Medicare Advantage Plans MAPD
Medicare Advantage Plans MAPD are also know as Medicare Part C. MAPD plans generally include low co-pays, deductibles, an HMO type list of doctors and hospitals. and often include Dental and Part D – Rx Prescriptions with low or no premiums. The main enrollment requirement is that you must have both Part A Hospital and Part B Doctor Visits which runs about $144/month.
Check out the Official Understanding Medicare Advantage Brochure & Millman Video at the right if you have a full screen monitor or scroll down or click the link to view.
How is zero or low premium coverage possible?
It’s not free, Medicare pays the Plan – Insurance Company about $1,000/month InsureMeKevin * to care for you, which includes paying us as your agent to help you at no charge. Here’s an more Explanation from * Insure Me Kevin.com
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What are Medicare Advantage Plans?
A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.
If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. In most cases, you’ll need to use health care providers who participate in the plan’s network. Some plans offer out-of network coverage. Remember, in most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.
Medicare Advantage Plans cover all Medicare Part A and Part B services
In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care.
Medicare Advantage Plans must cover all of the services that Original Medicare covers.
However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.
Some Medicare Advantage Plans offer coverage for things that aren’t covered by Original Medicare, like vision, hearing, dental, and other health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you might have to pay a monthly premium for the Medicare Advantage Plan.
Medicare Advantage Plans must follow Medicare’s rules
Medicare pays a fixed amount for your coverage 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 and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrollment year. Remember, you have the option each year to keep your current plan, choose a different plan, or switch to Original Medicare. S
Read More in Medicare & You – see side panel or scroll down if you are on a smartphone
When to Apply?
It’s best to apply when you turn 65 or a few months before or after for the Medi Gap – supplement plans or Medicare Advantage Plans, as that’s the main “Open Enrollment” period where coverage is guaranteed issue for any plan.
If you didn’t enroll in Medicare Advantage when you turned 65, you can do that or change plans at the Annual Coordinated Election Period (AEP) which runs from October 15 through December 7 each year.
There is a guaranteed right to enroll in Medi-Gap after a one year trial period in MAPD. Your new plan, renewal and enrollment changes are effective on January 1.
There is a navigational menu above and below for the Companies, we represent with their brochures, provider lists, etc. that pay us to help you enroll in their plans at NO additional cost to you.
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What are the different types of Medicare Advantage Plans?
Health Maintenance Organization (HMO) plans:
- Anthem MediBlue Plus
- Blue Shield 65 Plus HMO
- United Health Care
Private Fee-for-Service (PFFS) plans: See page 63. (I haven’t see these in CA)
- End Stage Renal – Kidney Failure
- Mental Health SNP Special Needs Plan
HMO Point-of-Service (HMO POS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
Medical Savings Account (MSA) Plans: (I haven’t seen these in CA) These plans combine a high deductible health plan with a bank account that the plan selects. The plan deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. MSA Plans don’t offer Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan.
- AARP – Part D Rx
- Blue Cross Rx
- Blue Shield Rx
- Premiums for those with High Income
- Shop & Compare Tools Part D Rx
For more information on MSA Plans, visit Medicare.gov. To find out if an MSA Plan is available in your area, visit Medicare.gov/find-a-plan. or find a qualified agent in your area.
If you are in CA, that’s Us!
Resources, Video’s & Links
Medicare Made Clear 64 pages from UHC
What is a Medicare Advantage Health Plan Publication 11474
History & Details of Medicare Advantage Part C since 1997 CMS.Gov
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What % of those on Medicare, pick a Medicare Advantage Plan? Which companies have what % of the market?
Some thoughts are that Medicare Advantage plans might leave sicker patients in a worse position CA Healthline 7.6.2017