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Different Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Medical Savings Account (MSA) Plans
Special Needs Plans (SNP)

Medicare


What Is Part A (Hospital Insurance)?

Part A helps cover :

You usually don't pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is called "premium-free Part A."

If you aren't eligible for premium-free Part A, you may be able to buy Part A if you meet one of these conditions :


In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you have limited income and resources, your state may help you pay for Part A and/or Part B.

Services Part A Covers :

Blood : In most cases, the hospital gets blood from a blood bank at no charge, and you won't have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.

Home Health Services : Limited to medically-necessary part-time or intermittent skilled nursing care, or physical therapy, speech-language pathology, or a continuing need for occupational therapy. A doctor must order your care, and a Medicare-certified home health agency must provide it. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment (see page 30), and medical supplies for use at home. You must be homebound, which means that leaving home is a major effort.

Hospice Care : For people with a terminal illness. Your doctor must certify that you‘re expected to live 6 months or less. Coverage includes drugs for pain relief and symptom management; medical, nursing, social services; and other covered services as well as services Medicare usually doesn’t cover, such as grief counseling. A Medicare-approved hospice usually gives hospice care in your home (or other facility like a nursing home).

Medicare covers some short-term inpatient stays for pain and symptom management that can’t be addressed in the home. These stays must be in a Medicare-approved facility, such as a hospice facility, hospital, or skilled nursing facility. Medicare also covers inpatient respite care which is care you get in a Medicare approved facility so that your usual caregiver can rest. You can stay up to 5 days each time you get respite care. Medicare will pay for covered services for health problems that aren’t related to your terminal illness. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you are terminally ill.

Hospital Stays (Inpatient) : Includes semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. Examples include inpatient care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care. This doesn't include private-duty nursing, a television or telephone in your room (if there is a separate charge for these items), or personal care items like razors or slipper socks. It also doesn’t include a private room, unless medically necessary. If you have Part B, it covers the doctor and emergency room services you get while you are in a hospital.

Skilled Nursing Facility Care: Includes semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (only after a 3-day minimum inpatient hospital stay for a related illness or injury). To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care in this setting.

What Is Part B (Medical Insurance)?

Part B helps cover medically-necessary services like doctors' services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Check your Medicare card to find out if you have Part B.

How Much Does Part B Cost?
You pay the Part B premium each month. Most people will pay the standard premium amount (link to current amount?. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.

Your modified adjusted gross income is your taxable income plus your tax exempt interest income. Social Security will notify you if you have to pay more than the standard premium. If you have to pay a higher amount for your Part B premium and you disagree (even if you get Railroad Retirement Board benefits), call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

How You Get Part B



Services Part B Covers :

There are two kinds of Part B-covered services:Medically-necessary services — Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Preventive services — Health care to prevent illness or detect it at an early stage, when treatment is most likely to work best.

What You Pay for Part B Services

Costs for Part B services depend on whether you have Original Medicare or are in a Medicare health plan. For some services, there are no costs, but you may have to pay for the doctor’s visit. If the Part B deductible applies, you must pay all costs until you meet the yearly Part B deductible before Medicare begins to pay its share. Then, after your deductible is met, you typically pay 20% of the Medicare-approved amount of the service.

Medicare Advantage (Part C)

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are health plans offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan provides all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

Medicare Advantage plans always cover emergency and urgent care. Medicare Advantage Plans must cover all the services that Original Medicare covers, except hospice care. (Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan.) Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most plans also include Medicare prescription drug coverage.

Medicare Advantage Plans must follow rules set by Medicare. However, each plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).

You usually pay one monthly premium to the Medicare Advantage plan, in addition to your Part B premium.

Different Types of Medicare Advantage Plans


Other less common types of Medicare Advantage Plans include :

What You Pay in a Medicare Advantage Plan

Your out-of-pocket costs in a Medicare Advantage Plan depend on:

How to Join a Medicare Advantage Plan

Not all Medicare Advantage Plans work the same way, so before you join, find out the plan’s rules, what your costs will be, and whether the plan will meet your needs.

USA Protection Agency is a Independent Insurance Agency that quotes specific plans you’re interested in. Providing quotes for more benefits and less cost. Once you choose a plan, you will be able to join by completing a online application, calling the plan, enrolling on the plan’s Web site. Get started comparing Medicare Advantage Plan with USA Protection Agency.

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Medicare approved HMO, PPO, PDP, and PFFS plans available to anyone entitled to Part A or enrolled in Part B of Medicare through age or disability (for MA plans, individuals must have both Part A and Part B). Medicare approved HMO and PPO Special Needs Plans (SNP) available to anyone who meets the specific eligibility requirements of the SNP and is enrolled in both Part A and Part B of Medicare through age or disability. (To qualify for a Chronic Disease SNP, physician diagnosis of the disease must be verified. People who do not have the condition will be disenrolled. To qualify for a Dual Eligible SNP, you must also be eligible for Medicaid assistance from the State. Premiums, copayments, and deductibles may vary based on income.) Enrollment period restrictions apply, call Humana for details. You must continue to pay your Medicare applicable premiums if not otherwise paid for under Medicaid or by another third-party. Plans may be renewed annually. All plan types may not be available in all areas. Copayment, service area, and benefit limitations may apply. All plans with prescription drug coverage require that members use network pharmacies. HMO members must use plan providers. You will be responsible for the costs of out of network care. Referrals may be required for all but primary care physician visits.


PPO members will pay more for covered services received outside the network. Specialists and facilities may require referrals from your PCP. Sometimes the selection of in-network providers is limited in certain geographic areas or limited in some specialties. If the network in your area does not offer the specialist you need, you may be allowed to go to a non-network provider at the in-network rate. Be sure to contact non-network doctors before you see them to make sure they accept Medicare assignment and have agreed to accept payment from Humana. A Medicare Advantage Private Fee-for-Service (PFFS) plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plans terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies.