Part C Advantage plan, HMO, PPO

Part C  Advantage plan

The Basics.

Part C  Advantage Plan     The plans provide in many cases a savings for the Medicare enrollee.  Note that there are 5 Medicare Part C Advantage plans available.  Selecting the best plan for you will need a meeting to review the Benefits and Drawbacks of each plan.   By Medicare regulations, Medicare Part C –Medicare Advantage plan (MA)  and Part D ( PDP – Drug) plans are sold by the county of each state. This is referred to as ” The Service Area.”.  For Example:  My local service area is Lake, Marion and Sumter counties.  The Part C Advantage plan designated for this area are are not available in other areas.  Some plans may also be state wide such as the Part D – Drug Plan which covers the entire state of Florida.

Often the Part C Advantage plans are incorrectly referred to as Medicare Replacement plans.

If you choose an Advantage Plan, you WILL NOT LOSE MEDICARE.

You must have Parts A & B to enroll into either an Advantage Plan or a Drug plan.

Should you consider an Advantage Plan ?

The current trend is to have an Advantage plan.

The benefits of having an Advantage plan is that it may possibly save you some money, while at the same time offering additional benefits not provided by Original Medicare..    Many like the “Pay as you go” format.  With often no monthly premium, enrollee’s prefer to pay a Co-Pay when they need care.  In the event of major expenses., there are limits to protect your financial liability.  

They of course will provide all of the benefits of care approved by Medicare.  The care between a Supplement and an Advantage plan will often, but not always,  be provided by the same providers.   Providers that accept Medicare are not obligated to accept a Medicare Advantage plan. Not all providers accept MA plans or are qualified to accept them.   Therein lies potential conflicts.  The number of medical providers is growing rapidly.  We will check to ensure your Dr. is a provider prior to your enrollment.    Anyone with employer coverage may be familiar with ” Networks” of healthcare providers.  Although the different companies have particular requirements, there are a lot of similarities.

Most companies will include the drug benefits, eliminating your need to purchase a separate drug plan. Other benefits not covered by Medicare may include vision and Dental benefits, Podiatry,  24 hour access to a nurse, Portability outside of your home state and Fitness club membership just to name a few items.

 

education advantage plans
At first glance Advantage plans may seem confusing. I educate clients about the plans. removing any questions. When I leave I insist that if they have any questions, they call me. In essence, I become your employee to provide what you need.

 

What plans are available ?

The 2 plans you will encounter most are the HMO or a PPO.   The HMO will normally require you to select providers within the network,  while the PPO allow you to go outside of the network.  Most plans will have a ZERO cost per month and work with Co-Pays at the time of service

Advantage plans payments to providers are different from a Medicare Supplement.  With the MA Plans, the issuing company is solely responsible for payment to the provider.  The plans are sometimes incorrectly referred to as a Medicare Replacement.   When you enroll into a MA Plan, you never lose your enrollment in Medicare.  That enrollment is required to enroll into a MA Plan.

Starting in 2017, the company, in our local service area,  I represent,  will also provide a HMO, HMO-POS, PPO with Drug Benefits, PPO without drug benefits and a SNP plan for persons on Medicare.

 

 

Contact us for the plan availability in your area.  Medicare Part C Advantage plan are available according to your location.  Some companies will not be available in all counties.  HOWEVER – the company we represent provides plans for every county in the state of Florida.  Because of the details, they can be initially more confusing. Before you enroll in one, be sure to contact us first.  The benefits and plans approved by the Medicare and therefore come with restrictions.  MEDICARE WILL NOT ENDORSE ANY PLAN FOR YOU. THEY WILL ENSURE ANY PLANS OFFERED THE PUBLIC,  MEET THE STANDARDS SET BY MEDICARE.  A word of caution – If you enroll into a Advantage plan that you do not understand, getting out of it can be a problem.  Call us and we will not let you get into the wrong plan for you.

Contact us for the plans available in your location.  For Supplements, Advantage and Drug plans, we can provide them anywhere in Florida.   Life and Annuities we can cross state lines for our clients.   We need to know your ZIP CODE. and the COUNTY of your residence.  You need to be a resident of Florida and the service area.  If there is a problem, we may be able to work around it.

 

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