Are All Medicare Plans Eligible
Individuals who pay their own Medicare Part B premium can be eligible for the Part B buy down. Those with Medicaid or other forms of assistance that generally pay the Part B premium cannot enroll in one of these plans. Persons with Medicare Supplement or Medigap coverage are not eligible for the Give Back Benefit.
Costs With Original Medicare Include:
- The Part B premium
- A low-cost or $0 plan premium
- A plan deductible
- Copays for covered health services and items
A note about financial protection: A really great benefit with a Medicare Advantage plan though is there is a limit on your out-of-pocket costs . This can really help keep your Medicare costs under control. Original Medicare does not provide any financial protection like this.
Medicare Advantage Vs Medigap
Medicare Advantage plans are sometimes confused with Medicare Supplement Insurance, also known as Medigap. Both are offered by private insurance companies, but the way your expenses are covered is different. As the name suggests, Medigap plans cover the gaps in Original Medicare by covering your share of covered charges. When you seek medical care, most or all of your cost-share will be covered by your Medigap plan. For this, you’ll pay a monthly premium.
Medicare Advantage plans, by contrast, are bundled plans that include the same coverage you’d get with Medicare Part A and Part B , plus often limited coverage for other things, like some dental services or an allowance for some over-the-counter drugs. You may pay a premium for a Medicare Advantage plan, but many are offered at no premium beyond your required Medicare Part B premium. Youll pay copays or coinsurance when you seek medical care. With a Medicare Advantage plan, youll pay out of pocket whenever you see a provider, and theres an out-of-pocket limit of $7,550 on covered care in 2022.
Also, because Medigap policies are standardized, its relatively easy to compare costs. Every Medicare Advantage plan is different, so comparison shopping can be difficult. You cant have both a Medicare Advantage plan and a Medigap plan at the same time.
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Can You Switch Between Original Medicare And Medicare Advantage
As a final note, no matter which option you decide is right for you, you can switch from Original Medicare to Medicare Advantage or vice versa. The two main times you can switch are the Medicare Annual Enrollment Period and the Medicare Special Enrollment Period for qualifying life events, if you qualify.
Many Plans Offer Additional Coverage
Medicare Advantage plans offer all the same basic benefits offered by Original Medicare .
But they may not stop there. Many Medicare Advantage plans may also offer additional benefits that are not covered by Medicare Part A or Part B, such as prescription drug coverage, dental, vision, hearing and more.
Some Medicare Advantage plans may offer even more additional benefits, such as transportation to doctors offices and grab bars for home bathrooms.
According to Medicare expert John Barkett, some Medicare Advantage plans started offering new benefits to beneficiaries with chronic illnesses in 2020. To hear more about these benefits, watch the video below.
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Who Qualifies For Medicare Advantage
Generally, Medicare Advantage is available for:
- Seniors age 65 or older
- Younger people with disabilities
- People with end-stage renal disease
With Medicare Advantage plans, you must also be enrolled in Medicare Part A and Part B and reside in the plans service area.
Enrollment only occurs during certain periods, but you cannot be denied coverage due to a preexisting condition. Specifically, you can join or switch to a Medicare Advantage plan with or without drug coverage during the following three windows:
- Initial Medicare Enrollment Period: Begins three months before you turn 65 and ends three months after you turn 65
- Open Enrollment Period: From Oct. 15 to Dec. 7
- Medicare Advantage Open Enrollment Period: Jan. 1 to March 31 annually
A Majority Of Medicare Advantage Plans Provide Traditional Supplemental Benefits
Nearly all plans provided traditional medical supplemental benefits such as vision, dental, hearing, and fitness services in 2020 . In addition, a substantial and growing number of plans offer over-the-counter benefits, which cover the purchases of certain nonprescription items such as first aid supplies and sunscreen. As shown in Exhibit 4, these benefits were common before CMS expanded its definition of primarily health-related benefits. Supplemental benefits such as dental, vision, and hearing have long been popular with plans and enrollees.
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What Is A Medicare Advantage Plan And Why Should I Buy It
A Medicare Advantage plan is a type of health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Parts A and B benefits. MA plans include health maintenance organizations, preferred provider organizations, private fee-for-service plans, and Special Needs Plans.
Coverage Choices For Medicare
If you’re older than 65 and not already getting benefits from Social Security, you have to sign up for Medicare Part A and Part B. It doesn’t happen automatically. However, if you already get Social Security benefits, you’ll get Medicare Part A and Part B automatically when you first become eligible .
There are two main ways to get Medicare coverage:
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The Evolution Of Medicare
Social programs inevitably change over time to meet evolving needs of the communities that they support. Its true that Medicare hasnt evolved significantly since its creation. But the program has seen a few substantial changes over the years that helped make it more viable to more people.
