Medicare Advantage Plans

  1. Must be eligible for Part A and enrolled in Part B of Medicare
  2. Must continue to pay Part B monthly premium
  3. Must physically reside in the service area. (county specific)
  4. Apply during a valid enrollment period
  5. Generally, not eligible if you have End Stage Renal Disease (ESRD)
  1. You select a primary doctor (PCP)
  2. You receive all of your medical within a specific network, including specialists
  3. Referrals are required for specialty care
  4. Emergency and Urgent care available nationwide
  5. Copays for nearly all procedures up to an annual maximum
  6. Part D - Prescription Drug coverage generally included in MAPDs
  7. Many plans offer additional benefits above Medicare requirements
  1. Generally, select a primary doctor (PCP)
  2. Generally, may get care from any provider in US who accepts Medicare
  3. Contact the plan when seeing out of network providers to ensure care is medically necessary and will be covered
  4. Copays are higher with out of network providers
  5. Annual copays may be higher than HMOs depending on use of in and out of network providers
  6. Part D - Prescription Drug coverage included in
  7. Many plans offer additional benefits above Medicare requirements
  1. Limits enrollment to certain beneficiaries based on health care status or eligibility for Medicaid
  2. Dual Eligible SNP: Those eligible for both Medicare and Medicaid
  3. Chronic Care SNP : Those with severe or disabling health conditions
  4. Institutional SNP : Those who for 90 days or longer have had or expect to need institutional care
  5. All SNPs include prescription drug coverage

  1. Generally, this is a HMO health plan and functions as a HMO (see HMO above)
  2. These plans work well for those who have credible prescription coverage from another source, i.e., the VA, or VEBA plans
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