Grand Prairie Texas Medicare Advantage
Medicare Advantage Made Simple
Grand Prairie Texas Medicare Advantage
You can get your Medicare benefits through Original Medicare, or you can choose a Grand Prairie Texas Medicare Advantage Plan. With Original Medicare, the government pays for your Medicare benefits when you get them. Medicare Advantage Plans, the Part C of Medicare are offered by private companies that have been approved by Medicare. Medicare pays these companies to administer your Medicare benefits.
If you join a Grand Prairie Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. They are completely different than a Medicare Supplement Insurance (Medigap) policy.
MA plans generally are either health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In HMOs you typically choose a primary care doctor who will then direct your care and usually will have to give you a referral to see a specialist. Under PPOs, there are networks of doctors that you can see and facilities you can use, often without the need of a referral. If you go to a provider who is not in the plan’s network, you likely will pay more.
There are the several types of Medicare Advantage Plans:
Health Maintenance Organization (HMO) plans: In most HMOs, you may only go to doctors, other health care providers, or hospitals that are in the plan’s network, except in an emergency or urgent situation. You probably also need to get a referral from your primary care doctor for diagnostic tests or to see other doctors or specialists.
Preferred Provider Organization (PPO) plans: With a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You generally pay more if you use doctors, hospitals, and providers outside of the network.
Private Fee-for-Service (PFFS) plans: PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they agree to accept the plan’s payment terms. The plan will determine how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
Special Needs Plans (SNPs): SNPs provide specialized and focused health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
HMO Point-of-Service (HMOPOS) plans: These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.
Medical Savings Account (MSA) plans: These plans combine a high-deductible health plan with a bank savings account. Medicare will deposit money into the account (usually less than the deductible). You can use the money to pay for your health care services throughout the year. MSA plans do not offer any Medicare drug coverage. If you want drug coverage, you have to join a Medicare Prescription Drug Plan, Part C of Medicare.
To be eligible enroll in a Medicare Advantage plan you must have both Medicare Parts A and B and live in the plan’s service area. People with End-Stage Renal Disease (permanent kidney failure) generally cannot enroll in a Medicare Advantage Plan.
You must continue to pay your Part B premium and generally pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join. Some may have a $0 premium.
The federal government requires MA plans to cover everything that original Medicare covers, and some plans pay for services that original Medicare does not, including dental and vision care. In addition, in recent years, the Centers for Medicare and Medicaid Services, which sets the rules for Medicare, has allowed MA plans to cover such extras as wheelchair ramps and shower grips for your home, meal delivery and transportation to and from doctors’ offices. Most MA plans also fold in prescription drug coverage. Not all MA plans cover the same extra benefits, so make sure to read the plan descriptions carefully.
Original Medicare will cover hospice care even if you are in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you will always be covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.
Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for both the plan’s medical and prescription drug coverage.
Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.
How To Enroll In Medicare
If you are receiving Social Security benefits before turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday or your 25th month of disability. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday.
It is best to apply during the three months prior to the month of your 65th birthday. If an application is made during that time, your coverage will begin on the first day of your birth month. Applying later will delay the start of your benefits. You may also apply for Medicare during the General Enrollment Period from January 1 through March 31 every year after your 65th birthday. Your coverage then starts July 1 of the year you signed up and you will pay a 10 percent surcharge on the Part B premium for each 12 months you were eligible but not enrolled. If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.
If you continue to work after age 65 or your spouse is working and you are covered by an employer group health plan (EGHP), you may want to delay enrollment in Part B of Medicare. Enrolling in Medicare Part B will trigger your open enrollment for Medicare supplement insurance at a time when you do not need supplemental coverage. The penalty for late enrollment in Part B does not apply if you are covered by an EGHP because of your or your spouse’s current employment. If you do work after age 65, you may apply for Medicare Part B at any time prior to retirement, but you must apply no later than eight months (the Special Enrollment Period) after your formal retirement in order to avoid paying a premium penalty. Even if your employer offers a retirement health plan, you will want to sign up for Medicare Part A and probably for Medicare Part B when you retire. Most retirement plans assume you are covered under Medicare and will not pay for services that Medicare would have covered. Veterans may be eligible for special medical programs. However, eligibility and benefits are very restrictive and are subject to change. The Department of Veterans Affairs advises veterans to apply for both Parts A and B of Medicare to ensure adequate medical coverage.
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Sonia, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance now since 2005. She has been married to John Ashford since 1982 and they reside in Bedford, Texas. They have six adult children and nine adorable grandchildren that they love to spoil. In Sonia’s limited spare time she enjoys quilting and crafting. They have several pets at home including freshwater fish and a Havanese Shih Tzu named Precious.