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Medicare helps with health care costs
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Basically, Medicare pays an
amount of money for your health care into
these private Medicare Advantage plans every
month. In return, these plans must provide
all of your Part A and Part B benefits, and
they must cover at least all of the medically
necessary services that the original Medicare
plan provides.
MA plans can charge different
co-payments, co-insurance and deductibles
for their services and generally have set
provider networks. This means you likely will
be limited to seeing only doctors who belong
to the plan, going to certain hospitals for
covered services and getting referrals to
see specialists. If you use providers who
aren't in the network, you may have to pay
the entire cost of the services rendered.
However, MA plans can offer extra benefits,
such as vision, hearing, dental and health
and wellness programs. Most include Medicare
prescription drug coverage (usually for an
extra cost).
Retirees can choose from five
different types of Medicare Advantage plans.
Most function like HMOs with specific networks
of doctors. Other plans, such as Private Fee-for-Service
plans, known as PFFS, allow you to go to any
doctor if the doctor agrees to accept the
plan's terms of payment before treating you.
Medicare Special Needs plans, or SNPs, serve
certain people who are chronically ill, live
in institutions such as nursing homes or have
other special needs. (The different benefits
the various types of Medicare Advantage plans
offer are outlined on pages 42-44 of the "Medicare
& You 2008" handbook.)
It's important to call any plan
before joining to find out what your services
will cost and make sure that a plan will meet
your needs. Some plans, for example, will
let you use out-of-network providers (sometimes
for a higher cost). Also, be sure to check
in advance with your doctors or hospital to
determine if they accept the plan. To enroll
in a Medicare Advantage plan, you can complete
a paper application, call the plan by telephone
or enroll online. Be aware that there are
limitations as to when you can join, switch
or drop a Medicare Advantage plan.
Remember, when you join a Medicare
Advantage plan, you will have to provide your
Medicare number from your Medicare card and
the date your Part A and Part B coverage started.
You also will generally still pay the monthly
Part B premium along with the Medicare Advantage
plan's premium (if it charges one). That includes
coverage for Part A and Part B benefits, prescription
drug coverage (Part D, if offered) and any
other extra benefits.
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