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Medicare is the most widely used health insurance program for individuals aged 65 and older. If you are nearing eligibility, it is essential to understand what Medicare is and how its four parts work. However, Medicare does not cover everything. You may need to enroll in additional plans to obtain full coverage.

What are Medicare Advantage Plans? Medicare Advantage Plans cover all Medicare services.  Some Medicare Advantage Plans also offer extra coverage, such as vision, hearing, and dental coverage.   

MA and MA/PD (Medicare Advantage Plans) were created as alternatives to Original Medicare and Medicare Supplement/Medigap insurance.  By joining one of these plans, you direct Medicare to pay the Advantage Plan a set monthly amount for your care.  In return, the plan will deliver all of your Part A & Part B benefits and services.

Both Medicare Part A and Medicare Part B are 80% government-paid, with the remaining 20% borne by the beneficiary or patient. With Original Medicare, you are free to choose a Doctor or Hospital that accepts Medicare Terms for payment. (Approximately 94% of all Doctors accept Medicare.

Medicare HMOs are common because of the lower premiums they often offer. In some plans, that premium may be as low as $0. However, you must remain enrolled in and pay for Medicare Part B. You usually must also use in-network providers, except in an emergency.  MEDICARE ADVANTAGE HMO PLANS = MEDICARE HEALTH MAINTENANCE ORGANIZATION PLANS In HMO Plans, you generally must get your care and services from providers in the plan's network, except:

Everything you need to know about Medicare starts here: there are three ways to receive Medicare coverage: Original Medicare, Medicare Advantage, and Medicare Part D. Each option has its own benefits and costs. 

Original Medicare includes Medicare Part A  (Hospital Insurance) and Medicare Part B (Medical Insurance).  The Government pays for 80% of all Medicare-covered and Medically Necessary procedures, while you, the Medicare Beneficiary, pa for the other 20% of health services not paid for by Medicare. You typically pay for services as you receive them. When you get services, you’ll pay a deductible at  the start of each year, and you usually pay 20% of the cost of the  Medicare-ap

A Medicare PPO Plan is a type of Medicare Advantage Plan (Medicare Part C) offered by a private insurance company. PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.

What makes matters confusing to the public is that it is different from any Healthcare we have ever had, and it uses words, concepts, and acronyms we have never seen or heard of before. However, once you have a chance to work with someone who not only understands Medicare but also has the requisite skills and attributes to teach and explain it to others, it becomes much less daunting. In this article, I have tried to encapsulate Medicare in a basic but friendly format that

The reason Special Needs Plans exist is to better serve individuals with a Team approach to their care. Having multiple "Specialists" in their networks is vital to these individuals receiving the best possible care possible. It is also an efficient way to coordinate resources for the Insurance companies. Medicare SNPs typically have specialists in the diseases or conditions that affect their members.

A Medicare PFFS Plan is a type of Medicare Advantage Plan (Medicare Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.  

CAN YOU CANCEL YOUR MEDICARE ADVANTAGE PLAN? Yes, you can cancel your Medicare Advantage plan. You need to qualify for one of the four Medicare Enrollment Periods during the Medicare Plan Year. The short answer is yes; however, you can only do this during certain times of the year, and there are a few trap doors you need to navigate. But if you are truly unhappy or dissatisfied with your Medicare Advantage Plan, this Article is definitely what you need to read.

Medicare uses Prior Authorization to ensure that certain medical services or prescription drugs meet specific coverage criteria before they are approved and paid for. Prior Authorization rules are implemented as cost-saving measures. Medicare wants to ensure that every Medical Procedure is medically necessary for the beneficiary's health.