Eligibility
ARE YOU ELIGIBLE FOR A MEDICARE ADVANTAGE PLAN?
You must have both Medicare Part A and Medicare Part B. You must live in the Plan's coverage area for at least 6 months of the year. You may NOT have End Stage Renal Disease.
MEDICARE PART A
Part A Coverage includes: -Inpatient care received at a hospital or skilled nursing facility, including critical access hospitals
-Hospice care (e.g. symptom management, pain relief, etc.)
-At-home health services when custodial care isn't the only care needed (e.g. part-time skilled nursing care, physical therapy, etc.)
-Inpatient care received at a religious non-medical healthcare facility.
-Blood transfusions after you pay for the first three pints used within a calendar year.
-For 2015, there is a deductible of $1260 during the first 60 days of each benefit period, as well as copays of $315 a day for days 61-90 of each benefit period.
-Days 91 and beyond; $630 coinsurance for each "lifetime reserve day" after day 90 for each benefit period (up tp 60 days maximum over your lifetime)
MEDICARE PART B
Part B Coverage: Medicare Part B is the category of Medicare medical insurance coverage that includes various outpatient medical services, doctor services, other home health services. In 2015,people who enroll in Part B will pay a monthly premium of $104.90. Individuals with income above $85,000 and couples with income above $170,000 will pay an even higher premium. Additionally, beneficiaries must pay a yearly deductibles of $147.00 before Medicare begins paying its share.Once this is covered, beneficiaries pay 20% of the Medicare approved amount while Medicare covers the remaining 80%.
MEDICARE PART C
Medicare Advantage Plans are private insurance health plans regulated by the government. Medicare Advantage Plans is also know as "MA Plans" or Medicare Part C. All individuals enrolled in Original Medicare Part A and Part B, are eligible to enroll in a Medicare Advantage Plan, with the exception of anyone diagnosed with End Stage Renal Disease (ESDN).
Medicare Advantage health plans offer the following coverage: Original Medicare coverage, the standardized hospitalization and medical benefits included in Part A and Part B, are required components of Medicare Advantage coverage. An MA Plan must deliver all the benefits and services that Original Medicare covers, with the exception of hospice care; however, MA plans do not have to deliver these benefits in the same way.
Additional Benefits may be included in certain MA Plans, for example; Prescription drug coverage, Vision, dental, and/or Hearing benefits and Health and Wellness programs (eg. Silver Sneakers).
Medicare Advantage plans deliver benefits through a number of different options including:HMO, HMO with POS, PPO and PFFS plans.
MEDICARE PART D
Prescription Drug Coverage: Medicare Part D Prescription Drug Plans, also known as "PDPs" are stand-alone prescription drug plans that are approved by Medicare and offered by a private insurance company.Medicare beneficiaries can sign up for Medicare Part D plans to add drug coverage to their Original Medicare coverage, Medicare Supplement (or Medigap) plan, or certain Medicare Advantage plans, include Cost Plans, Private Fee-for-Service (PFFS) plans, and Medical Saving Account (MSA) plans, Anyone enrolled in either Medicare Part A or Medicare Part B is eligible to enroll in a Medicare Part D plan.
ENROLLMENT DATES
When you are first eligible for both Medicare Part A and Part B either by being disabled or turning 65 you have 7 months for your initial enrollment period. Three months before the month you are eligible, the month you are eligible, and three months after the month you became eligible. If you miss this time table you will have to wait for the Annual Enrollment Period (AEP) which is October15th to December 7th each year to choose a Plan with a start date ofthe following January 1st.Special Election Periods (SEP) are exceptions, if you have Medicaid, or if you get LIS,or move into the plan service area.You can sign up at at different times.