Medicare Advantage Plans (MA) cover all Medicare A & B treatment & procedures plus provide additional benefits such as a full annual physical. Treatment is received by going to the plan's network of providers.
Note: MA plans are what Medicare calls Part C.
The additional benefits in MA plans vary and may include dental, vision, hearing, and fitness coverage.
MA plans focus not only on providing treatment but coordinating all medical services. Thus, most include medications and are called MAPD plans.
● Benefits for a specific MA plan are developed by a private company and then submitted to MediCare. When the companies proposed coverage is approved they receive a contract and can then make this plan available the first of the coming year.
● A MAPD proposal will include the State and specific Counties where they want to offer the plan. Individuals then select from plans approved for their County.
● When a person signs up for a MAPD MediCare pays the company a fixed monthly payment.
● In addition, plans (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 and 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 the person in a MAPD is the quality of their care is usually higher and treatment outcomes are often better!
How is that? The coordination of all medical treatment and medications!
● A recent study by the Better Medicare Alliance provides an example of the advantage of coordination — "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 MA plans because of annual physicals and extra benefits. Then too, a big plus for many is the monthly cost is lower (often ) than for a MediGap plan plus a stand alone Part D plan.
● When you go to a network MD you pay an office visit co-pay.
● Co-pays are higher to see a Specialist than for a primary care MD. Preventive visits have no cost.
● Cost sharing may be charged for other services.
● If hospitalized there is a per day fee for the first four or five days.
● All the co-pays, cost sharing, and other medical treatment costs you have each year are limited by the plan's Maximum Out of Pocket (MOP) provision.
Note: MediCare sets a limit for the MOP. ($6,700 in 2020) Plans may use it or have a lower MOP. If they do the monthly cost will be higher.
Yes! MediCare established a once a year time called the Annual Election Period (AEP).
● Individuals can select another plan from their company or change to another company.
● The AEP takes place from 10/15 to 12/7.
● 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, if you will 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.
-> selecting a MAPD to provide peace of mind and taking care of all implementation details.
Content on Medicare-Health-Plans-Southeastern-CT is © 2018 to 2020 by John C Parker, RHU, LTCP - All Rights Reserved.
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