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This 22-minute video goes over all you need to know about Medicare Advantage plans. You learn the primary types of Medicare Advantage plans (i.e. HMO's & PPO's) and who Medicare Advantage plans are best for. We talk about why there are Medicare Advantage plans without prescription drug coverage and why some have bundled prescription drug plans. You also learn what to watch out for when selecting a plan.
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When you start Medicare you have the choice of keeping your Original Medicare or switching to a Medicare Advantage plan run by a private, for-profit insurance company.
Original Medicare is the Medicare parts A & B and D that we have detailed in previous videos. In this video we will talk about Medicare Advantage plans. In our next video of this series we will discuss Medicare Supplement or Medigap plans. You are only allowed a Medicare Supplement plan if you keep your Original Medicare. You cannot have a Medicare Supplement or Medigap plan and a Medicare Advantage plan at the same time.
So, let’s talk about Medicare Advantage plans.
1. Medicare Advantage plans replace your Original Medicare. They are not supplements. They do not supplement or enhance your Medicare coverage, they replace it. (show book) When you choose a Medicare Advantage plan the benefits and appeals processes outlined in this guide are no longer relevant. You can throw this book away. Your benefits will be detailed in an “Evidence of Coverage” provided by the insurance company you choose to replace your Medicare, along with their “Annual Notice of Change”.
You no longer need to show your doctor your red, white and blue Medicare card or Medicare number, you will have a new card provided to you by the insurance company.
You can no longer appeal your benefits to Medicare. Medicare is out of the picture as far as your personal service in concerned. If you decide to appeal an insurance decision, you must appeal to the insurance company.
2. Medicare Advantage plans are typically HMOs or PPOs and on occasion a Private-Fee-for-Service plan. HMO stands for Health Maintenance Organization. PPO stands for Preferred Provider Organization. We will talk more about both of those in a minute. What is important to understand is that Medicare Advantage plans are not standardized, they are regulated to meet a certain minimum coverage.
That is an important concept, so let me explain further. Medicare Part A & B is standardized. Medicare Supplement plans are standardized. Everyone in those plans receives the exact same benefits, they can see the exact same doctors and should have the exact same experience. With Medicare Advantage plans, each plan has different benefits, different co-pays, and deductibles, covers different medical services and has a different network of doctors and hospitals. Everyone’s experience is different and depends on which plan they have chosen.
In additional; all the benefits, co-pays, deductibles and the doctors and hospitals in the network can and will change each and every year. It will be your responsibility to keep up with the changes via their mandatory Annual Notice of Change. It’s your responsibility to study this annual notice and determine how the changes may impact your healthcare.
Medicare Advantage plans are regulated to meet a certain minimum standard. That minimum standard dictates that they must be actuarially equivalent to Medicare Parts A and Part B.
That’s an interesting term “actuarially equivalent”. What does that mean?