Client: You MUST continue to pay your Part B Premium.
When you join a Medicare Advantage Plan you are taking yourself out of Original Medicare and contractually agreeing to follow the rules, regulations copayments, coinsurance and deductibles of the Medicare Advantage Plan you enrolled into. If your plan will not pay for your procedure Medicare will not step-in and pay for it either.
A Medicare Advantage Plan is a type of Medicare Health Plan offered by private companies contracted with Medicare to provide you with all of your Part A – Hospital Benefits, Part B – Medical Benefits and most of the time Part D – Prescription Drug Benefits. Medicare Advantage plans include plans like HMO Plans, PPO Plans, PFFS Plans, SNP Plans, and MSA Plans.
If you decided to enroll into a Medicare Advantage Plan, that plan may have Additional Benefits that Original Medicare does not cover. These Additional Benefits could range from some sort of fitness plan to some basic Vision/ Dental & Hearing Aide coverage.
A Medicare Health Maintenance Organization is a Medicare Advantage Plan that provides all Original Medicare Part A, Part B, and most times Part D. In most HMO’s you can only get care from in-network Doctors or Hospitals in the plans network (Except in the case of Emergencies). Most HMO’s require referrals to see a Specialist.
A Medicare Preferred Provider Organization is a Medicare Advantage Plan that provides all Original Medicare Part A, Part B and most of the times Part D. PPO’s have in-network Doctors & Hospitals; however, you can also us out-of-network providers, usually at a higher cost. PPO’s do not require a referral to see a Specialist.
A Medicare Private-Fee-For-Service Plan is a Medicare Advantage Plan in which you can go to any Medicare-Approved Doctor, Hospital and provider that accepts the Plan’s payment terms and conditions and agrees to treat you… not all provider’s will, and just because they agreed to see you once does not mean they are obligated to see you again. Most PFFS Plans have in-network Doctors and Hospitals from you to choose from. You will usually pay more to see an out-of-network provider.
A Medicare Special Needs Plan is a Medicare Advantage Plan that has a benefit package designed for people with special Healthcare needs. Examples of Special Needs served include specific groups who have both Medicare and Medicaid, people that reside in Nursing Homes, and those people who have certain, chronic medical conditions.
A Medical Savings Account is a Medicare Advantage Plan that combines a high deductible Medicare Advantage Plan with a Medical Savings Account (funded by Original Medicare). I do not offer these types of Medicare Advantage Plans.