Medicare Advantage Plans (Medicare Part C)

At T.W. Morgan Insurance Services, we are your source to help you navigate through the Medicare Advantage process. Our agents are fully trained and receive annual certification training each year to offer Medicare Advantage plans to our clients. Since 1991 we have helped Medicare eligible applicants secure the coverage they can afford during their golden years. Medicare Advantage plans (Part C) combine the coverage of Medicare Parts A and B (sometimes called "Original Medicare") and usually include additional benefits or services. Most plans include Medicare Part D prescription drug coverage.

Medicare Advantage plan types include:

• Health Maintenance Organization (HMO)
  You receive services from a plan's network of local doctors and hospitals who work together to provide care.
• Point-of-Service (POS)
  A type of HMO plan that also lets you receive certain services outside the plan's network, generally at a higher cost to you.
• Preferred Provider Organization (PPO)
  You can visit in-network and out-of-network doctors and hospitals, but services outside the plan's network will typically cost more.
• Private Fee-for-Service (PFFS)
  These can be network or non-network plans. You can receive care from any doctor or hospital that accepts the plan's payment terms and conditions.

Medicare Advantage plans work similarly to employer-sponsored health insurance plans, which may help you continue the same level of coverage you have now or be similar to ones you have had in the past.

What's covered?

Medicare Advantage plans cover:

• All the benefits of Medicare Part A, including hospital stays, skilled nursing care and home health care, but not hospice care. However, because you must be enrolled in Part A to get a Medicare Advantage plan, your Part A benefit helps cover hospice care.
• All the benefits of Medicare Part B, including doctor visits, outpatient care, screenings, shots and lab tests.
• Prescription drugs, if Part D prescription drug coverage is included in the Medicare Advantage plan (many do include this coverage).

Some Medicare Advantage plans may also include coverage for extra services such as a fitness benefit or routine hearing and vision care.

Are there limits to coverage?

Coverage limits vary by plan, so you'll have to look at the specific Medicare Advantage plan's details to see if there are any coverage limits or exclusions.

Plans that include prescription drug coverage may have additional restrictions, such as the cost-sharing amounts you pay for your medications. Late enrollment penalty may apply if you are not new to Medicare and you have not previously signed up for a prescription drug plan.

What doctors can I see?

This also varies by plan. In some plans (like HMOs), your health care is coordinated through a primary care physician, who manages the care you receive from doctors, specialists and hospitals within the plan's network. With these plans, only the services you receive from network providers are covered.

POS and PPO plans are also coordinated care plans like HMOs, but these plans let you receive covered services outside of the plan's network, generally at a higher cost to you.

Non-network plans (similar to many PFFS plans) let you receive care from any Medicare-eligible doctor or hospital that accepts the plan's payment terms and conditions before providing you with care. No referrals are ever needed.

All of these Medicare Advantage plan types offer nationwide coverage for emergency care and urgent care. In these situations, you can go to the nearest doctor or hospital.

How much does a Medicare Advantage plan cost?

If you join a Medicare Advantage plan, you'll continue to pay your monthly Part B premium (and Part A premium, if you have one). Some plans may charge an additional monthly premium, but not all do.

You'll need to look at each Medicare Advantage plan's details to see what cost-sharing expenses you might have, like deductibles, copays and coinsurance. How much you'll pay varies by plan. In addition, these plans help protect you from high cost sharing by limiting how much you'll be required to pay for your health care costs each year through an out-of-pocket limit.

If your Medicare Advantage plan includes prescription drug coverage, you may have additional copays, coinsurance and costs you'll have to pay for your prescription drugs.

How do I enroll in a Medicare Advantage plan?

You can join a Medicare Advantage plan as soon as you become eligible for Medicare, or during your initial enrollment period. You'll also need to enroll in Part A and Part B at this time.

Once you've joined Part A and Part B, you can't be refused coverage by any plans in your area that are accepting new members. However, special rules apply to people with end-stage renal disease.

Each private insurance company that offers a Medicare Advantage plan handles the enrollment process for its plans. You'll need to contact our Medicare agents directly at 503-245-3345 or 888-821-4717 Toll Free and ask how to enroll today.

How do I choose a Medicare Advantage plan?

Because there are many Medicare Advantage plans available through various health insurance companies, it's important to shop around for the best plan for you. At T.W. Morgan Insurance Services, we are here to take the confusion out of the process of applying for coverage. There are no additional fees to have us as your agent. To learn more about Medicare Advantage, call our office today at 503-245-3345 or Toll Free at 888-821-4717. Open Enrollment begins each year between October 15th to December 7. Please note that plans change benefits each year and they are disclosed during the Open Enrollment period and take effect the first of January each year.