If you are over or close to the age of 65, Medicare is something that you might be utilizing or thinking about using. If you are in that boat, then it is essential to know your open enrollment times. If you are looking to go with the Medicare Advantage Plan, open enrollment is upon us.
Recipients of Medicare have a choice between the Medicare Advantage Plan or the Medicare Supplement Plan which is like a PPO plan. The difference between the two is that in the Advantage plan you will pick a primary care physician who will direct your care. They are known as the gatekeeper. If you need to see any specialist, they will provide a referral for that. Under a PPO contract, you have the flexibility to direct your care. You do not have a primary care physician, and you have a choice of any doctor in your provider network. This option does have a higher cost in comparison to the Medicare Advantage Plan so we often see people in this area choose the Advantage Plan and it works well for them. Many doctors prefer this plan over the PPO option, as well, because there are Medicare Reporting standards that they are held to and it is easier to capture that data on this particular plan.
The Medicare Advantage plans and Part D have open enrollment starting on October 15 and ending on December 7. So if someone has original Medicare and purchases a drug plan without any other supplemental coverage that is the time that they can change their drug plan because Medicare by itself does not cover medication.
At Bernardini & Donovan, we work very closely with a majority of our clients who utilize the Medicare Advantage Plan. If that is something that you know that you want to look into, there is no one better for you talk to than us. Our years of experience allow us to help you plan and see how you can have the low cost of the Advantage Plan while having the best possible health care available to you. Please feel free to call us today to set up an appointment if you have questions.
When considering Medicare Advantage Plans, it helps to take a closer look at their benefits and costs so that you can more easily understand the plans.
As you may know, these plans contract annually with Medicare and a fixed monthly amount gets paid by Medicare. That amount can change yearly, based on Medicare, and varies by county.
The nice thing about these plans is that they sometimes offer coverage for things that Medicare does not cover. This can include things like eye exams, prescription coverage and dental visits, but it does vary by county.
You should know that there is a monthly premium for these plans and it is in addition to the Medicare Part B premium.
While some services under these plans require co-payment, they are often at a lower amount than the Medicare fees. And legally the amount is not allowed to exceed the Medicare fee amount.
Medicare Advantage plans are alternatives to traditional fee-for-service Medicare. The plans are sponsored by the federal Medicare program, which pays private health insurance companies to administer and provide coverage to those eligible for Medicare. In other words, Medicare coverage is provided by an insurance company like Humana or United Healthcare rather than directly from the Centers for Medicare and Medicaid Services.
There are several types of Medicare Advantage plans from which to choose:
1. Health Maintenance Organizations or HMOs.
These plans require beneficiaries to select a primary care doctor who manages all healthcare needs. Services from specialists require a referral from the primary care doctor before the plan will pay benefits.
2. Preferred Provider Organizations or PPOs.
These plans include a number of in-network providers who charge a lower co-payment than providers outside the network.
3. Private Fee-for-Service Plans or PFFSs
These plans allow beneficiaries to go to any Medicare-approved doctor or facility, as long as the specific plan is accepted by the provider.
4. Special Needs Plans or SNPs.
These plans are for people with people with certain health conditions or who are living in a nursing home.
To learn more about the Medicare Advantage plans that are available to California residents, please contact Bernardini & Donovan Insurance Services.
let Bernardini & Donovan find the right plan for you
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