메디케어 어드밴티지

Leverage the experience of Brooks Insurance Group to weigh your Medicare coverage options.

Medicare Advantage plans, also known as Medicare Part C, are another way Medicare beneficiaries can receive benefits through private insurance companies.

A Medicare Advantage plan combines the benefits of Original Medicare, Part A (hospital) and Part B (medical), into a single plan. Medicare Advantage plans often include additional benefits not covered by Original Medicare, such as prescription drug coverage (Part D), dental and vision, hearing, and wellness programs. A Medicare Advantage plan can provide lower out-of-pocket costs and flexibility in choosing healthcare providers and services.

When you enroll in a Medicare Advantage plan, you still have Medicare coverage. However, with a Medicare Advantage plan, your healthcare services are managed through a private insurance plan, which usually includes a broker or agent (like us!)

Types of Medicare Advantage Plans

건강유지기구(HMO): HMO 플랜을 이용하려면 응급 상황을 제외하고는 플랜 네트워크 내의 의사와 병원과 협력하여 이용해야 합니다.

건강 관리 기구 - 서비스 지점(HMO-POS): HMO-POS 플랜은 네트워크 외부의 의사와 병원을 통해 특정 서비스를 이용할 수 있도록 하는 HMO의 한 유형으로, 일반적으로 비용이 더 많이 듭니다. 일반 HMO보다 유연성이 더 높습니다.

선호 공급자 조직(PPO): PPO 플랜을 이용하면 네트워크 외부의 의사 및 병원과 협력하여 이용할 수 있지만, 이러한 유연성에는 비용이 많이 드는 경우가 많습니다.

메디케어 의료저축계좌(MSA): MSA 플랜은 건강저축계좌(HSA)와 유사합니다. 다른 메디케어 어드밴티지 플랜과 달리 MSA는 일반적으로 의사, 의료 서비스 제공자, 병원 등의 네트워크를 보유하지 않습니다.

Private Fee-for-Service (PFFS):
A PFFS plan breaks down coverage and cost by determining how much the plan will pay doctors, other healthcare providers, and hospitals and how much you must pay for care.

Special Needs Plan (SNP):
An SNP plan is available to people who have specific diseases or conditions, are eligible for Medicare and Medicaid, or live in certain facilities (like a nursing home).

Chronic Special Needs Plan (C-SNP):
A C-SNP is designed for individuals living with specific chronic conditions, such as diabetes, chronic heart failure, or chronic lung disorders. These plans tailor their benefits, provider choices, and drug formularies to best meet the needs of the chronic condition they target. C-SNPs often include care coordination services to help members manage their health more effectively and may offer extra benefits related to their illness.

메디케어 어드밴티지 플랜의 혜택

Comprehensive Coverage: Medicare Advantage plans allow you to consolidate coverage into a single plan. These plans typically include Medicare Part A (hospital) and Part B (medical) coverage, and many also offer Part D prescription drug coverage. Additionally, a Medicare Advantage plan could cover other health-related needs like dental, vision, hearing, senior wellness, fitness memberships, and medical appointment transportation.

Cost-Effective Options: Medicare Advantage plans often have lower out-of-pocket costs than Original Medicare. This can include lower deductibles, copayments, and coinsurance for covered services. Some plans also have annual out-of-pocket maximums, providing financial protection against high healthcare expenses.

관리형 의료 조정: HMO나 PPO와 같은 많은 메디케어 어드밴티지 플랜은 관리형 의료 모델로 운영되며 수혜자에게 조정된 의료 옵션을 제공할 수 있습니다. 이러한 플랜을 이용하려면 주치의를 선택하고 전문의 진료를 받으려면 의뢰서를 받아야 할 수도 있습니다.

Flexibility in Provider Choice: While some Medicare Advantage plans require you to use network providers, others offer flexibility to see out-of-network providers for a higher cost. This flexibility can benefit those who prefer continuity of care with their current healthcare providers.

Medicare Star Ratings:  Medicare uses a five-star rating system to evaluate the quality of Medicare Advantage plans. Plans are rated on customer service, member satisfaction, and healthcare outcomes. 

What to Consider When Choosing a Medicare Advantage Plan

When selecting a Medicare Advantage plan, it's essential to consider your individual healthcare needs, including additional benefits/coverage, prescription drug coverage, provider networks, and out-of-pocket expenses. Here are some factors to evaluate:

Costs: Compare the monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket-maximums for each Medicare Advantage plan against your current coverage.

보장 범위: 처방약, 치과, 시력 및 기타 서비스에 대한 보장을 포함하여 귀하의 건강 관리 요구에 맞는지 확인하기 위해 계획의 혜택을 검토하세요.

계획 평가: 계획 평가를 사용하여 계획의 품질과 성과를 측정합니다.

Prescription Drug Coverage: Ensure your prescription drugs are included in the plan’s formulary (list of covered medications) and accessible at your preferred pharmacies.

Provider Network: Determine if the plan’s network includes or is accepted by your preferred healthcare providers (primary doctor, specialists, etc.)

When to Enroll in Medicare Advantage Plans

You can enroll in, switch, or drop a Medicare Advantage plan during one of the two main enrollment seasons:

Annual Enrollment Period (AEP): Every year from October 15th to December 7th, you can add or make changes to your Medicare Advantage plan.

초기 등록 기간(IEP): 65세 생일 전후 7개월 동안 메디케어 가입 자격이 처음 부여되는 기간입니다. 65세 생일 3개월 전부터 시작하여 생일이 있는 달을 포함하며, 65세 생일 후 3개월까지 연장됩니다.

Open Enrollment Period for Medicare Advantage Plans (OEP): If you're enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare from January 1st to March 31st each year.

Special Enrollment Periods (SEPs): Certain life events may qualify you for a Special Enrollment Period.

메디케어 보충 플랜과 메디케어 어드밴티지 플랜의 차이점 이해

Medicare Advantage 플랜(파트 C)과 Medicare Supplement/Medigap 플랜의 차이점을 아는 것이 중요합니다.

Medicare Supplement plans work with Original Medicare, while Medicare Advantage plans are an alternative to it. 

Medigap plans work alongside Original Medicare, allowing you to see any Medicare-approved provider and offering more predictable costs.

Medicare Advantage plans often include additional benefits such as vision, dental, and wellness programs, but they usually require using in-network providers.

Speak with a broker today to discuss Medicare Advantage options ➜