Positives Of Medigap Plans
Medigap helps cover your out-of-pocket expenses if you decide to stick with Original Medicare.
The biggest advantage of Medigap may be your choice of doctors. You have more doctors and hospitals to choose from since you can go to any provider that accepts Medicare.
If your doctor is not in a Medicare Advantage plan youre considering, and you dont want to switch doctors, you may want to consider Medigap. This will allow you to see any doctor who accepts Medicare.
While Medigap premiums are generally higher than Medicare Advantage, Medigap will likely charge you lower out-of-pocket expenses. Youll need to calculate how much you expect to pay for health care over a year and compare that to your annual premium cost.
Finding a Medigap plan that works for you can be less confusing because there are only eight types to choose from. This can simplify enrolling in Medicare.
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Can You Switch From Original Medicare To Medicare Advantage
If you currently have Medicare, you can switch to Medicare Advantage from Original Medicare , or vice versa, during the Medicare Annual Enrollment Period. If you want to make a switch though, it may also require some additional decisions. The specific choices you need to make depend on which kind of coverage youre switching to and from.
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Who Is Eligible To Join Advantage Plans
If you live in the designated service area of the specific plan, and already have Part A and Part B , you may join a Medicare Advantage plan instead of Original Medicare . If you have union- or employer-sponsored insurance, you may be able to add an Advantage plan, but be forewarned that in some cases you may lose your employer or union coverage when you enroll in an Advantage plan.
Individuals with End-Stage Renal Disease were generally not eligible to enroll in Advantage plans prior to 2021 with the exception of Medicare Advantage ESRD Special Needs Plans, although these are not widely available. But this changed as of the 2021 plans year, as a result of the 21st Century Cures Act. Medicare Advantage plans are guaranteed-issue for all Medicare beneficiaries as of 2021, including those with ESRD.
You should know that if you enroll in a Medicare Advantage Plan, you will not need to purchase Medigap coverage, nor will you be able to buy it. If you already have Medigap coverage, you can keep the coverage , although it wont pay for Medicare Advantage out-of-pocket expenses, such as copayments and deductibles.
Is Medicare Advantage Or Medigap Coverage Your Best Choice
Generally, if you are in good health with few medical expenses, Medicare Advantage is a money-saving choice. But if you have serious medical conditions with expensive treatment and care costs, Medigap is generally better.
Speaking with a licensed insurance agent about your particular health situation can help you decide which is best for you. Since you are not allowed to have Medicare Advantage and Medigap at the same time, you have to choose carefully to make sure you have suitable coverage for your specific situation.
Weighing what options are most important to you and talking with a licensed insurance agent about your particular wants and needs can help you make an informed choice between Medicare Advantage and Medigap.
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Other Medicare Advantage Considerations
You may benefit from a Medicare Advantage plan if youre looking to receive full Medicare coverage, plus more. If youre interested in prescription drug coverage and yearly dental and vision appointments, a Medicare Advantage plan is a great option.
If you have chronic health conditions, an SNP can help cover some long-term medical costs. You may also benefit from an MSA plan if you want to have funds for a variety of medical services throughout the year.
However, if you feel that you dont need additional coverage for things such as dental, vision, hearing, or prescription drugs, a Medicare Advantage plan may not suit you.
The same applies if you want freedom to choose your own providers. If you need out-of-town coverage, a Medicare Advantage plan may not help cover these unexpected medical costs.
What About Medicare Part C
In the confusing alphabet soup of the federal retiree health insurance world, its important to understand that Medicare Advantage is just another name for Medicare Part C.
In effect, when you sign up for Medicare Part C, the private insurance company providing you with Medicare advantage also agrees to offer you the same Medicare Part A and Medicare Part B benefits that are included with original Medicare.
Medicare Part A covers hospitalization and skilled nursing care, for a limited period after hospitalization. Medicare Part B covers doctor visits, exams and care you receive outside of a hospital.
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Are Any Medicare Managed Care Plans Available Where I Live
Currently, you can choose from three types of Medicare Managed Care:
- Cost Contract HMO
- Medicare Advantage PPO
- Medicare Advantage PFFS
These plans are available in selected counties of Indiana and it is important to know the differences between them.
Cost Contract HMO
Medicare will reimburse the plan for covered services you receive. You choose a primary care provider within the HMO network. When you stay within the network, you pay nothing except the plan premium and any small copayment amounts preset by the HMO.
You may also choose to use services outside of the network. When you choose to use a service or provider outside the Cost Contract HMO network, Medicare would still pay their usual share of the approved amount. You would be responsible for the Medicare deductibles and copayments. The Cost Contract HMO would not pay these. Cost Contract HMOs may enroll you if you don’t have Medicare Part A but have and pay for Medicare Part B. Cost Contract HMOs do not have to enroll you if you have end-stage kidney disease or are already enrolled in the Medicare hospice program.
