MEDICARE ADVANTAGE
What You Need To Know About
The All-Inclusive Package
A Medicare Advantage Plan (aka Medicare Part C) is simply a Medicare approved private insurance company that manages your Medicare benefits. Essentially, Part C combines Part A, Part B and many times Part D as well as other necessary medical services a person may require such as hearing, dental and vision.
Many of the Original Medicare deductibles and coinsurances are lowered or even eliminated. For example, your hospital deductible will often be replaced by a flat co-pay per day for the first few days of hospitalization. Because Medicare Advantage plans often include prescription drug coverage, you avoid all Medicare penalties and receive a comprehensive benefit package that is reasonable and attractive for those who may not be able to afford a Medicare Supplement plan.
There are a few rules to follow before you can receive coverage through a Medicare Advantage Plan. The rules are simple...Your primary doctor is responsible for obtaining approval for referrals to specialists and select medical services like surgeries and medical equipment.
That’s it. This is because most are structured as an HMO, which means you will have to wait for an approved referral before you can make an appointment for the new doctor or service. If you try to use the service or see the specialist without the authorization (approval for payment), then you would be on the hook to pay for the entire bill. With that said, there are processes for urgent matters to allow same day and/or next day approval for services, or even waive approvals entirely for emergency services. If a procedure or referral is needed ASAP, then it’s possible to get you care ASAP.
It is important that all of your doctors are contracted with the same Medical Group to ensure continuity of care (a medical phrase meaning to continue all current doctors and services). To find out which Medical Group all of your doctors accept, you may either call each doctor individually or contact us to help you through it. Each Medical Group only works with certain Health Plans. Because of these selective partnerships, there may be Health Plans with great benefits that would not be available to you because they unfortunately do not contract with your doctor’s Medical Group. Therefore, it is important to find out which Medical Groups your doctors work with before comparing Health Plans.
The good news is that you have access to great benefits with reasonable rules!