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Surprise costs in Medicare Advantage plans generally arise because of how these plans are structured. Unlike Original Medicare, which is a fee-for-service program managed by the federal government, Medicare Advantage plans are managed care policies sold by private insurance companies.

Selecting the best Medicare plan depends on your health needs, budget, and preferences. Here are some practical tips: Assess Your Health Needs: Consider your current health status, medications, and preferred doctors. Compare Costs: Review premiums, deductibles, copayments, and out-of-pocket maximums. Check Provider Networks: Ensure your doctors and hospitals are in the plan's network. Review Extra Benefits: Some plans offer vision, dental, hearing, or wellness programs.

WHY ARE MEDICARE ADVANTAGE PLANS BAD? Misinformation and a lack of understanding can lead to Medicare Advantage nightmares. So, we are here to help clear the air. Medicare Advantage plans are not always problematic. However, they are certainly not a good fit for everyone. You should only enroll in Medicare Advantage coverage if it is the best fit for your unique situation. Below, we clarify why these seemingly too-good-to-be-true plans have a less-than-stellar reputation an

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.

All Medicare Advantage plans offer their own summary of benefits, and these benefits, as well as the plan’s formulary, pharmacy network, provider network, premium, and/or co-payments/coinsurance, may change on January 1 of each year.

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:

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.  

Original Medicare has always consisted of Two Parts, Medicare Part A and Medicare Part B, since Lyndon Johnson signed it into law.  Then, under Bill Clinton, Medicare introduced the third part of Medicare, Medicare Part C. Initially referred to as Medicare Choice at the time, it later became known as Medicare Advantage.   Lastly, George W. Bush added the final component of Medicare, Medicare Part D, which covers Prescription Drug plans.