Medicare Advantage Plans (MA) are developed by private insurance companies and cover all the treatment & procedures in Medicare Part A & Part B. In addition, individuals receive additional benefits such as a full annual physical. A person receives any needed treatment by going to the plan's network of providers.
Note: MA plans are what is called Medicare Part C.
MA plans focus on coordinating all medical services not just to provide treatment. 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 and may include dental, vision, hearing, and fitness coverage.
● The benefits planned for a specific MA plan are submitted to MediCare. When the companies proposal is approved they receive a contract and can then begin to offer this plan to individuals effective the first of the coming year.
● A proposal for a MAPD includes 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, the lower monthly cost (often ) than with a MediGap plan plus a stand alone Part D plan is a big plus for many.
● 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 costs for medical treatment you have each 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.
● You will also have co-pays and cost sharing on the prescription coverage part of the plan which vary based on the Tier a medication is in,
-> Prescription plan benefits vary based on coverage stages. First is the Deductible, which most plans only use on higher Tiers, next is Initial Coverage, then Coverage gap [donut hole], then the Catastrophic stages.
MediCare has an annual time for individuals who want to make a change called the Annual Election Period. (AEP) A person using the 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 special situations where a change can be made. Federal regulations limit 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, 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.
● Meeting is not possible but many enrollment forms can now be completed on line.
Content on Medicare-Health-Plans-Southeastern-CT is © 2018 to 2020 by John C Parker, RHU, LTCP - All Rights Reserved.
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