Medicare Advantage Plans explained

Medicare Advantage Plans, or Medicare Part C, are a health care choice for Medicare beneficiaries.  These plans are offered by private companies that have been approved by Medicare and the state’s department of insurance.  Medicare Advantage [MA] plans provide all of the coverage for both hospital and doctors visits for their insured.  Every plan must cover all the services that Original Medicare covers—except hospice care.  Original Medicare covers hospice care even if the beneficiary is a member of a Medicare Advantage plan.

Medicare beneficiaries must have Medicare Part A [hospital] and Medicare Part B [doctors] to enroll in a MA plan.  For most beneficiaries the Part A premium is free; the Part B premium is currently $96.40 per month for 73% of Medicare beneficiaries [will not increase in 2010 due to the lack of a cost-of-living increase by Social Security].  New Medicare enrollees in 2010 will pay $110.50 for their Part B premium.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans; this is why many offer the insurance coverage to Medicare beneficiaries at a very low or $0 premium.  However, each MA Plan charges different out-of-pocket costs and has different rules for how beneficiaries are provided services.

There are several types of Medicare Advantage plans:

·     Health Maintenance Organizations – HMO’s

·     Preferred Provider Organizations – PPO’s

·     Private Fee-for-Service – PFFS plans

·     Medical Savings Account – MSA plans

·     Special Needs Plans – SNP 

Not all Medicare Advantage Plans work the same way, so before you join, find out the plan’s rules, what your costs will be, and whether the plan will meet both your health and financial needs.  Just because a plan charges a $0 premium, does not mean all your medical care is provided at no cost.  Every plan has a cost structure; it is your responsibility as a consumer to find out what those costs are before enrolling in a health plan.  Most, but not all, MA Plans offer prescription drug coverage which means Medicare beneficiaries do not need to enroll in a Medicare Prescription Drug Plan.

The Nebraska Senior Health Insurance Information Program [SHIIP] has a list of insurance companies who have been authorized to offer MA Plans in the State of Nebraska; you may contact them at 1-800-234-7119 or by accessing their website:  DOI.SHIIP@nebraska.gov or you can also visit www.medicare.gov and select ‘Compare Health Plans and Medigap Policies in Your Area’ to compare cost and quality information.

When can you join, switch, or drop a Medicare Advantage Plan?  You can join, switch, or drop a Medicare Advantage Plan at these times:

·     Join when you first become eligible for Medicare—three months before the month you turn 65, the month of your 65th birthday, and three months after you turn 65.

·     If you get Medicare due to a disability, you can join during the three months before or three months after your 25th month of disability.  You will also have a chance to join upon reaching age 65.

·     Between November 15 and December 31 [Annual Open Enrollment period] each year.  Coverage will begin January 1 of the following year.  During this period you cannot:  1) join or switch to a plan with prescription drug coverage unless you already have a Medicare Part D plan; 2) drop a plan with prescription drug coverage; or 3) join, switch, or drop a Medicare Medical Savings Account plan.

If you are currently enrolled in a Medicare Advantage Plan that will not be approved by Medicare for 2010, you will receive a letter explaining your options.  If you don’t choose another MA Plan, you will automatically return to Original Medicare.  You will also have the right to buy certain Medigap policies.  If your plan stops providing service in your area, you may be able to keep your coverage if there are no other MA Plans in your area, but you must be willing to travel to the plan’s service area to get all your services.

Detailed information about Medicare Advantage plans can be found in your 2010 Medicare & You handbook from the Centers for Medicare and Medicaid Services.  You may also want to contact the University of Nebraska-Lincoln Extension office in your area.  Questions can be directed to Mary Ann Holland, Extension Educator and trained SHIIP Volunteer at 402-267-2205.  Open Enrollment for Medicare Part D and Medicare Advantage Plans is November 15 to December 31, 2009.