Medicare Advantage Plans

MEDICARE ADVANTAGE - PART C 

Medicare Advantage are health plans offered by private companies that are contracted with Medicare. These companies must follow rules and offer services at least equal to what is set by Medicare.  You must be signed up in Part A and Part B to be enrolled into Medicare Advantage.  You must live in the service area of the plan you want to join.

Medicare Advantage (Part C) – Medicare Advantage Plans with Prescription Drug coverage is also known as MAPD.  All 3 are included in a plan and  you do not have to purchase a separate drug plan.  The list of covered prescription drugs called Formularies vary by each plan.  The amount you pay for each drug depends on the plan and  where the drugs are placed into different “Tiers”  on their formularies including brand-name drugs and generic-name drugs.

 Here are some information on what Medicare Advantage offers that Original Medicare do not:

• Plans have Low Maximum Out of Pocket Varies

• No Part D Deductible

• No Part B deductible

Medicare Advantage also offers services for people with special medical needs such as Chronic and Dual Special Needs Plan.  Chronic Special Needs also called C-SNP are for people with chronic conditions like Diabetes, Cardiovascular Disorders, Chronic Heart Failure, Dementia, Cancer, Stroke and other severe and disabling chronic conditions. Dual Special Needs Plan called D-SNP are for people who has both Medicare and Medi-cal. 

Your Primary care physician manages your healthcare needs and a referral and/or authorization is required to see a specialists and other services.  The most common Medicare Advantage Plan types are HMO, PPO, PFFS and SNPs. These plans have copays, coinsurance and require services from providers in the plan’s network called In-Network Services.  You may be able to go Out-of-Network with some plans but you will pay more or may pay all of the cost if you use outside network services. 

For more information,  book an appointment today so you can discuss your current medicare situations with a qualified licensed agent.