Medicare Advantage for Omaha-Lincoln Metro Residents
You may find that your Original Medicare benefits are lacking but can’t afford a Medicare Supplement Insurance plan to close your out-of-pocket expenses. There is another choice available for you. It’s Medicare Advantage (Part C Plans), and at Omaha Insurance Solutions we can help you choose the right plan for you.
Medicare Advantage plans are offered by private health insurers and provide Medicare Part A and Part B coverage (hospital and medical benefits). You’ll receive everything that Original Medicare covers, including emergency and urgent care. But how much you pay out of your own pocket when you receive health care can differ. For instance, you may have lower copayments and coinsurance or a smaller deductible.
In addition, there may be differences in the coverage you receive. Some Medicare Advantage plans include routine vision, routine dental, and/or wellness programs. Many plans also include prescription drug coverage called Medicare Advantage Prescription Drug plans. Note that hospice care is covered by Original Medicare, and hospice benefits continue to be covered by Original Medicare even if you have a Medicare Advantage plan.
Please be aware that you must remain enrolled in Original Medicare even if you add a Medicare Advantage plan, and continue to pay your Medicare Part B premiums. However, if you join a Medicare Advantage plan, you won’t need and can’t be sold a Medicare Supplement Insurance plan.
How Medicare Advantage Works
Like millions of Baby Boomers retiring, you’re looking at your how to finance your healthcare needs. You’re eligible for Original Medicare coverage, which covers many important healthcare services, including hospital stays, doctor visits, and prescription drugs. But there is also another option that most retirees can select: A Medicare Advantage plan, also referred to as Medicare Part C.
Medicare Advantage plans cover the same services as traditional Medicare, but the way in which the plans work is slightly different from what those covered under Medicare’s regular Part A and Part B plans. Also, additional coverage may be available. With Medicare Advantage, the insurance company basically agrees to provide all of the ordinary benefits under Part A hospital and inpatient coverage and Part B outpatient care, and in exchange, you may pay additional premiums to the insurer in addition to what you pay Medicare directly for regular Part A and Part B premiums.
There are different types of Medicare Advantage plans available from various healthcare providers including HMOs, PPOs and fee-for-service plans. Often, Medicare Advantage plans offer prescription drug coverage as part of their overall insurance package. If a particular plan doesn’t have drug coverage, though, you can use Medicare Part D to cover prescription costs.
The Basics of Medicare Advantage
- Medicare pays a fixed amount for your coverage each month to insurers offering Medicare Advantage Plans.
- The insurers must follow rules set by Medicare.
- Each Medicare Advantage Plan can charge different out-of- pocket costs (copayments, coinsurance, deductibles) and have different rules for how you get services. For example, some plans might require a referral before seeing a specialist. Other plans may require you to go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care. What’s important to know is that these rules can change each year and the provider must notify you of any changes before the next enrollment year begins.
- There are certain established enrollment periods in order to enroll in a Medicare Advantage plan.
Is Medicare Advantage Right for You?
Medicare Advantage plans cover everything that Original Medicare does, but they can also include additional coverage such as vision, hearing, dental and other health and wellness programs. You can also choose particular plans tailored to your own individual needs. If a plan offers better benefits for a specific treatment, it might be perfect for you and greatly reduce the total amount you have to pay for healthcare. And you have the flexibility in being able to switch plans each year, which can result in substantial savings.
At Omaha Insurance Solutions, we’ll help you take a close look at the Medicare Advantage plans available and assist you in deciding whether they’re the best choice to meet your healthcare needs.
Types of Medicare Advantage Plans
Deciding to get a Medicare Advantage plan is an alternative way to obtaining your Medicare coverage. You’ll receive your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits from the Medicare Advantage plan, not Original Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private insurance companies approved by Medicare.
Which Plan is Suited for You? Talk to Us.
There are several different types of Medicare Advantage plans available. Omaha Insurance Solutions is happy to discuss each with you and help you select the plan that will suit you:
- Health Maintenance Organization Plan (HMO): You can see the doctors and other health professionals participating in the plan network.
- Preferred Provider Organization Plan (PPO): Covers both in- and out-of-network providers, giving you the freedom to choose any doctor, which can work if you prefer that kind of flexibility. You’ll pay more for out-of-network providers.
- Private Fee-for-Service Plan (PFFS): Similar in how Original Medicare works, you can generally go to any doctor, other health care provider, or hospital as long as they agree to treat you. The plan determines how much it will pay doctors, other healthcare providers, and hospitals, and how much you must pay when you get care.
- Special Needs Plans (SNP): Focused on those with special needs, there are three SNP plans: Medicare beneficiaries living in institutions, those who are dual-eligible for Medicaid and Medicare, and those with chronic conditions. This type of plan always includes prescription drug coverage.
- Health Maintenance Organization-Point of Service Plan (HMO-POS): Covers both in- and out-of-network health services, but at different rates. You pay less out of pocket when you go to in-network doctors, labs, hospitals, and other healthcare providers.
- Medical Savings Account Plan (MSA): Includes both a high deductible and a bank account to help you pay that deductible. The amount deposited into the account varies from one plan to the next. The money is tax-free as long as it’s used for IRS-qualified medical expenses, which include the health plan’s deductible.