• Medicare Advantage

  • What is Medicare Part C, or Medicare Advantage?

    Medicare Advantage plans are sometimes referred to as Medicare Part C. They are Medicare-approved private health insurance plans for individuals enrolled in Original Medicare, Part A and Part B. When you join a Medicare Advantage plan, you are still in the Medicare program and must continue paying your Part B premium.

    Medicare Advantage plans provide all of your Medicare Part A (hospital insurance) andMedicare Part B (medical insurance) coverage. They generally offer additional benefits, such as vision, dental, and hearing, and many include prescription drug coverage. These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan’s network to get care.

    Medicare Advantage plans may potentially save you money because out-of-pocket costs in these plans can be lower than with Original Medicare, Part A and Part B, in some cases. Pricing will vary by plan provider, so it’s worthwhile to compare all plans in your area. Your costs will vary by the services you use and the type of plan you purchase. Each Medicare Advantage plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or can use only doctors, facilities, or suppliers in the network).

    Plan options can include:

    • Health Maintenance Organization (HMO)
    • Preferred Provider Organization (PPO)
    • Private Fee-for-Service (PFFS)
    • Special Needs Plans (SNPs)
    • HMO Point-of-Service (HMOPOS)
    • Medical Savings Account (MSA)

    You can generally join if:

    • You live in the service area of the plan you want to join.
    • You have Original Medicare, Part A and Part B, coverage.
    • You don’t have end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant); however, there are a few exceptions.

    Choose your plan carefully. Outside of when you first become eligible to enroll and other personal circumstances that may qualify you for a Special Election Period, you are only able to change plans once a year during the Annual Election Period. The Annual Election Period lasts from October 15 through December 7 of each year.

    There is also a Medicare Advantage Disenrollment Period, which runs from January 1 through February 14. During this time, individuals enrolled in a Medicare Advantage plan can disenroll from their plan and return to Original Medicare coverage.

  • DON'T WAIT UNTIL A CRISIS

    Many families wait until a payment crisis to discover the options they might have had, if only they had acted sooner. Don't make that mistake.

    We will help you identify your care needs and map out the best alternatives. Read more about how we can help make a difference for your family.

    There are three steps to any Medicaid crisis plan.

    First, we will get a handle on your current Medicaid eligibility. Are there any red flags from your past that we need to deal with? Gifts or transfers of assets to family members, friends, or even your spouse (really!) can cause a loss of Medicaid benefits.

    But it's not just obvious gifts that we need to look out for. In some cases, reimbursing a family member who has been helping out with the finances can be a problem. As can paying for goods or services without the proper documentation to back it up

    Second, we will protect what assets we can. Protecting assets needs to be done carefully. One wrong move could result in a penalty lasting months or years, during which time Medicaid benefits will be denied.

    Don't do anything without fully understanding how it will impact your eligibility and the application process.

    Third, we will apply for Medicaid benefits. The Medicaid application process is quite rigorous. The Department of Human Services will want to see everything you have done with your money for the last three years (and in some cases five years). If the caseworker finds anything not permitted by the rules, you may have to wait through a long penalty period before receiving benefits.

    Becoming eligible for Medicaid could save you thousands of dollars each month on your nursing home bills. But it needs to be done right. We'll help you find some calm waters on the other side of this storm that just came into your life.