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Lesson 07: Medicare Part C (Advantage Plans)

Medicare Advantage Plans

Medicare Advantage Plans previously called Medicare + Choice, is a result of the 1997 Balanced Budget Act that, among other things, increased the number of health care options available to those who qualify. Companies that sponsor MA plans contract with the Centers for Medicare and Medicaid Services (CMS) if they choose to participate. All Medicare Advantage plans must offer at least the same basic benefits as original Medicare.

Eligibility

To enroll in a Medicare Advantage plan, a person must:

  • Be enrolled in Medicare Parts A and B.
  • Live within the plan`s service area.
  • Not have End Stage Renal Disease (ESRD).
    Note: Those who are diagnosed with ESRD after enrolling in a MA plan can remain in the plan.

Benefits

MA plans must offer, at the very least, the benefits that original Medicare offers. Premiums and co-insurance payments may differ, or a plan may offer additional benefits, but all plans must offer the basic benefits. Providers under contract with a managed care plan are generally required to accept the plan`s payment as payment in full.

Different Types of Medicare Advantage Plans

There are other less common types of Medicare Advantage Plans that may be available:

  • HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.
  • Medical Savings Account (MSA) Plans - A plan that 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.

 

Enrollment and Disenrollment

Enrollment and disenrollment from Medicare Advantage is permitted only during Open Enrollment (November through March of the next year). Once enrolled, members must remain in the plan from April to December, except for special circumstances.

To Disenroll:

  • Contact the plan or local Social Security office and complete a disenrollment form to return to Original Medicare. No disenrollment form is needed if switching from one Medicare Advantage plan to another. Disenrollment from the old plan is automatic when the new plan begins.
  • Enrollment in the new Advantage plan and disenrollment from the old plan is automatic.

Help choosing a Medicare Advantage Plan

Back To: Medicare 101
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Medicare.gov
Medicare Contact Center P.O Box 1270
Lawerence KS 66044

Description:

Medicare.gov has all of the information and tools you need for questions or help with Medicare. You can:


Medicare Nursing Home Compare

Use the site to obtain a free copy of A Guide to Choosing a Nursing Home.You can search the site to obtain and compare nursing home information from all parts of the country, including their performance at their last Medicare state survey.

Medicare Plan Finder

Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area.  

Use Medicare's Plan Finder to find and compare Medicare Advantage (Part C) plans available in your area.  Have the enrollee's zip code ready.

You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Part A and Part B deductibles, coinsurance, and copayments if you meet certain conditions.

Medicare Savings Programs

There are four kinds of Medicare Savings Programs

  1. Qualified Medicare Beneficiary (QMB) Program
  2. Specified Low-Income Medicare Beneficiary (SLMB) Program
    If you have income from working, you may qualify for SLMB benefits even if your income is higher than these limits.
  3. Qualified Individual (QI) Program
    You must apply every year for QI benefits. QI applications are granted on a first-come, first-served basis, with priority given to people who got QI benefits the previous year. (You can't get QI benefits if you qualify for Medicaid).
  4. Qualified Disabled and Working Individuals (QDWI) Program
    The QDWI program helps pay the Part A premium. You may qualify if any of the following apply to you:

Are a working disabled person under 65
Lost your premium-free Medicare Part A when you went back to work
Aren't getting medical assistance from your state
Meet the income and resource limits required by your state

How to Apply for Medicare Savings Programs

Many people do not know or understand if they qualify for Medicare Savings Programs.  Council on Aging can help.  Call us at 513-721-1025 for help in determining your eligibility. 

If you qualify for a Medicare Savings Program in your state, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

Print Resource

Ohio Senior Health Insurance Information Program (OSHIIP)
50 W. Town St.
Columbus OH 43215

Description:

Ohio Senior Health Insurance Information Program (OSHIIP)

 

OSHIIP provides free health insurance information and services for Ohioans with Medicare. They will answer your questions about any of the matters listed below.

 

  • Medicare health coverage for seniors and for people under age 65 with disabilities
  • Medicare prescription drug plans
  • Medicare Advantage Plans (example: HMOs and PPOs)
  • Medicare supplemental insurance
  • Financial assistance programs for people with limited income
  • Long-term care insurance
  • Home health care coverage
  • Retiree health plan coverage

Toll-free Hotline

OSHIIP's Medicare experts speak with hundreds of callers daily. They provide objective, accurate information and assistance. Call toll-free from anyplace in the USA: 1-800-686-1578

Local volunteer counselors

OSHIIP is involved in your neighborhood.

  • OSHIIP has trained and certified more than 800 volunteers across the state
  • Volunteer counselors are experts on Medicare and related health insurance matters
  • A local volunteer can meet with you in person or speak with you over the telephone 

Want to become an OSHIIP volunteer?

Without volunteers, OSHIIP could not fulfill its mission. Dedicated people are needed to be volunteers in all parts of Ohio. As a volunteer, you will:

  • Learn about Medicare in a free 22-hour course
  • Help people in your community
  • Have the satisfaction of taking part in a truly worthy cause

For more information, contact OSHIIP about the next training course in your area.  Call 1-888-686-VOLS or email oshiipmail@insurance.ohio.gov.

Click here for an OSHIIP fact sheet.

(513) 721-1025