Medicare Advantage PPO
This type of managed care plan maintains a list of preferred providers but lets you see doctors and hospitals outside the plan for an additional cost. If you choose to use a provider outside of the network, the plan will pay the same reimbursements as Original Medicare will unless you need emergency or urgent care.
Medicare Advantage PFFS
What Cards Do I Use If I Have Medicare A And B
- Your original Medicare card
Your Medicare card provides proof that you Medicare eligible and enrolled in the Medicare program. Your Medicare card is red, white and blue. The card also shows your effective dates of coverage and which parts of Medicare you are enrolled in . This is the only card you will need to provide when checking in for a doctors appointment, medical facility or hospital if the only coverage you have is original Medicare Part A and/or Part B. Typically, since original Medicare does not cover but a select few prescription medications, your original Medicare card is not needed when you go to a pharmacy to get prescriptions. Most prescriptions that are covered under original Medicare Part B are for medications administered in a medical facility or doctors office, such as injections.
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How Medicare Advantage Plans Work
Medicare Advantage plans also known as Medicare Part C are required to provide the same benefits as Medicare Part A, which covers hospitalization, and Medicare Part B, which covers doctors visits. Medicare Advantage plans also typically include Medicare Part D prescription drug coverage and may include benefits not covered by Medicare, providing some savings on routine dental care, eye exams and glasses, and hearing aids.
Medicare Advantage Plans Coordinate Care Among Your Health Care Providers
Typically Medicare Advantage plans are managed care and have networks of contracted health care providers. Example would be Health Maintenance Organization Medicare Advantage plans. These HMO plans require you to select a Primary Care Physician who helps to coordinate your care.
Medicare Advantage plans that include prescription drug coverage may also have medication therapy management. This care coordination can be a convenience and a valuable aid to your health.
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What Is Medicare Part D
Medicare Part D is prescription drug coverage. You can get Medicare Part D either through a stand-alone plan or through a Medicare Advantage plan. If your Medicare Advantage plan includes prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D Prescription Drug Plan at the same time. Stand-alone Part D prescription drug plans generally go together with Original Medicare coverage.
All Medicare Part D coverage is offered by private insurance companies and not by the federal government. The governments Medicare program, Original Medicare, does not include coverage for most prescription drugs you take at home. You will generally only get Original Medicare coverage for prescription drugs if you receive them as a hospital inpatient or as injection as a doctor office outpatient. There may only be other limited situations where Original Medicare will pay for prescription drugs. Without Medicare Part D coverage, you may have to pay for most of your prescription drugs out of pocket.
How Much Do Medicare Advantage Plans Cost
Here are some costs you may need to pay if you choose a Medicare Advantage plan:
- Part B premium. Even if youre enrolled in Medicare Advantage, youre still responsible for paying the Part B premium. This amount can cost up to $170.10 per month. However, some Advantage plans cover a portion or even all of this premium cost.
- Coinsurance and copayments. Most Medicare Advantage plans charge a copayment or coinsurance amount for services rendered. These services could include a doctors office visit, specialists office visit, or even a prescription drug refill. Specific coinsurance and copayment amounts are set by the plan youre enrolled in.
- MedicareAdvantage plan costs. Medicare Advantage plans can charge a monthly premium thats separate from the Part B premium. Other Advantage plans may be premium-free. In addition, Advantage plans can charge separate drug and health plan deductibles.
Individual healthcare needs play a huge role in how much you may end up paying out of pocket for your Medicare Advantage plan. For example, your plan costs can be affected by:
- how often you seek services
- whether you visit out-of-network providers
- if you enroll in extra benefits
Original Medicare eligibility includes individuals who:
- are 65 years old or over
- have been receiving Social Security or Railroad Retirement Board disability benefits for 24 months
Medicare beneficiaries who are already enrolled in Medicare Part A and Part B are eligible to enroll in a Medicare Advantage plan.
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How Do I Know If I Am Eligible For Medicare Advantage
If you have Medicare, you may be wondering if theres a way to cover more healthcare services, such as dental care, prescription drugs, or hearing exams. The answer may be a Medicare Advantage Plan.
A Medicare Advantage Plan, also called Medicare Part C, covers all the services currently offered as part of the Original Medicare Plan . But it can also provide additional coverage where Medicare doesnt, saving you out-of-pocket costs for important treatments or medications
To be eligible for a Medicare Advantage Plan, you must:
- Qualify for Medicare Part A and Part B
- Live in the area the Medicare Advantage Plan serves
Medicare Advantage Plans are offered by private companies that Medicare approves. Each Plan is licensed to serve a specific area, so you must check with your Plan to make sure it covers where you live. If you have certain doctors or providers that you see, its also important to check whether theyre covered by the Medicare Advantage Plan youre considering.
