About Medicare Advantage

Understanding How Medicare Works

The essential ABCs (and D!) of Medicare

The Medicare program was designed in four parts, each part covering a different benefit category. As a Medicare eligible person, you will likely need and use a combination of these services depending on your health and as you get older.

Part A – Hospital Coverage

Most people who qualify for Medicare automatically get Part A coverage without having to pay a premium. Part A includes inpatient hospital care, long-term care in hospitals and treatment in a critical access hospital.

Part B – Medical Coverage

Part B covers your medically necessary doctors’ services and outpatient care. A Part B premium is deducted from your social security check each month to help pay the cost of this coverage.

Part C – Medicare Advantage Plans

If you have part C, your coverage is provided by a private health plan called a Medicare Advantage plan. The health plans are contracted with Medicare. The coverage includes everything covered under Part A and Part B, except hospice care (original Medicare continues to cover hospice care) and may include additional benefits not available with Original Medicare.

Part D – Prescription Drug Coverage

If you choose Part D coverage, it can help lower your prescription drug costs. This coverage is available as a stand-alone plan or may be included in a Medicare Advantage plan. To learn more and have your questions answered, contact your local licensed insurance agent. You may also desire to attend an upcoming Medicare 101 session taught by local area licensed insurance agents. To find one near you, click here.

Choosing Coverage Based on Your Health Needs

Choosing Original Medicare Only. This means that you have Medicare Part A and/or Medicare Part B only. Keep in mind, Medicare does not cover 100% of your medical and hospital costs, which will require you to meet a deductible and then pay a percentage of the cost of your care. Original Medicare also does not provide coverage for prescription drugs. For this, you need an additional standalone plan that may charge an expensive monthly premium.
Purchasing a Medicare Supplement. The supplement provides additional, variable coverage to fill in part or all of the gaps or costs not covered by Original Medicare, but the cost to you may be an expensive monthly premium.
Selecting a Medicare Advantage plan. A Medicare Advantage plan (Medicare Part C) includes all the healthcare benefits you are entitled to under Original Medicare, and may include coverage like vision, hearing, dental and prescription drug coverage or provide monies toward over-the-counter supplies. Some Medicare Advantage plans may come with a $0 premium. Medicare Advantage plans can, however, choose not to cover the costs of services that are not medically necessary under Medicare. Medicare Advantage plans contract with the government to provide coverage to you, so you are still in the Medicare program but you don’t need to use your Medicare card when you obtain medical services.

To learn more and have your questions answered, contact your local licensed insurance agent. You may also desire to attend an upcoming Medicare 101 session taught by local area licensed insurance agents. To find one near you, click here.

Why Medicare Advantage May Be A Good Choice for Patients Who Are Over 65

Many Medicare Advantage plans offer benefits that are ideal for helping you afford good healthcare coverage for current and future healthcare needs.

If you find that you spend a lot of money on healthcare for things like specialist visits, prescriptions and testing, a Medicare Advantage plan can help lower these costs with affordable copays on these services. A copay is a set, fixed amount of money that you pay as your share of the cost of care. You are still required to pay a monthly Part B premium as part of a Medicare Advantage plan, but may find Medicare Advantage plans with premiums as low as $0 per month.

Pioneer Physicians Network and Community Health Care physicians participate in a special program called Paradigm Senior Care Advantage in partnership with select Medicare Advantage plans by Aetna, Anthem, Humana and SummaCare. When you select these plans, you have access to a new approach to care delivery that focuses on keeping you healthy and helping coordinate care resources when you need them.

What is Included in a Medicare Advantage Plan?

Medicare Advantage plans offer a variety of benefits designed to help members save on their healthcare spending. An experienced advisor can help review the benefits of each plan and help find the right one for you. One way to do this is to make an appointment with a licensed agent, who can help you compare plans and understand which providers belong in the network and what the cost of any medications you are currently taking would be. If you see a healthcare provider that doesn’t belong to the plan, your services may not be covered or your costs could be higher.

To find a plan that is right for you and continue receiving care from your Pioneer Physicians Network or Community Health Care primary care doctor, contact your local licensed insurance agent. You may also desire to attend an upcoming Medicare 101 session taught by local area licensed insurance agents. To find one near you, click here.

Medicare Advantage: Saving on Hospital Care and Prescription Drugs

Receiving health care at a hospital can be very costly. However, many Medicare Advantage plans offer low copays on physician visits and include a limit on how much you pay for these services.

Each Medicare Advantage plan can charge different out-of-pocket costs, making it even more important to compare benefits and find the plan that is right for your needs and budget. Original Medicare does not cover prescriptions and adding a supplemental prescription plan can often cost you more in monthly premiums. However, many Medicare Advantage plans include prescription coverage for no additional cost.

Medicare Advantage plans can offer a number of benefits for you that are not offered in Medicare Part A and B plans. They may include dental, vision and hearing coverage, as well as additional benefits designed to help members save money and stay healthy including:

Exercise facilities
Nutritional programs
Transportation to and from medical appointments
Preventative testing and care
Over-the-counter medical supply allowances

To find a plan that is right for you and continue receiving care from your Pioneer Physician Network or Community Health Care primary care physician, contact your local licensed insurance agent. You may also desire to attend an upcoming Medicare 101 session taught by local area licensed insurance agents. To find one near you, click here.

Need help navigating your Medicare options?

A licensed Medicare broker is a professional that is independent of any specific health plan, is appointed to represent multiple health plans, and can review your specific needs and help you compare Medicare coverage options for this enrollment year.

We can put you in touch with brokers that understand the Paradigm Senior Care Advantage program. These brokers can help you evaluate coverage options to find one that meets your needs. With your permission, we will give your contact information to a broker to contact you to discuss coverage options.

Prefer to discuss over the phone? Call us at (330) 220-2491.

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