Irving Medicare Advantage

What is Medicare?

Medicare has different “parts” that cover different things. You choose the ones that best meet your healthcare needs. Let’s look at the first two parts:

Part A pays for hospital stays. Plus, some home health and hospice care.

Part B pays for doctor visits and care. It also covers some other health needs, like flu shots and walkers.

Parts A and B together are known as “Original Medicare.”

They’re not covered in Original Medicare, so you’ll need to add a separate plan, known as a Medicare prescription drug plan (Part D). These plans are offered by private insurance companies and are approved by the government.

Part D covers medications prescribed by doctors.

There’s another insurance plan option, called a Medicare Supplemental Insurance (Medigap) policy, that you can add to Original Medicare.

A Medigap policy can help pay for certain healthcare costs that you will have with Original Medicare, such as deductibles and copays. Keep in mind that you cannot have a Medicare Advantage plan and a Medigap policy at the same time. You must choose one or the other.

Medicare Part C, or Medicare Advantage

Also called Medicare Part C plans, Irving, TX Medicare Advantage plans are offered by Medicare-approved private companies to Medicare-eligible individuals in Irving and across Texas. If you are already enrolled in both Medicare Part A and Medicare Part B, you have the option of replacing your Part A and Part B coverage with similar coverage provided by your Part C plan. But that is just the beginning. Medicare Advantage can go further by covering a wide range of services—dental, vision, hearing, and prescription drugs to name just a few—that Original Medicare cannot. Medicare Advantage plans also go together with Medicare preventive services by requiring no cost-sharing in most cases for Medicare-covered preventive services including mammograms and prostate exams. Irving Medicare Advantage plans also typically cover annual physical exams. Ashford Insurance offers Irving Texas Medicare Advantage Plans (Part C of Medicare).

• Medicare Part C, the Medicare Advantage program, gives you a way to get your Part A and Part B benefits through a private insurance company that contracts with Medicare.
• Under Medicare Part C, you get all your Part A and Part B benefits (except hospice care, which you still get through Part A).
• Most Medicare Advantage plans under Part C also include prescription drug coverage. This is something that you don’t get through Original Medicare except in certain cases (for example, in a hospital or clinic). Original Medicare doesn’t cover most medications you’d take at home.

Irving Medicare Advantage plans, often called Medicare Part C, combine Medicare Parts A & B (Original Medicare) into one plan. However, instead of receiving the benefits of Parts A & B through Original Medicare, Medicare Advantage plans are offered through private insurers that are approved by Medicare. Many Medicare Advantage (Part C) plans also include prescription drug coverage and routine eye and dental care coverage not offered by Original Medicare.

Many Medicare Advantage (Part C) plans include prescription drug, vision, hearing, and dental coverage not offered by Original Medicare (Parts A & B). Additionally, each Medicare Advantage plan is required by law to feature an annual maximum cap on out-of-pocket costs, meaning once that limit is reached you will pay nothing for additional covered medical services.

• Medicare Part D is prescription drug coverage.
• Like Medicare Advantage, Medicare Part D is available through private, Medicare-approved insurance companies.
• You can sign up for a stand-alone Medicare Part D prescription drug plan if you stay with Original Medicare (Part A and/or Part B).
• However, under Medicare Part C, some Medicare Advantage plans include this coverage as well. They are sometimes called Medicare Advantage prescription drug plans.

If you join a Texas Medicare Advantage Plan, the plan will provide all your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. They are completely different than a Medicare Supplement Insurance (Medigap) policy.

There are several types of Irving Texas 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 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 healthcare 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 like 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 (HMO-POS) 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.

Eligibility for Medicare Advantage

To be eligible to enroll in a Texas 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.

Irving Texas Medicare Advantage Plans must cover all the services that Original Medicare covers except for hospice care. 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.

In Summary, Original Medicare was never designed to cover 100% of your healthcare costs. If you depend on Original Medicare alone, gaps in your Medicare coverage will be evident sooner than you realize. You will be responsible for the Medicare Part A deductible, which in some cases you can be obligated to pay several times a year. You will also be responsible for the Medicare Part B deductible, the 20% coinsurance for your Part B charges, and more.

All the out-of-pocket costs associated with Original Medicare can play havoc with your budget—and some people have been ruined financially because they had no health coverage other than Medicare Part A and Medicare Part B.

Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.