There are 3 requirements to enroll in a Medicare Advantage Plan:
- You must be enrolled in both Medicare Part A and Part B
- You must live in your plan service area, which includes cities in West Palm Beach
- You must not have end-stage renal disease.
It’s important to know that Medicare Advantage plans are not the same as Medicare supplement plans. Because you can only opt for one or the other, if you choose a Medicare Advantage Plan then you cannot qualify for a Medicare Supplement (or Medigap) Plan later.
You must continue paying for your Medicare Part B plan the entire time that you have your Medicare advantage plan. You will also be responsible for paying your Medicare advantage premium as well as your Medicare Part B premium for each month. However, many times Medicare Advantage plans are free, as in they have no premiums that you have to pay. If your Part B payment comes out of your Social Security check, then you will be responsible for paying your Medicare Advantage premium separately. Let’s take a closer look at this.
How Do Medicare Advantage Companies Get Paid?
Medicare pays money directly to your Medicare Advantage plan to administer your plan for you. Medicare Advantage enters a contract with local doctors, specialists, nurse practitioners and other healthcare providers in your local area. These providers will practice preventative care and manage medications and other health concerns for you. You will pay a co-pay whenever you see any one of these providers in the area where you live.
With Medicare Advantage the Federal Government pays your healthcare providers on your behalf by contracting with a private insurance company, such as Humana or Aetna. It’s important to understand that they are now administering your plan and paying your providers. If you opt for a Medicare Advantage plan then you should put your Medicare cards in a safe place once you receive your new cards. You do not want to accidentally present your Medicare card when receiving health services, because your claim will be denied. Your Medicare Advantage plan is now your primary insurance, not Medicare.
You will be required to pay a copay each time you see a provider for any service at any hospital, laboratory, doctor’s office, etc.
Always Check Who Is In-Network
Because this plan lasts for an entire year and because you are limited to only seeing the providers in your network (unless you want to pay out of network fees), you must be sure that your plan includes all of your providers. If you don’t, then you will have to find a new doctor, home health nurse, or other provider if yours isn’t in your new network. It’s important to think about all of the different people you rely on for care such as:
- Primary care physicians
- Durable medical equipment (DME) providers
- Your pharmacy
- Urgent care centers
- Your local hospital
- Diabetes suppliers
- Your home health care company
If you choose a plan and your provider is not one of the members of it, then you will need to find another local West Palm Beach provider. Each Medicare Advantage Plan can set their own premiums and pricing, so it’s important to check your plan.
I require dialysis. I’ve heard of the Medicare End-Stage Renal Disease (ESRD) Program. Can It Help Me?
If you worked for Social Security, the Railroad Retirement Board (RRB) or a Medicare-covered government employer, then call South Florida Medicare Specialists today.
Why People Choose Medicare Advantage Plans
There are a number of reasons why some people choose Medicare Advantage over a Medigap plan.
- Low premiums, or no premiums
- May be more affordable for those on a fixed income
- Consolidates the usefulness of your Medicare ID card, Medigap ID card, and Medicare Part D card into only one card, which is easier to manage and remember.
- Anyone who doesn’t have kidney problems, disease, or kidney failure can qualify, including people under age 65
- Anyone who missed the Medigap enrollment period, or finds that they need supplemental insurance but doesn’t qualify for the Supplement
- Out-of-pocket costs are capped at $6,700 until December 31, and every time you pay a copay to a provider that money counts toward that cap
There are also some ancillary benefits, such as dental or vision or hearing coverage, but they vary based on plan. Call to speak with your representative at the South Florida Medicare Specialists and ask about the ancillary benefits that you could receive with a Medicare Advantage plan.
Is Medicare Advantage Right For You?
One of the most important things that you need to remember with this type of plan is that every provider you see until you reach your deductible will require you to pay a co-pay. So, let’s say you see your primary care physician and pay a $40 co-pay, but based on your symptoms and your medical history your doctor tells you that you need some lab tests done. When you go to the lab you will also have another copayment. If your doctor says that you need to have a specific test done then you will need to cover the co-payment to that provider, such as a specialist, for administering the test. Even if all of these services were provided in the same building, you are still responsible for paying each individual provider.