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OHIO MEDICARE PLANS 

Buckeye Senior Benefits Agency

Medicare Part C – Medicare Advantage Plans


What Is Medicare Part C?

 

Medicare Advantage Plans, also known as MA Plans are private health companies that have teamed up with the Federal government to offer plans with benefits that cover both Part A and Part B expenses. Some Medicare Advantage plans may contain extra benefits not covered by Original Medicare such as dental, vision, hearing along with health and wellness programs . These plans can also include Medicare prescription drug coverage or Medicare Part D benefits.

 



How Does It Differ From Having Just Medicare Part A and Part B?

 

  • Medicare Part C combines Medicare Part A and Part B to cover all medically required services.

 

  • This health plan is usually offered by private insurance providers that are approved by Medicare. These companies enter into a business agreement with Medicare whereby they agree to follow certain ground rules.

 

  • plan benefits may change from year to year, so you need to stay informed.

 

  • this is a lower cost alternative than Original Medicare because most plans have Maximum Out Of Pocket (MOOP) benefits that can help a senior from paying too much when healthcare expenses stack up  

 

  • MA Plans provide many extra benefits and includes Medicare Part D (prescription drug coverage*).

 

  • Provides extra benefits that are important to your mental and physical well-being i.e. hearing, vision, dental and even health and wellness programs.

 

* YOU CANNOT ENROLL IN BOTH A MEDICARE SUPPLEMENT AND A MEDICARE ADVANTAGE PLAN AT THE SAME TIME.

* YOU CANNOT ENROLL IN BOTH A MEDICARE ADVANTAGE PLAN AND A PART D STAND ALONE PRESCRIPTION PLAN, UNLESS IT'S A PFFS AND A PART D PLAN

 

Who Is Eligible For Medicare Part C Plan?


If you have both p

 

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* Minor exceptions are there. Check an expert.

 

 

What Different Types of MA Plans are Availabl

There are FOUR major different MA Plans:

 

  1. HMO or Health Maintenance Organization Plan
  1. You will have at your disposal a network of doctors which you can see when needed (cannot go outside this network).
  2. For specialist consultation, you will need a referral.

 

  1. You can see any doctor of your choice within the network.
  2. You can see doctors outside the network - at higher cost.
  3. You can see a specialist without a referral.

 

PFFS or Private Fee-for-Service Plan
  1. You can see any doctor or specialist, provided they accept the PFFS’ prescribed fees and terms & conditions.
  2. You can see a specialist without a referral.

 

SNP or Special Needs Plan
  1. You are suffering from certain chronic diseases
  2. You have special health needs
  3. You are covered by Medicare Part A, Part B and Part D

 

HMOPOS or HMO Point of Service Plan
  1. You can avail certain services outside the prescribed network for a higher cost

 

MSA or Medical Savings Account Plan
  1. Medicare combines your health plan with a saving account.
  2. Medicare deposits a certain amount in your bank account (less than the deductible).
  3. The amount deposited can be used to pay for medical services during the year.

 

How Much Do I Pay For Medicare Advantage?

 

You would have to pay monthly premium in addition to Medicare Part B. This plan heavily reduces your out-of-pocket costs for medical care. These costs would be charged according to the following criteria:

 

  1. Monthly premium of  the  insurance plan
  2. Payment of  Part B premium.
  3. Yearly deductibles or any additional deductibles of the insurance plan
  4. The amount  you pay per visit or service to a doctor
  5. Type of health care services you need and how often you get them.
  6. Your compliance to the insurance plan’s rules, such as using network providers.
  7. Extra benefits you require and  the charges this health insurance plan  imposes for such benefits
  8. The yearly limit placed on your out-of-pocket costs for all medical services according to the plan

 

What Are the other details I need to know about MA Plans?

 

Change of Plans

 

For those who have made changes in the Medicare Advantage Plan between 01 January – 14 February 2011:

 

  1. You can revert to the Original Medicare plan.
  2. In that case, MA plans are limited to charge maximum as much as the Original Medicare services like:

    1. dialysis,
    2. chemotherapy, and
    3. skilled nursing facility care.
  1. You can make changes to your plan ONLY during certain time periods, i.e. the enrollment period, which on occurs from October 15 to December 7 of each year.  Known as the Annual Coordinated Election Period (AEP),  anyone who enrolls during this period can change/ modify/ select a new Medicare health plan.