When it comes to choosing the best Medicare plan for your unique situation, nothing will serve you better than experience. Why? You will likely find more than 30 plans (or more) from which to choose in your market area. Which is the best? HMO? PPO? Special Needs? Give Back Plan?

There are important differences among these plans. We’ll explain them so you can make an informed decision to choose the right plan.

Oh brother, is it always this way? Yes, but our experience will make it so much easier for you to sort out. It’s what we do!

So what is next?


Medicare Advantage-Bundled Plans

A Medicare Advantage Plan is an alternate way to get Medicare quality health care. Typically, these plans provide coverage for medical, dental, and vision treatments that Medicare does not include. And there are a host of additional benefits that vary from plan to plan.

For example, do you remember that Part A and Part B of Medicare have no limit on your share of medical expenses? Unlike Medicare, EVERY Medicare Advantage Plan is required to have a “Maximum out of pocket limit” that will cap your costs for a calendar year at a stated plan maximum.

Most of the time, a Medicare Advantage Plan includes Part A, Part B, and Part D. If the plan includes Part D the plan is Medicare Advantage and Part D,(also called MAPD). If there is no Part D coverage, the plan is known simply as Medicare Advantage (MA).

If you select an MA or MAPD plan, it is very important you understand that you are still part of the Medicare system (Part C). Your enrollment must be recorded with Medicare so your care can be provided and paid for by the MA or MAPD and tracked by Medicare.

MA and MAPD plans MUST provide coverage for every medical treatment Medicare covers. These plans may provide coverage for a wider range of medical treatments than Medicare, but never less.

Does this sound like a lot to know? Yes, but we deal with it every day. So it is easy for us, which makes it easy for you.

smiling elderly couple walking outside with their grandchildren

Other Benefits

There are numerous benefits that are commonly included in a MA or MAPD plan that are not included in Medicare, such as gym memberships, dental, vision, hearing coverage, and non-prescription over-the-counter items that are not included with Medicare. These benefits vary from plan to plan.

Carefully discussing each of these additional benefits, and the differences in them between each plan, will ensure that you enroll in the best plan for your circumstances.

How it works

MA and MAPD plans must be approved annually by Medicare. Where the plan can be marketed, copayments for treatment, the network of medical providers you must use for treatment, as well as the additional coverages noted above, are included in this process. In addition, Medicare will determine if each plan meets rigid standards to measure quality requirements, in order to apply a STAR RATING. This star rating is a very important indicator of the quality of the plan.

When you enroll in a MA or MAPD, you remain in the Medicare system, but all of your medical care becomes the responsibility of the plan. Medicare pays the plan an agreed amount and from this the plan is responsible for paying for your care, as well as the quality of your care. Please be sure to carefully note the Star Rating of any plan(s) you are considering.

Non-emergency care must be provided by medical providers who are part of a network established and maintained by the plan. Emergency care may be provided by any medical provider, with the guarantee that treatment must be covered by the plan regardless of whether the providers are part of your plan’s network.

Prescription Drug Coverage

As we said before, most Medicare Advantage Plans include prescription drug coverage. Whether you are currently prescribed medications or not, you should be careful to make certain that all plans you might consider include this important coverage. While there may be extremely rare exceptions to this caution, such as Veterans who may have prescription coverage with the Veterans Administration, the consequences of failure to include this coverage are severe.

All MAPD prescription coverage follows the model described in the Part D explanation and Part D Video at this website. Rather than attempt to provide a brief overview, which I think would create more questions than provide answers, I suggest you visit Part D explanation or view the Part D Video.

Prescription coverage is the cause for the most confusion of any part of Medicare. If you have any questions about any aspect of MA or MAPD’s, please contact us. We take great pride in resolving those questions for you.

Call, or email Florida Medicare Specialists today to discuss the information so that you can make an informed decision about the best health care plan for your needs.

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