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What You Need to Know About Medicare Advantage Plans

As a senior over the age of 65, you are entitled to Medicare insurance but it doesn’t cover everything. Medicare Advantage Plans and supplemental insurance are there to help fill the gaps. Medicare Advantage Plans (also called Part C or MA Plans) are bundled health insurance plans offered by private companies approved by Medicare. The bundled plans include Original Medicare, which is Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare prescription drug (Part D). Kupuna who choose a Medicare Advantage plan will have their Medicare benefits administered through that plan.

What do Medicare Advantage Plans cover?

Medicare Advantage Plans are required to cover all Medicare services and most provide additional services that Original Medicare doesn’t cover. For example, some Medicare Advantage Plans provide coverage for vision, hearing and dental as well as wellness plans, which are not covered by Original Medicare. Some more recent plans also provide coverage for services such as adult day-care centers and transportation to doctor visits. All Medicare Advantage plans cover emergency and urgently needed care.

Note that a MA plan can choose not to cover the cost of a service that it doesn’t deem medically necessary under Medicare so it’s important to check with your provider or Medicare Agent before you receive care.

Rules for Medicare Advantage Plans

Apart from requirements to include all services offered by Original Medicare and follow the rules set by Medicare, MA plans may also have other rules for services such as a requirement to see in-network providers and whether you need a referral to see a specialist.

Costs for Medicare Advantage Plans

The cost of Medicare Advantage Plans varies. Some plans have no monthly premium, others have a premium but include your Part B Medicare fee, and still others may have a low monthly premium but come with a high deductible or coinsurance. It’s important to factor in the services that you will receive from a MA plan and compare them carefully to the costs and services provided with the other options you’re weighing.

Drug coverage in Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D). It is also an option to sign up for just Medicare Part D in addition to Original Medicare or along with specific types of plans like a Medicare Medical Savings Account. Speak to a Medicare Agent about your prescription drug coverage options.

Can I have Medigap and Medicare Advantage?

No, Medigap policies, also called Medicare supplement insurance or Medicare supplemental insurance, do not work with Medicare Advantage Plans. Medigap plans are used to cover the cost of a lot of the co-pays and some of the coinsurance charged to Medicare enrollees for services provided in hospitals, skilled nursing facilities, ambulance rides, home health care, durable medical equipment, and doctor charges.

If you want to know more about whether Medigap, Medicare Advantage plans or other supplemental insurance would benefit you; we are here to answer your questions. Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed.

Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.

At PBC our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.


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