Kentucky Health Insurance

A Medicare Advantage plan is Part C of Medicare. It is the program that allows Medicare beneficiaries to enroll in a private health plan to receive Medicare cover and also enjoy a few added perks. Medicare Advantage plans are offered by private insurance companies approved by Medicare. Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules fixed by Medicare.

Understanding Medicare Advantage

Traditional Medicare is a Fee for Service plan that covers many healthcare services. When you receive your healthcare service, you show you Medicare Card that is issued to you when you enroll in Medicare. This original plan pays for many health services and supplies but does not cover all your healthcare costs like copays and deductibles.

Medicare Advantage Plans are health plan options approved by Medicare, but offered through private health insurance companies. If you join one of these plans, you are still in Medicare, but generally get all your Medicare coverage through private companies and use the insurance that the plan provides.

The main differences between Traditional Medicare and Medicare Advantage are as follows:

•    Firstly, copays and deductibles are lower with Medicare Advantage than with traditional Medicare.

•    Medicare Advantage plans provide Medicare Part A or Hospital Insurance and Medicare Part B or Medical Insurance. However, Medicare Advantage Plans do not cover hospice care, which is covered by Original Medicare even if you are in a Medicare Advantage Plan.

•    Medicare Advantage plans may also offer extra benefits such as vision, hearing, dental, preventive care services, and health and fitness programs.

•    Medicare Advantage plans have Medicare Part D (Prescription Drug Coverage) built in. With Traditioanl Medicare, Part D has to be purchased separately.

•    Finally, with Traditional Medicare, you can see any doctor or hospital. Many Medicare Advantage plans work with contracted providers – doctors and hospitals with whom they have worked out a long-term contract.

Different types of Medicare Advantage Plans

•    Health Maintenance Organization (HMO) Plans
•    Preferred Provider Organization (PPO) Plans
•    Private Fee-for-Service (PFFS) Plans
•    Special Needs Plans (SNP)

Other Medicare Advantage Plans

•    A HMO Point of Service (HMO POS) Plan that allows you to get some services out-of-network for a higher cost.

•    A Medical Savings Account (MSA) Plan combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year. You will then also have to pay out of pocket for care, until the MSA plan deductible is met, after which plan coverage begins. MSA plans may or may not have contracted providers, but MSA plans cannot restrict access to a network of doctors, facilities or suppliers.

When you enroll in a Medicare Advantage plan, you pay a monthly premium to Medicare and also a monthly premium to Medicare Advantage for the added benefits it offers.

Medicare thus offers you the option of getting your health insurance through Traditional Medicare or through private insurance with a Medicare Advantage plan. If you choose a Medicare Advantage plan, you must specifically opt to and give the authorization to receive your healthcare through the plan.

To make the right choice, compare costs and benefits carefully. Professional help is always at hand. So contact a knowledgeable insurance dealer who can explain the details and help you select the best Medicare plan.

What is Medicare?

Medicare, America’s government health insurance program, was signed into law by President Lyndon B. Johnson on July 30, 1965. It provides health insurance coverage for persons aged 65 and older, for the disabled and for those with permanent kidney failure. Medicare is now assuming even more significance as the baby boomer generation is poised to turn 65, making millions of Americans eligible for Medicare.

Medicare is often confused with Medicaid. They are not the same. Medicare was created in 1965 with the aim to provide health coverage to people on social security. Medicare is also state-run, but meant to help with the hospital and medical coverage of people in poverty or with little resources.

How Medicare Works

Medicare is divided into four parts: A, B, C and D.

Part A – Inpatient care in hospital, skilled nursing facility, hospice, and home health care
Part B – Medically necessary services like outpatient care, doctors’ services and screenings
Part C – Medicare Advantage Plan managed by private insurance companies
Part D – Prescription Drug Coverage

•    Part A covers hospitalization. You become eligible when you sign up for social security. It is free if you have signed up for social security and paid Medicare taxes when you were working. It also covers your spouse.

You are eligible for Part A if:

- You receive or are eligible to receive Social Security benefits; or
- You receive or are eligible to receive railroad retirement benefits; or
- You or your spouse (living or deceased, including divorced spouses) worked long enough in a government job where Medicare taxes were paid; or
- You are the dependent parent of a fully insured deceased child.

Most people don’t pay  Part A premium because they paid Medicare taxes while working. This is called “premium-free Part A.”