Keep in mind that each Medicare Advantage Plan is different and can choose to cover only medically necessary services. This means if a service isnt required to diagnose or treat your condition, you may pay out-of-pocket for those services.
If Your Provider Charges You And Youre In The Qmb Program
Inform who is requesting payment that youre in the QMB program. If youve already paid, youre entitled to a refund.
To ensure this does not happen, show your QMB card or Medicare and Medicaid card to your providers each time you receive care. Your Medicare Summary Notice can also serve as proof that youre in the QMB program. You can access your MSN electronically through your MyMedicare.gov account.
If a provider continues to bill you, call Medicares toll-free number. They will confirm your QMB status and request cessation of billing and/or refunds from your provider. In the case that debt collectors wrongly pursue payment, you can submit a complaint to the Consumer Financial Protection Bureau online or via telephone.
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Why Might I Need A Medicare Advantage Plan
The type of Medicare coverage that works best for you is your decision. Here are some of the ways Medicare Advantage plans might appeal to some beneficiaries:
Medicare Advantage plans: scope of benefits
Medicare Advantage plans often offer more benefits than Medicare Part A and Part B. Many Medicare Advantage plans offer additional benefits which may include one or more of the following :
- Medicare Part D prescription drug coverage
- Routine vision care
- Routine dental care
- Gym membership and/or other wellness programs
You might find a Medicare Advantage plan that provides the benefits you want. And you might appreciate the convenience of getting all of your health-care coverage in a single plan rather than dealing with multiple insurance companies.
Its important to note that if you pay a premium to your Medicare Advantage plan, its not the only premium youll need to pay. You still need to pay your monthly Medicare Part B premium as well, no matter what Medicare Advantage plan you might sign up for.
Medicare Advantage plans: maximum out-of-pocket costs
Medicare Advantage plans: HMO, PPO, HMOPOS plans
If you had group health insurance coverage under an employer or union plan, you might be familiar with health plans such as health maintenance organizations , preferred provider organizations , and HMO point-of-service plans. Similarly, some common types of Medicare Advantage plans include HMOs, PPOs*, and HMOPOS plans.
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When Can I Change Medicare Plan Options From Medicare Advantage To Medicare Supplement
To buy a Medicare Supplement plan, you must first leave your Medicare Advantage plan and return to Medicare, Part A and Part B administered under the federal Medicare program. But heres what you need to know about changing from Medicare Advantage to Medicare Supplement:
- You can only leave your Medicare Advantage plan during certain times of the year, in most cases: during the Medicare Advantage Open Enrollment Period , or during the Medicare Advantage and Prescription Drug Annual Election Period . There are some exceptions, such as if you move from home to an institutional setting such as a nursing home, or from an institutional setting to home. Other exceptions are noted below.
- Once youve returned to Original Medicare, you can apply for a Medicare Supplement plan anytime you want but your acceptance into a plan isnt always guaranteed. For example, if you have health problems, the insurance company can base its decision on your health history in a process known as medical underwriting. The company can decide not to sell you a plan, or to charge you more because of your health condition.
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How Has Health Reform Impacted Medicare Advantage
The Patient Protection and Affordable Care Act has restructured payments to Medicare Advantage plans in an effort to reduce budget spending on Medicare, but for the last few years, the payment changes have either been delayed or offset by payment increases. When the law was first passed, many people including the CBO projected that Medicare Advantage enrollment would drop considerably over the coming years as payment reductions forced plans to offer fewer benefits, higher out-of-pocket costs, and narrower networks.
But that has not been the case at all. Medicare Advantage enrollment continues to grow each year. There were nearly 28 million Advantage enrollees in 2021, which accounts for more than 43% of all Medicare beneficiaries Thats up from just 13% in 2004, and 24% in 2010, the year the ACA was enacted.
The number of Medicare Advantage plans available has increased for 2022 to the highest in the last decade, with a total of 3,834 plans available nationwide. The majority of beneficiaries still have at least one zero-premium plan available to them, and the average enrollee can select from among 39 plans in 2022.
Can I Switch From Medicare Advantage To Medigap
There are generally only a few situations that allow you to leave Medicare Advantage and pick up a Medigap plan without being subject to medical underwriting.
If you joined a Medicare Advantage plan when you were first eligible for Medicare and you arent happy with the plan, youll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining.
If you are moving to a different state or part of the state and your Medicare Advantage plan does not serve that area, you also have special rights to return to Original Medicare and pick up a Medigap plan.
Remember, If you had a Medigap policy in the past then left it to get an MA plan, when you return to Original Medicare, you might not be able to get the same Medigap policy back or in some cases, any Medigap policy unless you have a trial right or guaranteed issue right.
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