Medicare Advantage Plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services. Most Medicare Advantage Plans also cover Part D (prescription drugs) benefits.
In Nebraska, the most common types of Medicare Advantage Plan include:
- Private Fee-for-Service Plans (PFFS)
- Medicare Preferred Provider Organization Plans (PPO)
- Medicare Managed Care Plans (HMO & HMO/POS)
- Medicare Special Needs Plans (SNP)
Some plans offer extra benefits, such as dental and vision services. Medicare Advantage plans are required to accept all Medicare beneficiaries, with the exception of those beneficiaries with End-Stage Renal Disease. Medicare Advantage plans cannot have a waiting period for pre-existing conditions.
Beneficiaries are able to review and change their plan once every year during open enrollment (October 15 to December 7). Each plan has an out-of-pocket-maximum; this is the maximum amount a beneficiary will have to pay for hospital and medical services.
If you are considering joining a Medicare Advantage Plan, keep the following in mind:
- You are responsible for co-payments. Under Medicare Advantage, you must pay co-payments for each Medicare-covered service, such as physician office visits and inpatient hospital stays. These co-pays vary according to plan.
- Your provider may or may not accept your plan. Doctors or hospitals from which you receive care are not required to accept payment from Medicare Advantage Plans. If the provider does not accept the plan, you may be responsible for the entire payment.
To enroll in a Part C plan, you must have Medicare Part A and Part B. Some Part C plans do not charge a monthly premium, but you must continue to pay the Part B premium.
You may join a Medicare Advantage Plan when you first become eligible for Medicare, whether by age or disability. A seven month initial enrollment period is granted to new Medicare enrollees that includes the three months before your first month of Medicare eligibility, your month of Medicare eligibility, and the three months after your first month of Medicare eligibility.