Medicare is the federal government’s health insurance program generally for people who are 65 or older, however it’s also available to certain younger people but who have disabilities and persons that have End-Stage Renal Disease (which is permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
One way to receive your medicare is through a type of Medicare health plan offered by private insurance companies that are approved by Medicare and have a federal contract with the Centers for Medicare and Medicaid Services (CMS). Medicare Advantage Plans are required by the government to provide all of your Part A and Part B benefits. Medicare Advantage Plans include the following types:
If you’re enrolled in a Medicare Advantage Plan you should know:
Most Medicare Advantage Plans package prescription drug coverage in their plans although there are some rare plans available without prescription drug coverage.
Things to Remember If You Choose to Enroll in a Part C Medicare Advantage:
How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
Medicare Advantage Part C Plans have an annual limit on your out-of-pocket costs. If you enroll in a Medicare Advantage Plan, once you reach a set maximum limit, you’ll pay $0 for covered services for the rest of the year. This makes a Medicare Advantage plan an enticing option that may be more cost effective for you.
If you’re in a Medicare Advantage Part C plan, review the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) your plan sends you each year, usually in the fall. The EOC gives you details about what the plan covers, how much you pay, and more. The ANOC includes any changes in coverage, costs, or service area effective in January. If you don’t receive an EOC or ANOC, be sure to contact your insurance plan as soon as possible. Get your plan’s contact information from your member ID card or contact us if you need assistance finding contact information for the insurance carrier.
How well does the Medicare Advantage plan cover the services you’ll need?
Plans must cover all of the services that Original Medicare covers. Many plans offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.
If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefitsadministrator or insurer before making any changes.
Because Original Medicare doesn’t cover all your deductibles, copayments and coinsurance it may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). And, many Medicare Advantage plans offer vision, hearing, and dental. You cannot use (and can’t be sold) a Medicare Supplemental insurance policy if you’re in a Medicare Advantage Plan.
Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network ? Do you need to get referrals?
Doctor’s and Hospital Choices in a Medicare Advantage Part C Network
You may need to use health care providers who participate in the plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of-network coverage.
Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services?
Will the plan cover you if you travel to another state or outside the U.S.?
Travel Coverage in Medicare Advantage Plans
Medicare Advantage Plans (Part C) usually don’t cover care you get outside of the U.S.