Medicare Advantage Plans – 5 Things you should know and more…

At Palmas Clinic, our goal is to partner with our patients as they strive to achieve or maintain their best health. We care deeply about seniors and their healthcare and see ourselves as a practice that primarily cares for seniors – Medicare members – whether they are on Traditional (Original) Medicare with or without supplements or Medicare Advantage Plans.

We work very closely with some Medicare Advantage Plans due to the immense value we believe they bring to seniors. We see their value in quality of care, cost-effectiveness and love the focus on outcomes rather than the traditional fee-for-service arrangements that incentivize doctors to see many patients but with no checks and balances nor incentives to ensure that seniors are getting the best care and health outcomes.

Here are some things to consider whether you are an existing Medicare member or new to the Medicare program:

  1. Traditional Medicare requires you to pay 20% of the bill if and when you are treated at a hospital. Medicare Advantage plans eliminate the 20% financial burden and instead have relatively small daily co-pays for a set number of days in the hospital, after which they take care of the full bill. They also have a limit on how much money comes out of your pocket each year for hospital bills (these limits are regulated by the government but each plan may quote different numbers within the range permitted by the Centers for Medicare and Medicaid Services – CMS)

  2. Drugs! Traditional Medicare DOES NOT cover drugs. You have to purchase a Part D drug plan separately if you are on original/traditional Medicare alone. Medicare Advantage Plans typically offer plans that include prescription drug coverage, with very few exceptions (there are a few plans that do not cover prescription drugs).

  3. Most Medicare Advantage plans have minimal out-of-pocket costs

  4. Medicare Advantage Plans partner with primary care physicians to deliver the best quality care and outcomes. Your doctors are rewarded if they make you healthier, not by how many patients they see.

  5. Added benefits! Most Medicare Advantage Plans offer benefits that are not available through traditional Medicare. Benefits like Dental Care, Vision, Hearing Aids, Exercise/Gym Programs (like Silver Sneakers), Over-the-counter drug benefits, Transportation, and the list goes on.

Call us at (813) 626-0066 if you want to learn more. We can help you enroll in a class that teaches you more about Medicare Advantage (when offered).

At Palmas Clinic, we partner with companies like Humana Health Plan to deliver the best quality of care to seniors in Tampa Bay. Learn more about Humana’s Bold Goal here.

Here are a few other things you should know about the Medicare Advantage program courtesy the Center for Medicare and Medicaid Services’ website. If you join a Medicare Advantage Plan:

  1. You’re still in the Medicare Program.

  2. You still have Medicare rights and protections.

  3. You still get complete Part A and Part B coverage through the plan.

  4. You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year.

  5. You can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).

  6. You can check with the plan before you get a service to find out if it’s covered and what your costs may be.

  7. You must follow plan rules, like getting a referral to see a specialist to avoid higher costs if your plan requires it. The specialist you’re referred to must also be in the plan’s network. Check with the plan.

  8. If you go to a doctor, other health care provider, facility, or supplier that doesn’t belong to the plan’s network, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.

  9. Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.

  10. If you join a clinical research study, some costs may be covered by your plan. Call your plan for more information.Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name.

  11. Medicare Advantage Plans can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.

  12. Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan.

  13. If the plan decides to stop participating in Medicare, you’ll have to join another Medicare health plan or return to Original Medicare.