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Medicare Advantage

Medicare Advantage, sometime known as "Part C," is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage.  These “bundled” plans include Part A, Part B, and usually Part D.  Plans may have lower out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental.

What are the rules?

Medicare pays for a fixed amount of your health care to the company offering your Medicare Advantage Prescription Drug / Medicare Advantage (MAPD/MA) plan. Beyond that, each plan requires different out-of-pocket fees. Those fees can vary from plan to plan.

In most cases, you'll need to use doctors who are in the plan's network. Depending on your plan, you may have different rules you need to follow when seeking a medical referral to get treatment from a specialist or if you are seeking non-urgent care (even from health care providers within the plan).

It’s also important to remember that rules, requirements, and features may change from year to year. It will be important to make sure that those changes line up with any treatment that you need.

What about my prescription?

Most MAPD plans in the State in California offer Part D coverage for prescription drugs, but some don’t.  In cases where the plan can’t or chooses not to offer prescription drug coverage, you may have the ability to join a separate Medicare Prescription Drug Plan, depending on the type of plan you enroll in.

You will likely have a number of questions and concerns as you examine your options for Medicare Advantage plans. Discuss these with a trusted financial professional who can help you make choices that may best fit your lifestyle.

Things to consider:

  • You must be enrolled in Medicare Part A and Part B in order to sign up for a Part C Medicare Advantage plan.
  • You do still need to pay for your Part B Premium.
  • There may also be a premium for your Medicare Advantage plan. 
  • There are 6 Different Types of Medicare Advantage Plans. Availability of plans depends on your service area determined by your zip code.
  • These plans do have out of pocket costs for medical services such as co-pays, coinsurance and deductibles but there is an annual limit on your medical out-of-pocket costs. These limits can be extremely reasonable but can also reach some significant levels.
  • Plan costs may change every year – it is important to review your Medicare Advantage plan each during the Annual Election Period/  Open Enrollment (Oct15th – December 7th) – we review this with our current clients!

How can we help you?

There are quite a few questions you need to answer before you choose a Medicare Advantage plan and we are more than happy to walk you through the process of making a great decision. We also offer our clients an annual review of their plan during the various enrollment periods and are always available to answer any questions you have about your plans.

We are contacted/certified with several insurance carriers to represent their Medicare Advantage plans. This means we can offer you are broad look at all available plans in your area to ensure you are getting the right plan for YOU.

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