Long-Term Care Planning: Medicare Advantage Plans - dummies

Long-Term Care Planning: Medicare Advantage Plans

By Carol Levine

Copyright © 2014 AARP. All rights reserved.

Your long-term care plans might involve some sort of assistance from Medicare. Medicare Part C offers an alternative to original Medicare called the Medicare Advantage program, a collection of health plans (such as Health Maintenance Organizations and Preferred Provider Organizations) that combine Parts A and B services (usually with Part D prescription drug coverage) in their benefit packages.

The plans are offered by private companies with Medicare approval. They must cover all the services in original Medicare but may also offer extra coverage, such as vision, dental, hearing, and health and wellness programs. Medicare Advantage plans set their own fee schedules, and this is important information when you are choosing a plan.

In original Medicare — a fee-for-service arrangement — you go to a doctor who participates in the program and pay a copay, and the doctor bills Medicare for the visit and any tests or procedures that were performed. Medicare Advantage plans receive a set amount every month for each person enrolled in the plan, whether they use many services or just a few.

The plan can charge different copays and have different rules about whether you need a referral to see a specialist, for example, or whether you can only go to doctors or hospitals that belong to the plan. There are several different kinds of Medicare Advantage plans, and their rules, costs, and benefits differ and can change each year. You can change plans once every year and at other times in certain circumstances.

If you enroll in a Medicare Advantage plan, you can’t buy a Medigap policy. This kind of insurance can be used only with original Medicare and can’t be used for any expenses under a Medicare Advantage plan. However, if you drop your Medigap policy to join a Medicare Advantage plan and then decide to go back to original Medicare, you may not be able to get the Medigap policy reinstated.

For more information about Medicare Advantage pans, go to the Medicare Plan Finder.