In my ALTERNATIVES posting I said I would name what those options are - and I will - but it gets quite complicated so I'll go slow.
Some of the options replace Original Medicare Parts A and B and others add coverage to Original Medicare.
The CMS allows private insurance companies to offer a product called Part C or Medicare Advantage (MA). It is a complete replacement for Parts A and B, often with some additional features. CMS dictates to the insurance companies that their Advantage products must contain, at the very least, all of the coverges that make up those of Parts A and B. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies.
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs.
Each plan can also have different rules for how you get services, like:
- Whether you need to stay within a specific network of hospitals, doctors, labs, etc.
- Whether or not you need to have a Primary Care Physician (PCP) or not
- Whether you need a referral from your PCP to see a specialist
- If you have to go to doctors, facilities, or suppliers that belong to the plan's network for non-emergency or non-urgent care
In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.
These plans can choose not to cover the costs of services that aren't medically necessary under Original Medicare. If you're not sure whether a service is covered, you will have to check with your provider before you get the service. If you need a service that the plan says isn't medically necessary, you may have to pay all the costs of the service.
Most Medicare Advantage Plans offer extra coverage, like vision, hearing, dental, and/or health and wellness programs.
You must have had both Plans A and B before you can convert (sign up for) an MA plan. There are also limited timeframes when you can make the change.
In addition to continuing to pay Part B premiums you may also have to pay an additional premium for these plans.
Not all insurance companies will offer plans in all states and counties, and if they do they may offer a number of different plans with different coverage levels and different premiums.
As you can see from the chart below there are still other options for additional coverages for both Original Medicare and Advantge plans.
In my next posting I will cover Part D - Drug coverage. See you then.