Medicare Advantage (MA) plans, developed by private insurance companies, take over from MediCare and are MediCare's Part C. They provide you with:
● All the treatment and procedures covered by Part A & Part B
● A full annual physical plus various additional benefits.
● All needed medical related treatment and services through the plan's network of providers.
Note: Benefits such as dental, vision, hearing, and fitness coverage are being added. Some include certain benefits and others offer options for an additional cost.
The focus of MA plans is to improve treatment outcomes by monitoring and coordinating your medical services. Outcomes are also improved by including and coordinating prescriptions. Plans with medications & medical are called a MAPD.
A new and evolving focus for MAPDs is on Social Determinates of Health. (SDOH). These are the things in a persons life which cause them to not get treatment or to not follow after treatment recommendations such as the after surgery.
In investigating why individuals health was declining MAPD companies found many people didn't make their appointments because they didn't have transportation. Thus, including no cost transportation to needed medical visits as a covered benefit is becoming common. When SDOH factors are included the result is better health. Plus paying for transportation is cheaper than when a person needs additional expensive treatment.
● The quality of care is usually higher and treatment outcomes are often better!
Why is that? When all your medical treatment and medications are coordinated the results are better!
● Then too, a recent study by the Better Medicare Alliance showed — "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 MAPSs because:
-> they receive a real annual physical and the extra benefits.
-> the monthly cost is usually lower than with a MediGap plan plus a stand alone Part D plan. This is a Big Plus for many.
● Continue to pay your monthly Part B cost. Plus MA companies (usually) have a monthly cost. The amount is based on the level of benefits in the plan you select. For example, plans with lower co-pays, cost sharing, and a Maximum Out of Pocket will have a higher monthly cost.
● Select MDs and providers in the companies network when any treatment is needed. Show them your MA plan ID card, not your MediCare card. They will bill your MA company for your treatment not the MediCare system.
When going to a network MD for medical treatment:
● Office visits such as a PCP have a co-pay. Preventive visits have no cost.
● Seeing a Specialist means a higher co-pay than a primary care MD.
● Some services have cost sharing or a specific fee.
● When in a hospital you pay a per day fee for the first four or five days.
● All your co-pays and other medical treatment costs are limited each calendar year by the plan's Maximum Out of Pocket (MOP) provision.
Note: MediCare sets a limit for the medical MOP. (up to $7,550 in 2021) Many plans with no monthly cost plans use the maximum MOP. Some plans with a higher monthly cost have a lower MOP.
When goin to the Pharmacy for a medication:
● The cost of medications is not included in the plan's medical cost MOP, but they have their own MOP.
● When using the prescription part of the plan your benefits vary based on coverage stage of your prescription plan:
-> First is the Deductible. Many plans only apply it on higher Tiers.
-> The next stages are called — Initial Coverage — Coverage gap [donut hole] — Catastrophic . Co-pays and cost sharing are used based on the Tier the Plan placed a medication in.
First: The Initial Coverage Election Period (ICEP). When a person turns 65 they have a seven month time to sign up for a MA plan. It includes the three months before eligible for MediCare, the month when eligible, and three months after.
Second: The Annual Election Period. (AEP) Each year Medicare has this time in the for individuals to change their plan. It currently takes place from October 15 to Dec 7. Any change made in the AEP will be effective January 1st. Individuals can make changes such as to select a:
● different plan from their current Medicare Advantage company..
● plan with a different Medicare Advantage company;.
Here are the other federal periods when a MAPD can be changed.
John C Parker's Google Voice # — (860) 451-9793 today.
In talking we can:
● Discuss whether your looking ahead to 65 or planning to leave an employer, and:
-> your interests
-> to simplify how Medicare Advantage Plans in New London County Connecticut work.
● Select, when an enrollment period is available, the best MAPD for you situations which will provide peace of mind.
Note: In thinking about selecting a MAPD be alert for deceptive TV ads:
-> some say anyone on Medicare can get more benefits. However, only individuals with MedicAid & MediCare can sign up during the year
-> many benefits mentioned are only available to individuals who are dual eligible.
-> one is for a MediGap plan (a Medicare Supplement) not approved in CT!
● Face to face meetings are becoming safe again — we can talk on the phone about your situation and review options. Then if you decide to sign up we can meet. Then too, most enrollment forms can also be completed on line.
● Companies develop the benefits and where they want to offer a specific MA plan.
● The plan is submitted to MediCare for approval. The proposal also indicates the States and often spwhere the company wants to offer the plan. States and often specific Counties.
● When approved the company signs a one year contract.
● Marketing the plan to individuals can begin Oct. 1st for a Jan 1st effective date.
● Individuals living in an approved County can enroll from Oct 15th to Dec, 7th.
MediCare pays the MA company a fixed monthly payment for each person who signs up for their MAPD.