Basics of Medicare Advantage Plans, a must know
People get the coverage for their health from the Original Medicare, while some enjoy the Medicare Advantage plans benefits and this is also referred to as Part C or Medicare private health plan. The plans offer Medicare benefits.
The common types of MA Plans are:
- HMOs- Health Maintenance Organizations
- PFFS- Private Fee-For-Service
- PPOs- Preferred Provider Organizations
Remember, one thing is certain that even on getting enrolled with Medicare Advantage plans, you have Medicare. This means you pay for Part B and A monthly premium in case you have it. In case you are enrolled in an MA Plan, you get to enjoy the same benefits offered by the Original Medicare. Bear in mind the Medicare Advantage plans may apply different rules, restrictions and costs that may affect as you receive care. They may provide certain benefits that Medicare fails to cover, such as vision and dental care.
The Medicare Advantage Plans include out of pocket costs limit for the services of Part A and B. For instance, the out of pocket expenses as maximum in 2018 for HMO plans is $6700. These are high. Apart from this, the plans cannot charge coinsurances or higher copayments that the Original Medicare for services such as dialysis and chemotherapy, but they car charge more for other services.
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Note: MA Plans may have diverse:
- Providers of Networks
- Rules of coverage
- Premiums besides part b premium
- Covered services cost sharing.
In fact the truth is that even with same plan types provided from different companies come with different rules. Thus, before choosing one, check directly about the plan and its coverage.
Joining Medicare Advantage plans is possible if:
- You own Part A and B Medicare
- You live in the service area that offers this plan
- You do not have crucial health problems such as renal disease end-stage
Many Medicare Advantage Plans give Part D, the prescription drug coverage. If you join without drug coverage, the Medicare Advantage plans, you can enroll in Part D as stand-alone plan. Remember Original Medicare with Part D coverage also enrolls Part D plan as a stand-alone.
Another important point is if you are covered by your employer or union on becoming Medicare eligible, you get enrolled automatically in sponsored Medicare Advantage plans, however, you may choose the plan, enroll in new MA plan, quit from Original Medicare as well, but remember if you change to another plan, your union or employer may reduce the health and other company benefits.