MEDICARE ADVANTAGE PLANS ( PART C)
MEDICARE ADVANTAGE PLANS - PART C

Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans. 

 

In HMO Plans, you generally must get your care and services from providers in the plan's network, except:

  • Emergency care
  • Out-of-area urgent care
  • Out-of-area dialysis

In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option. Find and compare HMO Plans in your area.

 

Are prescription drugs covered in Health Maintenance Organization (HMO) Plans?

In most cases, prescription drugs are covered in HMO Plans. Ask the plan. If you want Medicare prescription drug coverage (Part D), you must join an HMO Plan that offers prescription drug coverage.


When you qualify for medicare, (aging in at age 65 or being on disability for 24 months) you may sign up for both PART A and PART B. We can help you with that. (Click here for PART A coverage information.) (Click here for PART B coverage.)

MEDICARE ADVANTAGE PLANS / SNPs (Special Needs Plans - click link below)

A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include:

• Health Maintenance Organizations
• Preferred Provider Organizations
• Private Fee-for-Service Plans
• Special Needs Plans
• Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

• Most Medicare services are covered through the plan
• Medicare services aren’t paid for by Original Medicare

Most Medicare Advantage Plans offer prescription drug coverage.

MORE ABOUT PART B

 

 

 
PRESCRIPTION DRUG PLANS - PART D

Medicare prescription drug plan coverage is an optional benefit.  Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to get Medicare drug coverage when you're first eligible, you'll likely pay a late enrollment penalty if you join later, unless one of these applies:
• You have other creditable prescription drug coverage
• You get Extra Help
Generally, you'll pay this penalty for as long as you have Medicare prescription drug coverage.


 

MORE INFORMATION ABOUT:
TRICARE • SNPs • EXTRA HELP • IF I STILL WORK... (CLICK HERE)

 

Extra Help for Prescriptions



Lower prescription costs

If you meet certain income and resource limits, you may qualify for a program called Extra Help from Medicare to pay the prescription costs, premiums, deductibles, and coinsurance of Medicare prescription drug coverage. 

This year prescription costs are no more than $3.60 for each generic/$8.95 for each brand-name covered drug for those enrolled in the program.

Some people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 

This year you may qualify if you have up to $19,140 in yearly income ($25,860 for a married couple) and up to $14,610 in resources ($29,160 for a married couple).


If you don't qualify for Extra Help, your state may have programs that can help with prescription costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.

Countable resources include:

• Money in a checking or savings account

• Stocks

• Bonds

Countable resources DON'T include:

• Your home

• One car

• Burial plot

• Up to $1,500 for burial expenses if you have put that money aside

• Furniture

• Other household and personal items

Apply for Extra Help.

 

Some people automatically qualify for help with prescription costs

You automatically qualify for lower prescription costs through Extra Help if you have Medicare and meet any of these conditions:

• Have full Medicaid coverage

• Get help from your state Medicaid program paying your Part B premiums (from a Medicare Savings Program)

• Get Supplemental Security Income (SSI) benefits

Even if you automatically qualify this year, you may not qualify for Extra Help next year. Changes in your income or resources may cause you no longer to qualify for lower prescription drug costs through one of the programs listed above. You’ll get a notice (on grey paper) by the end of September if you no longer automatically qualify. Even if you get this notice, you may still qualify for help with prescription costs, but you need to apply to find out.

• If your copayment amounts change next year, you'll get a notice (on orange paper) in the mail in early October with the new amounts.

• If you don't get a notice from Medicare, you'll get the same level of Extra Help that you got for this year.

 


MORE INFORMATION
TRICARE • SNPs • EXTRA HELP • IF I STILL WORK...

(CLICK HERE OR IMAGE ABOVE)

 

Working with an agent

Medicare Insurance Agents and Brokers can provide information about health plans. 

CLICK HERE
Check list BEFORE you enroll

3 Months Before Your 65th Birthday: Did you enroll in Part A during your Initial Enrollment Period?

CLICK HERE
Your EXPERT guide to finding the RIGHT plan

We made it as easy as 1., 2., 3... to connect to your expert guide to finding the right plan.

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READY TO ENROLL

CONGRATULATIONS! You've compared plans and you are now ready to enroll. 

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