MedInformatics - Medicare coverage: Part C - Medicare Advantage
While the majority of people with Medicare get their health coverage from Original Medicare, some choose to get their benefits from a Medicare Advantage Plan, also known as a Medicare private health plan or Part C.
MA Plans contract with the federal government and are paid a fixed amount per person to provide Medicare benefits.
Remember, you still have Medicare if you enroll in an MA Plan. This means that you likely pay a monthly premium for Part B (and a Part A premium, if you have one).
If you are enrolled in an MA Plan, you should receive the same benefits offered by Original Medicare.
Keep in mind that your MA Plan may apply different rules, costs, and restrictions, which can affect how and when you receive care.
They may also offer certain benefits that Medicare does not cover, such as dental and vision care.
All Medicare Advantage Plans must include a limit on your out-of-pocket expenses for Part A and B services.
In addition, while plans cannot charge higher copayments or coinsurances than Original Medicare for certain services, like chemotherapy and dialysis, they can charge higher cost-sharing for other services.
Many Medicare Advantage Plans also offer prescription drug coverage (Part D).
If you join an Medical Savings Accounts (MSAs) plan or a PFFS plan without drug coverage, you can enroll in a stand-alone Part D plan.
Remember that people with Original Medicare who want Part D coverage also enroll in a stand-alone Part D plan
If you have health coverage from your union or employer (current or former) when you become eligible for Medicare, you may automatically be enrolled in an MA Plan that they sponsor.
You have the choice to stay with this plan, switch to Original Medicare, or enroll in a different MA Plan.
Be aware that if you switch to Original Medicare or enroll in a different MA Plan, your employer or union could terminate or reduce your health benefits, the health benefits of your dependents, and any other benefits you get from your company.
Talk to your employer/union and your plan before making changes to find out how your health benefits and other benefits may be affected.
Medicare coverage: Part A
Medicare Part A coverage may include inpatient hospital, skilled nursing facility, hospice, and eligible home health care. As noted above, this type of Medicare health insurance is also known as Medicare hospital insurance.
Part A-covered hospital services generally include medically necessary services and equipment to treat your condition. This may include a semi-private room, general nursing services, and prescription drugs needed as part of your inpatient treatment.
You may be surprised to hear that Medicare Part A coverage doesn’t include long-term care, or the type of care you’d normally get in a nursing home or other long-term facility. Part A only covers limited skilled nursing facility care where personal care (i.e. help with daily tasks like bathing and eating) isn’t the only type of care you need.
Part A covers hospice care if your doctor determines that you’re terminally ill and have six months or less to live. Medicare Part A coverage of hospice services includes doctor and nursing services, hospice aide services, physical and occupational therapy services, prescription drugs for symptom control, and limited, short-term respite care for caregivers.
Medicare Part A coverage may also cover certain home health services, including physical therapy, speech-language pathology, occupational therapy, and/or speech therapy services.
Most people are automatically enrolled in premium-free Part A at age 65 if they’ve worked at least 10 years (40 quarters) under Medicare-covered employment and paid Medicare taxes while working, but you may also manually sign up for it and pay a monthly premium for it if you haven’t worked long enough to get Part A for free. If your spouse qualifies for Part A without a premium, you may be eligible to get premium-free Part A based on his or her work history.
Your Medicare Part A coverage may also come with other costs, including deductibles, coinsurance, and/or copayments.