Healthcare in America has long been the subject of debate among politicians. Inflated premiums, minimally regulated standards of care and the high cost of specialty medical treatments make healthcare difficult to understand and navigate. Nowhere is this idea truer than in the realm of senior care. In response to various needs, Medicare was modified to reflect the changing culture of senior healthcare.
Seven years after the passage of the Medicare bill, an amendment was added to the law that allowed for coverage of physical therapy, speech therapy and chiropractic care. These forms of care help seniors, particularly those with disabilities, to achieve alternate forms of medical treatments. In some instances, physical therapy may reduce the need for expensive prescription drugs. Another example is that chiropractic care may help alleviate stress and neuromusculoskeletal conditions.
What Are The Benefits Of A Medicare Supplement Plan
A Medicare Supplement plan makes your out-of-pocket costs more predictable and easier to budget.
From a cost-sharing perspective, many people like it because you dont need to worry about how much is owed every time you go to the doctor or are hospitalized, said Jacobson. You can literally see any doctor around the country that you would like to see. For example, if you live in Arizona, you can fly to Minnesota to go to the Mayo Clinic.
Unfortunately, Jacobson says having this benefit tends to be much more important for people when theyre sicker. When people first go on Medicare, theyre usually relatively healthy and not thinking necessarily about when theyre sick and what type of plan would be best for them in that situation. The inability to easily switch back and forth between Medicare Advantage and Medicare Supplement makes it pretty complicated for people, she says.
For example, if you join a Medicare Advantage plan for the first time and arent happy with it, federal law grants you special rights if you return to Original Medicare within the first 12 months. After that, you can only disenroll or change plans during the Open Enrollment Period or if you qualify for a Special Enrollment Period. Depending on the type of Special Enrollment Period, you may or may not have the right to buy a Medigap policy.
At the end of the day, the decision often comes down to whether you can afford a Medigap plan, as they can be more expensive.
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Medicare Advantage Plans Have Specific Service Areas
Most Medicare Advantage plans have regional networks of participating providers. To enroll, you must reside in the Medicare Advantage planâs service area at least 6 months of the year. If you divide your time between homes located in different areas, this requirement may be difficult to meet.
The bottom line is that Medicare Advantage plans may provide more affordable coverage than you would receive otherwise. The trade-off is that you have to follow the Medicare Advantage planâs rules to receive payment for covered services.
Do you have other questions about Medicare Advantage? Call us and speak with a licensed insurance agent about finding Medicare Advantage plans in your area and your Medicare coverage options. Or just enter you zip code on this page.
Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.
Original Medicare Vs Medicare Advantage: Coverage
Original Medicare covers inpatient hospital and skilled nursing services Part A – and doctor visits, outpatient services and some preventative care Part B.
Medicare Advantage plans cover all the above , and most plans also cover prescription drugs . Additionally, Medicare Advantage plans each offer extra benefits, which while they vary by plan and provider, may include coverage for dental, vision, hearing, fitness programs, rides to doctor appointments and more.
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Medicare Advantage Open Enrollment
During the open enrollment period, which runs from October 15 to December 7 each year, you can join, switch or drop a plan for your coverage to begin on January 1 of the following year.
If youre already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or Original Medicare during the Medicare Advantage open enrollment period, which starts on January 1 and ends on March 31 annually. You can only make one switch during that time period.
If youre already enrolled in Original Medicare , you may be eligible to switch to a Medicare Advantage plan . You must be at least 65 years old or have certain disabilities, such as permanent kidney failure or amyotrophic lateral sclerosis . If the Medicare Advantage plan you choose doesnt already have prescription drug coverage, you will have the option to enroll in Part D.
What Types Of Medicare Advantage Plans Are There
Coordinated Care Plans
Most Medicare Advantage plans are coordinated care plans. Coordinated care plans have a network of doctors and providers. If you use the plan’s network doctors and providers, you generally pay less out-of-pocket for care.
Health Maintenance Organization plans
HMO plans use a network primary care provider to help coordinate care. HMO plans usually only pay for doctors and providers in the plan network.
Point of Service plans
POS plans have the benefits of an HMO, but with more flexible doctor/provider choice. Costs are generally lower for using in-network doctors/providers.
Preferred Provider Organization plans
PPO plans cover doctors and providers both in and out of network. These plans pay a portion of the cost for using an out-of-network doctor or provider.
Special Needs Plans
Special Needs Plans have benefits that cover special health care or financial needs. All SNPs include prescription drug coverage.
