Important Things to Consider when Choosing Medicare Advantage Plans

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Medicare Advantage Plans are private insurance plans that offer all-in-one medical and drug coverage in collaboration with all Medicare Part A and Part B plans.  These plans may offer extra coverage like vision, hearing, dental, and/or health and wellness programs.  They are offered by private companies in contract with Medicare.

The Medicare Advantage 2016 Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans (PFFS), Special Needs Plans (SNP), HMO Point Of Service (HMOPOS), and Medical Savings Account Plans (MSA).

Here are a few things that you need to consider before opting for Medicare Advantage Plan Enrollment:

  1. Medicare Advantage Plans cover all Original Medicare services, except hospice care. If you are in a Medicare Advantage Plan, Original Medicare will cover hospice care.
  2. Every Medicare Advantage Plan may cost differently and have different rules for how to get coverage and services, like whether you need a referral to see a specialist, or if you can only use specialists listed with the Plan. These rules can change every year.
  3. Medicare Advantage Plans will differ from state to state. Extra coverage, like vision, hearing, dental, and/or health and wellness programs may or may not be provided by each Plan, so make sure you check what is available in your area.  You can use the Medicare Plan Finder at Medicare.gov and browse the website for plans, or speak to an agent.
  4. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the Plan and aren’t paid for under Original Medicare. Medicare provides a fixed payment to the Plan to cover your Medicare Part A and Part B coverage.  There are usually additional copayments and deductibles, depending on the type of Plan you join.  (This means that you must be enrolled in Medicare Plan A or B to enroll in the Medicare Advantage Plans)
  5. Most, but not all, Medicare Advantage Plans offer prescription drug coverage: be sure to ask your advisor or check details. If your Medicare Advantage Plan does not offer drug coverage, you can join a Medicare Prescription Drug Plan.  If you are in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you’ll be dis-enrolled from your Medicare Advantage Plan and returned to your original Medicare Part A and Part B coverage.
  6. Medicare enrollment for Medicare Advantage Plans is done during the annual Medicare Enrollment season; this year it is October 15th through December 7th. The Medicare Advantage Plan enrolled during this period will take effect on January 1st.
  7. If you change your mind about your Medicare Advantage Plan, you can modify your plan during the enrollment season, or dis-enroll from your Medicare Advantage Plan during the Medicare allowed dis-enrollment period lasting from January 1st to February 14st. If you leave your Medicare Advantage Plan and a new Medicare Advantage Plan is not chosen, your original Medicare Part A and Part B coverage will resume.
  8. During the Medicare allowed dis-enrollment period, you can only change your Medicare Advantage Plan if you are enrolled in one. If you want to switch your Medicare Advantage Plan, you have to first enroll in the new Medicare Advantage Plan.  You will then be dis-enrolled from the previous one automatically.  You can only do this in the respective seasons mentioned in points 6 and 7.
  9. You cannot enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD). You can however enroll in Medicare Advantage Plan if:
    1. you were already enrolled with a Medicare Advantage Plan.
    2. you are already getting your health benefits through the same private insurance organization that offers the Medicare Advantage Plan.
    3. you had ESRD, but have had a successful kidney transplant, and qualify for Medicare benefits (based on your age or a disability).
    4. SNP is available in your area.

If you have ESRD, and are enrolled in a Medicare Advantage Plan, but the private insurance organization leaves Medicare or no longer provides coverage in your area, you have a one-time right to join another Medicare Advantage Plan.

  1. If you need a medical service that the Medicare Advantage Plan says isn’t medically necessary, you may initially have to pay all the costs of the service, but you can file an appeal of the decision taken by Medicare. This is usually done to disagree with a Medicare coverage or payment decision to recover necessary costs.
  2. To avoid being in such a situation mentioned in point 10, ask your Medicare Advantage Plan for summary of benefits if unsure about a medical service being medically necessary and covered.
  3. All Medicare Advantage Plans cover you for emergency or urgently needed care.
  4. To obtain information about Medicare Advantage Plans and to enroll in a Medicare Advantage Plan, contact the private digital insurance provider, e-TeleQuote Insurance, Inc. at www.etelequote.com.

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