Is a Medicare Advantage Plan Right for You?

In 2011,Annual Election Period for Medicare Advantage plans ran from October 15th to December 7th, and should occur in the same time frame in 2012. There are, of course, exceptions, so discuss your situation with a qualified Medicare Advantage Plan health insurance professional before taking a decision. (Each year, in order to sell Medicare Advantage plans and Part D Prescription Drug Plans, agents must complete a detailed educational program and pass a rigorous examination. Ask to see a copy of their Certificate of Completion.)

Just what are Medicare Advantage Plans, anyway? Taken from Medicare & You,  2012, the official government handbook published by the Centers for Medicare & Medicaid Services: Medicare Advantage Plans are health plan options (like HMOs and PPOs) approved by Medicare and run by private companies. These plans are part of the Medicare Program and are sometimes called 'Part C' or 'MA plans.' Medicare pays an amount for your care every month to these private health plans. Medicare Advantage Plans must follow rules set by Medicare. Medicare Advantage Plans aren't supplement insurance.

How Medicare Advantage (MA's) Plans work: MA's must provide all of your Medicare Hospital Insurance (Medicare Part A), Medical Services provided under Medicare Part B, and must cover at least all medically necessary services that original Medicare provides. In exchange for those healthcare services MA Plans charge differing co-payments,(HMO plans) and/or deductibles and coinsurance, (PPO plans). MA's may offer additional benefits such as vision, dental, hearing, health/wellness programs. Medicare Advantage Plan providers offer Plans that include Prescription Drug (Medicare Part D) benefits (MA-PD's), and MA Plans that do not include the Part D feature.

Expect your MA Plan to include a provider network. If your MA Plan is a HMO, you must obtain your healthcare services from a network provider, and you may be required to obtain a referral from your network primary care physician to see a specialist. If you obtain healthcare services from an out-of-network provider, you may have to pay the full cost of the covered service out of pocket. If your MA Plan is a Preferred Provider Orgainzation (PPO) plan, expect to pay deductibles and co-insurance amounts in exchange for healthcare services.

There are other forms of MA Plans: Private Fee for Services Plans (PFFS), Medical Savings Account Plans (MSA), and Special Needs Plans, each of which occupies a niche under Medicare. If you live in a rural area, your best bet may be a MA Private Fee For Service Plan, as there may not be a provider network in your location. Typically, you can go to any Medicare-approved doctor or hospital if they agree to the PFFS plan's conditions, terms and payment schedule before treating you. Before joining a PFFS plan, be sure your intended doctor/hospital is willing to contact the Plan and accept its terms, conditions, and payment schedule.

Medical MSA Plans incorporate a High Deductible Health Plan and a Bank Account. Medicare provides dollars to the plan each year for your health care. The plan, in turn, deposits part of those dollars into your account. You may use the money in your account to pay for approved medical expenses, including Medicare-approved Part A and Part B services, with such counting toward your plan's deductible. After your deductible has been met, your plan covers your Medicare-covered expenses. Any cash remaining in your account at year-end is added to your next deposit.

Special Needs Plans (SNP's), are just that. SNP's are for those living in nursing homes or similar institutions; those requiring in-home nursing care; those with certain chronic/disabling conditions; those eligible for both Medicare and Medicaid. Discuss your case with Medicare and/or your Medicaid contactto determine your eligibility for a SNP.

Medicare Advantage Plans may be available in your area in exchange for premiums starting as low as zero dollars per month. More comprehensive plans require higher monthly premiums; however, most should fit a tight monthly budget. If you are okay with HMO's and/or PPO's...and if the doc's and hospitals most important to you are members of the offering insurance company's provider panel, a MA Plan may be right for you. ( Note: If you need financial assistance, or if your are now on Medicaid, contact Medicare at 1-800-633-4227, to get the phone number for your state medical assistance office. You may also visit Medicare at: www.medicare.gov.)

Medicare Advantage Plans are not Medicare Supplement Plans. Medicare Supplement Plans are designed to "fill the gaps" in original Medicare Parts A and B. If you want complete freedom to use the services of any qualified doctor or hospital, while retaining your original Medicare Parts A and B coverages, consider obtaining a comprehensive Medicare Supplement Plan together with a separate Part D Prescription Drug policy. Caveat: Depending upon how long you have been eligible/enrolled in Medicare Parts A & B, your application for a Medicare Supplement policy may be subject to strict health history underwriting requirements.

Each year the Centers for Medicare & Medicaid Services mails an information booklet called Medicare & You to those of us on Medicare, and each year far too many of us fail to take a few minutes to review it. I borrowed from the 2012 edition, liberally, to write this short article, and there is much more information in it for you. Your assignment today is to dig it out and spend twenty minutes reading through it...after all, you paid for it.