Medicare Advantage

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.

The Medicare enrollment period is a designated time each year when beneficiaries can make changes to their Medicare coverage. This period typically runs from October 15 to December 7 annually. During this time, you can: Switch from Original Medicare to a Medicare Advantage plan. Change from one Medicare Advantage plan to another. Enroll in a Medicare Part D prescription drug plan. Drop your Medicare prescription drug coverage.

MEDICARE SUPPLEMENT vs MEDICARE ADVANTAGE, which option is better? This has been an ongoing battle for decades and will continue for the foreseeable future. It is one of the most common and confusing decisions people face when enrolling in Medicare.

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

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.

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:

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.

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.

Here at Braden Medicare Insurance, it is almost an oxymoron to say the words Medicare and Reader's Digest Form in the same sentence. That is simply because Medicare is so broad and complex that it is challenging to encapsulate the concepts in a book, let alone a chapter, and have them make sense. In this article, we have done our best to present the condensed Reader's Digest version of Medicare. We hope you find the article helpful and worthwhile.

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.

When deciding which plan to enroll in, your first step should be to choose between Medigap plan vs. Medicare Advantage plans.