled and sent back to an Original Medicare program
Patients With Other Coverage
•Talk to your employer, union, or benefits administrator to learn about their rules before considering a Medicare Advantage Plan
•It is possible to lose union or employer coverage by joining an Advantage Plan
•This may also result in loss of coverage for a patient’s spouse and dependents
•Those who drop their union/employer coverage may not be allowed to get it back
End Stage Renal Disease (ESRD)
•If the ESRD occurred when the patient was already in the plan
•If the patient is getting health benefits from the same organization offering the plan
•If the patient had a successful kidney transplant and qualifies for Medicare benefits
Patients with ESRD are only allowed to join a Medicare Advantage Plan in certain situations:
Important Considerations
•If a patient is in an Advantage Plan HMO, they must choose a PCP and only use network services
•It is not necessary to purchase Medigap if the patient is already enrolled in a Medicare Advantage Plan
•It is illegal for anyone to sell a Medigap policy to someone already on an Advantage Plan
Important Considerations
•There is an annual limit on out-of-pocket costs for medical services
•Medicare Advantage Plans are not allowed to charge more than Original Medicare for services like dialysis, chemotherapy, and skilled nurse facility care
•It is possible to join a plan with any pre-existing condition except for ESRD, in most cases
Information Citations
http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-
advantage-plans/types-of-medicare-advantage-plans.html
http://medicare.com/medicare-advantage-part-c/about-medicare-advantage-part-
c/medicare-advantage-plans
http://www.webmd.com/health-insurance/insurance-basics/medicare-advantage-
private-health-insurance-through-medicare
http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-
advantage-plans/things-to-know-medicare-advantage-plans.html
http://www.medicare.gov/your-medicare-costs/medicare-health-plan-costs/costs-for-
medicare-advantage-plans.html
http://www.medicare.gov/sign-up-change-plans/get-drug-coverage/get-drug-
coverage.html