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Medicare Advantage Plans

What do Medicare Advantage Plans cover?

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs. Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for the plan’s medical and prescription drug coverage. Plan benefits can change from year to year. Make sure you understand how a plan works before you join.

Medigap (Supplement) Plans

Medigap (Supplement) Plans

Original Medicare pays for many, but not all, health care services and supplies. A Medigap policy is private insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits. Note: Medicare doesn’t pay any of your costs for a Medigap policy.

Prescription Drugs

Prescription Drug Coverage

Medicare drug coverage helps pay for prescription drugs you need. Even if you don’t take prescription drugs now, you should consider getting Medicare drug coverage. Medicare drug coverage is optional and is offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.
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FAQs:

You can join a plan when you first become eligible for Medicare when you turn 65 years old. This begins three months before the month you turn 65 and ends three months after the month you turned 65.
AEP : Annual Enrollment Period

Runs October 15th - December 7th each year.

It’s when you can add, switch or drop your Medicare Advantage plan or your prescription drug plan.

OEP : Open Enrollment Period Runs January 1st - March 31st each year. Those enrolled in a Medicare Advantage plan can make a one time change to their plan or return to Original Medicare.
SEP : Special Enrollment Period These occur with special circumstances. Some examples are: Leaving a group employer plan Moving out of your service area Becoming eligible for or losing low-income assistance

Original Medicare includes Parts A (Hospital) and B (Doctors). Most American citizens are eligible for Medicare when they turn 65 years old. Whether you should enroll in Medicare Parts A and B depends on several factors:

  • Original Medicare
  • Medicare Supplement with Prescription Drug Coverage
  • Medicare Advantage Plan

There is not a one-size-fits-all when it comes to health care.

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Yes.  I have set aside Thursdays in my calendar for the Enrollment period of October 15th to December 7th to meet in an office in Columbia.  You can schedule a time to meet with me there at this link:  Columbia location appointments

  • Phone: 717-487-4382
  • Email: rjrill@yahoo.com