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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

Medicare Managed Care Manual

My Advocate Helps   This website helps you Save money, engage with your community, and improve your health.

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

 

Technical Resources

Wikipedia.org

Medicare Acronyms

 

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 $135/month.  

How is zero or low premium coverage possible? 

Here’s an Explanation from  *   Insure Me Kevin.com   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.

Click here to view the Medicare & You Pamphlet # 10050 or What is a Medicare Advantage Plan # 11474  where Medicare has done an excellent job of explaining how these plans work, the rules and options.

See the menu above to get more details on the plans we offer, service and represent in California.  See also our webpage comparing Original Medicare, Medi-Gap and Medicare Advantage.

Please email us  to discuss your options. 

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.  You can also  change prescription drug plans, return to Original Medicare  (or must you wait for the disenrollment period?) and look into Medi Gap plans (PPO Any Medicare Provider).  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.

For more details and the exact rules, see our page on when can you enroll for more details, or email us.

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.

Understanding Medicare Advantage Plans
Understanding Medicare Advantage Plans

Insurance Companies get a fee from the Federal Government, when you enroll in one.  That's why the premium is very low or ZERO!

Video Understanding Medicare Advantage - Millman

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions


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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.

What are the different types of Medicare Advantage Plans?

• Health Maintenance Organization (HMO) plans: See page 61. of Medicare & You – Link in Side Panel

Anthem MediBlue Plus

Blue Shield 65 Plus HMO 

United Health Care
• Preferred Provider Organization (PPO) plans: See page 62.

Blue Cross PPO Orange County

• Private Fee-for-Service (PFFS) plans: See page 63. (I haven’t see these in CA) 
Special Needs Plans (SNPs): See page 64.

• 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.

Part D Rx Prescriptions

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.

 

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. See page 65.  Medicare & You – see link in the side panel

Read More in Medicare & You – see link in the side panel

Travel Policies

4 comments on “Medicare Advantage Plans – Part C

  1. Can you give me a brief overview of the MA landscape.

    Will MAPD in Northern California actually be a decent option in 3-5 years?

  2. My Father died last month. My mom needed to go to the hospital over the weekend. Now all of a sudden Kaiser (under my Dad’s Retiree Program from AT & T) is saying that my Mom’s Medicare Advantage plan is cancelled. My Mom was not given any notification of termination. I had to pay cash to get her admitted.

    How can a MAPD plan terminate coverage without notification?

    • IMHO the best way to see the rules on termination would be to look at the actual evidence of coverage EOC. I don’t have yours, so let’s look at this one. CMS sets the rules… so they should be basically the same.

      Using the table of contents We see that termination and ending membership is in chapter 10 starting on page 203.

      On page 209 – When must the Insurance Company end your plan, I don’t see a spouse passing away as a reason! On page 210 the policy states:

      If we end your membership in our plan, we must tell you our reasons, in writing, for ending your membership. We must also explain how you can file a grievance or make a complaint about our decision to end your membership. You can look in Chapter 9, Section 10 for information about how to make a complaint.

      My SWAG guess is that since the primary holder of the policy passed away, they just cancelled the entire policy. CRAZY huh!

      Kaiser doesn’t charge for their MAPD plan, so I can’t see any premium issues. There might be issues with the Part B premium as maybe that was paid for under the retiree plan your Dad worked for.

      I would need to review the retiree plan documents from your Dad’s employer.

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