Medicare Advantage Plans (MA) provide all the treatment and procedures covered by MediCare Part A & Part B plus all have a full annual physical and often additional benefits such as dental, and vision. Plans are developed by private insurance and when a person enrolls all needed treatment is received by going to the plan's network of providers.
Note: MA plans are what is called Medicare Part C.
Companies providing MA plans focus on improving a person treatment outcomes by coordinating all medical services. To make the coordination as effective as possible most MA plans also include medications. The plan is then called a MAPD.
Companies are expanding the additional benefits they offer. Some include dental, vision, hearing, and fitness coverage and others offer them as options.
● A look at the development:
-> Companies decide on the benefits for a specific MA plan
-> The plan is then submitted to MediCare. When approved a contract for one year is signed
-> Marketing can begin on Oct 1st for a Jan 1st effective date
-> Individuals living in an approved County can enroll from Oct 15th to Dec, 7th.
● A proposal for a MAPD will include the State and specific Counties where the company wants to offer the plan. Individuals living in an approved County can then buy the new plan.
● MediCare pays the company a fixed monthly payment for each person who signs up for their MAPD.
● In addition to this payment, companies (usually ) charge a monthly cost based on the benefits, co-pays, and cost sharing in a specific plan.
● When a person needs treatment they select MDs or other providers in the companies network, The provider bills the company not the MediCare system for any treatment a person receives.
● A big advantage to individuals in a MAPD is the quality of their care is usually higher and treatment outcomes are often better!
Why is that? Better results come from the coordination of all of a person's medical treatment and medications.
● The advantage of coordination can be found in a recent study by the Better Medicare Alliance — "individuals in private MA plans had:
> one-third fewer ER visits
> 23% fewer stays in a hospital than those in traditional fee for service MediCare."
● People like MAPDs because of the complete annual physical and the extra benefits. Then too, a big pus for many is the lower monthly cost (often ) than with a MediGap plan plus a stand alone Part D plan.
● You pay an office visit co-pay when you go to a network MD.
● Co-pays to see a Specialist are higher than a primary care MD. Preventive visits have no cost.
● You may be charged cost sharing for some services.
● A per day fee is charged for the first four or five days if hospitalized.
● All the co-pays, cost sharing, and other medical treatment costs you have during a calendar year are limited by the plan's Maximum Out of Pocket (MOP) provision.
Note: MediCare sets a limit for the medical MOP. ($6,700 in 2020) Many plans use this. Some may offer a lower MOP with a higher monthly cost.
● The medical MOP does not include your medication costs. The prescription part of the plan also has a MOP for the various co-pays and cost sharing based on the Tier a medication is in.
● Prescription plan benefits vary based on coverage stages.
-> First is the Deductible. Many plans only use it on higher Tiers.
-> The next stages are the — Initial Coverage — Coverage gap [donut hole] — Catastrophic .
Yes — at certain times!
The primary time for a person to make a change is called the Annual Election Period. (AEP) A person using the MediCare's AEP can:
● Select another plan from their company or change to another company.
● Make changes from 10/15 to 12/7 with the new coverage effective Jan 1st.
MediCare also has other special times such as a life change situation where a change can be made. Federal regulations limit the times to enroll in or change a MAPD plan.
Call or Text John C Parker's Google Voice # — (860) 451-9793 today:
● Discussion during a call, whether you'll soon be 65 or have a qualified enrollment period such as leaving an employer, will be on:
-> your situation & interest
-> simplifying how Medicare Advantage Plans in New London County Connecticut work.
● When an enrollment period is available the focus will be on selecting a MAPD best for your situation, which will provide peace of mind.
● Setting up a face to face meeting is not safe but we can, review options over the phone. Then if you want to sign up many enrollment forms can now be completed on line.