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Need help Understanding all your Options?
Having an expert who can help guide you through the structure, plans, benefits and costs of Medicare can make a big difference as you explore your options at no additional cost to you!
How Medicare Works
Medicare is the federal health insurance program for people over 65 years of age and people with certain disabilities or End-Stage Renal Disease (permanent kidney failure).
There Are Four Parts to Medicare:
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Part A – Hospital Insurance
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Part B – Optional Medical Insurance
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Part C – Optional Medicare Advantage Insurance
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Part D – Optional Prescription Drug Insurance
Medicare Part A
Helps pay for care in hospitals, some skilled nursing facilities, hospice, and some health care. For most people, Part A is premium-free because they paid Medicare taxes.
Optional Medicare Part B
Optional coverage to help pay for doctors, outpatient hospital care, and some other medical services not covered by Part A. Part B monthly premium amounts are based on income and change each year. There may be a late-enrollment penalty.
Part C Optional Medicare Advantage Plan Monthly
An alternative to traditional Medicare, Part C is another way to get Medicare benefits. It combines Part A, Part B, and, sometimes, Part D (prescription drug) coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. However, plans can charge different copayments, coinsurance, or deductibles for these services.
Part D Optional Medicare Prescription Drug Plan
This optional coverage may help lower an individual’s prescription drug costs and help protect against higher costs in the future.
Medicare Advantage & PDP
The Annual Election Period is October 15 through December 7. We’re here to help with your preparation and answer your questions.
What is a Medicare Advantage Plan?
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan you pick and not Original Medicare.
Click here to find which medicare plans are in your area here.
Covered services in Medicare Advantage Plans
Medicare Advantage Plans cover all Medicare services that original Medicare cover. Medicare Advantage Plans may also offer extra coverage such as vision, hearing, dental, and/or health and wellness programs. Most Medicare Advantage Plans include medicare prescription drug coverage (Part D).
Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs.
Things to consider when choosing a Medicare Advantage Plan
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Could have no monthly payment in addition to your Medicare Premium.
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Some plans require a referral to see a specialist.
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You must go to doctors that accept the plan and you must stay in the network.
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Not all plans offer out of network coverage.
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You can choose an HMO or a PPO.
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Make sure your medications are covered on the plan.
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Do you have Medicaid? Some plans work with your medicaid for low out of pocket cost.
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Companies can change there benefits each year.
Costs for Medicare Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors. Depending on the state you live in, some Medicare Advantage plans have a monthly premium in addition to your Medicare premium and some plans have no monthly payment. Typically when you go to the doctor or hospital you will have a co payment for the service. Each service you get requires a different co payment amount so its good to check several plans and make sure you understand the out of pocket cost. Its good to check with an insurance professional to find the best plans in your area or visit medicare.gov.
Drug coverage in Medicare Advantage Plans
You usually get prescription drug coverage (Part D) through the Medicare Advantage plan. In some types of medicare advantage plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan. You can't have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you do you'll be dis-enrolled from your Medicare Advantage Plan and returned to Original Medicare.