What You Should Know About Medicare Advantage Plans
Whether you're new to Medicare, or just want to brush up on your Medicare information, we've laid out some key elements for you.
What Is Medicare Advantage (Part C)?
As a Medicare recipient, you are eligible for additional health plan choices, such as Medicare Advantage. This type of plan, sometimes referred to as "Part C", combines health insurance with health services. The benefits include all of Part A (hospital insurance) and Part B (medical insurance), and certain plans may also include Part D (prescription drug coverage).
Medicare coverage is broken up into parts and cover specific services.
Medicare Part A (hospital insurance) includes:
- Hospital and inpatient care
- Nursing facilities, hospice, and home health care
Medicare Part B (medical insurance) includes:
- Doctors' services, hospital outpatient care, and home health care
- Preventive services
Medicare Part D (prescription drug coverage) includes:
- Prescription drug coverage through Medicare-approved insurance companies
- Discounts on prescription drugs
Each health insurance company must follow the guidelines set by Medicare. However, there are no set rules regarding out-of-pocket costs or how a member receives services (referrals, in-network vs. out-of-network). These rules vary according to health insurance carrier and may change each year.
MEDICARE PPO: With Medicare PPO plans, members can see any provider of their choice and do not need a referral when going to a specialist. This plan type includes the flexibility and freedom to see any doctor a member chooses, however, out-of-network doctors will have higher fees.
MEDICARE HMO: Medicare HMO plans include a list of in-network providers that all members must select from. Each member has a primary care physician who oversees all of their health care, including referrals to all other doctors and specialists. This type of plan is often called managed health care for this reason.
MEDICARE SNP: Medicare Special Needs plans are for individuals with either certain chronic diseases and/or conditions or who are elgible for both Medicare and Medicaid. These plans offer coverage for Medicare Part C (medical care) and Part D (prescription drugs).
Medicare Advantage Is Ideal For People Who Prefer:
- A less expensive alternative to Medigap.
- Coordinated care with a network of providers to choose from.
- Less insurance paperwork.
It is also ideal for individuals with pre-existing conditions for which a waiting period may be a hardship.
Am I Eligible?
Anyone who is entitled to Part A and enrolled in Part B, lives within the plan service area, and does not have end-stage renal disease is eligible for Medicare Advantage. There is an open enrollment period starting three months before you turn 65 and ending three months after. Once this period has passed, there is an annual enrollment period for newly joining members and members who want to change plans.
Health Net has a contract with Medicare to offer HMO, PPO and HMO SNP plans. Health Net has a contract with Medicare and Medicaid to offer HMO SNP plans. Enrollment in a Health Net Medicare Advantage plan depends on contract renewal.
Y0035_2014_0303_C (H0351, H0562, H5439, H5520, H6815, EG) CMS Approval [PENDING]