Medicare Part A works with a fee-for-service plan and you would be charged only if you are hospitalized. It covers hospital stays and emergency care. If a person had an accident and needed to be hospitalized, Medicare Part A would take care of this.

Most Americans are eligible for Part A, but even if you are not, you can purchase it for a premium. You have the option of adding on B, C or D.

•    Part B covers doctor’s office visits, medical services and supplies including preventive screenings. For instance, if you have a fever and need to see a doctor, you would be covered by Part B. Usually, you are automatically enrolled in Part B when you have Part A. Part B is not free and you have to pay a monthly premium for these services.

An individual has the option to cancel Part B coverage by contacting the Medicare Office. However, the cost of Part B is minimal and so it is advisable to keep it.

•    Part C is Medicare Advantage. This is optional Medicare coverage offered by private health insurance companies that are approved by Medicare. If you have Medicare Parts A and B, you can join a Medicare Advantage plan. With a Medicare Advantage plan, you can get the benefits of Parts A, B and D as well as some additional advantages.

Medicare Advantage plans include:

- Medicare managed care plans
- Medicare preferred provider organization (PPO) plans
- Medicare private fee-for-service plans, and
- Medicare specialty plans

Medicare Part C is not free. The health plans that private insurers offer work through hospital, doctor and other service provider networks that they are associated with. So you would get medical services only through these networks. Prescription drug coverage would also have to be paid for.

•    Part D is prescription drug coverage. You are eligible for Part D if you have Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C). When you opt to join a Medicare prescription drug plan, you have to pay an additional monthly premium for the coverage.

To sum it up:

Medicare Part A covers hospital stays and emergency care
Medicare Part B covers doctor office visits and routine health procedures
Medicare Part C is the Medicare Advantage plan run by private insurance companies. It combines the benefits of A and B and also gives the option to add D, if not already included
Medicare Part D is prescription drugs. A fee is usually charged for a drug care service or supply service.

Kentucky Medicare

You become eligible for Medicare when you reach age 65. If are nearing eligibility, you need to make your Medicare coverage choice at least three to four months in advance. You have two basic choices: Original Medicare Coverage and Medicare Advantage Plans.

Medicare comprises four parts: A, B, C and D.

Part A covers hospital stays and emergency care

Part B covers doctor visits and routine health procedures

Part C is the Medicare Advantage Plan approved by Medicare and run by private companies

Part D is prescription drug coverage

Original Medicare Coverage

This includes Medicare Part A and Part B and is provided by Medicare.

• You can choose your doctors, hospitals, and other providers, and you or your supplemental coverage pays deductibles and coinsurance. While most people do not have to pay for Part A, everyone must pay a monthly premium for Part B.
• If you want Prescription Drug Coverage (Part D), you must join a Medicare Prescription Drug Plan offered by a Medicare-approved private company.
• Any gaps in insurance can be covered by adding on a supplemental policy like Medigap from a private insurance company.

Medicare Advantage Plans

This comprises plans like a HMO or PPO provided by a private insurer approved by Medicare.

• With most plans, you need to use approved doctors, hospitals, and other providers, and if you don’t, you have to pay more or all of the costs.
• Besides the premium for Part B, you also have to pay a monthly premium and a co-payment or coinsurance for services that are covered. Costs, extra coverage, and rules differ from plan to plan.
• Prescription drug coverage is usually offered by most these plans. If it is not, you can choose to join a Medicare Prescription Drug Plan.
• With a Medicare Advantage Plan, you don’t need and can’t use a Medigap policy.

Besides the above two choices, Medicare also offers other types of plans. These include Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE). Most of the plans provide Part A and Part B coverage, and some also cover Part D.

Your choice of plan can be influenced by health and/or prescription drug coverage that you may have from a former or current employer or union.

What Medicare Does Not Cover

While Medicare offers basic protection against health care costs, it does not cover all your medical expenses or the costs of most long-term care. For that, you need a long term care plan. It would cover nursing home and other charges such as at-home health care, custodial care like help (not from skilled nurses) with dressing, walking, or eating, adult day care, and so on.

Making the Right Choice

To understand all about how Medicare works and make an informed choice, talk to an independent medical insurance agent. You can get comprehensive information on various kinds of plans and how to fill gaps in coverage. Professional guidance is also necessary when it comes to buying long-term health insurance.