- Dual-Eligible Special Needs Plans for people who have both Medicare and Medicaid
- Chronic Special Needs Plans for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
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Top Advantages & Disadvantages Of Medicare Advantage
Medicare Advantage plans, also called Medicare Part C plans, operate as private health plans within the Medicare program, serving as coverage alternatives to Original Medicare.
In many cases, Medicare Advantage plans provide more services at a cost that is the same or cheaper than the Original Medicare program.
What makes Medicare Advantage plans bad is they have more restrictions than Original Medicare on which doctors and medical facilities you can use. The plans also impose copays, deductibles and other out-of-pocket costs that can make it complicated to predict the actual cost of your health care.
Find Cheap Medicare Plans in Your Area
|Bundled coverage usually includes Rx drugs and perks
|Low or no monthly costs a limit on annual medical spending
|Medical costs vary based on your needs
|Provider restrictions, regional networks and prior authorizations
Switching Back To Original Medicare
While you can save money with a Medicare Advantage Plan when you are healthy, if you get sick in the middle of the year, you are stuck with whatever costs you incur. If you decide that the Medicare Advantage Plan isn’t for you, you have the right under federal law to purchase any Medigap plan if you switch to Original Medicare within 12 months of the date that you joined a Medicare Advantage Plan for the first time.
You may also switch from your Medicare Advantage Plan to Original Medicare during the annual Open Enrollment Period or if you qualify for a Special Enrollment Period. However, you may not be able to purchase a Medigap policy . If you are able to do so, it may cost more than it would have when you first enrolled in Medicare.
Keep in mind that an employer only needs to provide Medigap insurance if you meet specific requirements regarding underwriting . The wait time for Medigap coverage can be avoided if you have what is called a “guaranteed issue right.”
A thorough breakdown of what is considered a “guaranteed issue right,” where an insurance company can’t refuse to sell you a Medigap policy, can be found on the Medicare website.
Most Medigap policies are issue-age rated policies or attained-age rated policies. This means that when you sign up later in life, you will pay more per month than if you had started with the Medigap policy at age 65. You may be able to find a policy that has no age rating, but those are rare.
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Find A $0 Premium Medicare Advantage Plan Today
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.
The purpose of this communication is the solicitation of insurance. Callers will be directed to a licensed insurance agent with TZ Insurance Solutions LLC, TruBridge, Inc. and/or a third-party partner who can provide more information about Medicare Advantage Plans offered by one or several Medicare-contracted carrier. TZ Insurance Solutions LLC, TruBridge, Inc., and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.
Medicare Advantage Transportation Benefits
As technology and needs are ever-changing, older adults are considering giving up their vehicles and moving more to use rideshare services for their transportation needs. Some Medicare plan options are heeding the call and adding robust transportation benefits to help members get to their medical appointments.
These quickly changing situations and new technology has made getting an Uber or Lyft a quick, affordable, and easy process. This, combined with declining health or medical conditions, can accelerate or force a senior to give up the keys.
Giving up your mode of transportation isnt an easy decision as, for many seniors, your vehicle symbolizes your freedom and independence. But it can be a viable choice for a positive impact on their wellness.
Below well discuss how different Medicare insurance options will cover transportation. Then, well go over what is and isnt covered, which option offers the most transportation benefits, and answer some frequently asked questions.
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A Small Share Of Medicare Advantage Enrollees In Individual Plans Have Access To Special Supplemental Benefits For The Chronically Ill But A Larger Share Of Enrollees In Snps Have Access To These Benefits
Beginning in 2020, Medicare Advantage plans have also been able to offer extra benefits that are not primarily health related for chronically ill beneficiaries, known as Special Supplemental Benefits for the Chronically Ill . The majority of plans do not yet offer these benefits. Fewer than half of all SNP enrollees are in plans that offer some SSBCI. The share of Medicare Advantage enrollees who have access to SSBCI benefits is highest for food and produce , meals , transportation for non-medical needs , and pest control .
It Is Better To Have Medicare Advantage Or Medigap
Medicare Advantage plans and Medicare Supplement Insurance are not the same thing. You cannot have a Medicare Advantage plan and a Medigap plan at the same time.
If you’re choosing between Medicare Advantage vs. Medicare Supplement plans, you may want to consider the following:
- Do you prefer to pay more of your health care costs up front in exchange for lower or zero costs when you receive care?
- Do you prefer to pay lower out-of-pocket health care costs up front and potentially pay more in costs later on if and when you receive care?
If you prefer lower or no coinsurance and copay costs in exchange for higher monthly premiums, you may want to consider a Medicare Supplement plan.
If you prefer to pay low or $0 monthly premiums and don’t plan on receiving frequent health care services, you may want to consider a Medicare Advantage plan.
A licensed insurance agent can help you compare your options and discuss your eligibility for different types of Medicare plans.
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