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Medicare Advantage Plans
Eligibility for any Medicare Advantage Plan:
Must be eligible for Part A and enrolled in Part B of Medicare
Must continue to pay Part B monthly premium
Must physically reside in the service area. (county specific)
Apply during a valid enrollment period
Generally, not eligible if you have End Stage Renal Disease (ESRD)
Health Maintenance Organization (HMO):
You select a primary doctor (PCP)
You receive all of your medical within a specific network, including specialists
Referrals are required for specialty care
Emergency and Urgent care available nationwide
Copays for nearly all procedures up to an annual maximum
Part D - Prescription Drug coverage generally included in MAPDs
Many plans offer additional benefits above Medicare requirements
Preferred Provider Organization (PPO)
Generally, select a primary doctor (PCP)
Generally, may get care from any provider in US who accepts Medicare
Contact the plan when seeing out of network providers to ensure care is medically necessary and will be covered
Copays are higher with out of network providers
Annual copays may be higher than HMOs depending on use of in and out of network providers
Part D - Prescription Drug coverage included in
Many plans offer additional benefits above Medicare requirements
Special Needs Plans (SNP)
Limits enrollment to certain beneficiaries based on health care status or eligibility for Medicaid
Dual Eligible SNP: Those eligible for both Medicare and Medicaid
Chronic Care SNP : Those with severe or disabling health conditions
Institutional SNP : Those who for 90 days or longer have had or expect to need institutional care
All SNPs include prescription drug coverage
Medicare Advantage Plan without prescription coverage
Generally, this is a HMO health plan and functions as a HMO (see HMO above)
These plans work well for those who have credible prescription coverage from another source, i.e., the VA, or VEBA plans
“Secure Highground Inc is not connected with or endorsed by the United States government or the federal Medicare program.”
MEDICARE SUPPLEMENTS
PRESCRIPTION DRUG PLANS
DENTAL INSURANCE