When trying to sign up for Medicare or a Medicare Advantage plan, it can get confusing if you’re not familiar with your options or the process for signing up. Let’s take a look at some basics you should know about Medicare Advantage.
What is Medicare Advantage?
Medicare Advantage (MA) plans, sometimes called Medicare Part C or Part C, are health insurance plans provided by licensed insurance companies and provide all the benefits of Original Medicare (Part A and Part B), along with additional bundled benefits. Medicare Advantage plans are an alternative to Original Medicare.
Medicare Advantage plans are also sometimes called Medicare Advantage Prescription Drug plans or MA-PDs if the plan offers prescription drug coverage.
How is Medicare Advantage different from Original Medicare?
Original Medicare consists of Parts A & B and is offered by the federal government. Part A (hospital insurance) helps pay for inpatient care in a hospital, skilled nursing facility care following a hospital stay, hospice care and home health care. Part B (medical insurance) helps pay for services from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment, and some preventative health services.
Medicare Advantage Plans are offered by private insurance companies, approved by Medicare and are regulated by the Centers for Medicare & Medicaid Services (CMS), a federal government agency. These plans include all benefits covered under Original Medicare’s Part A and Part B but offer additional benefits.
What is covered by a Medicare Advantage Health Plan?
Medicare Advantage plans offer additional benefits not included under Original Medicare, such as vision, dental, hearing and gym membership coverage.
For example, benefits under New Hanover Health Advantage’s Medicare Advantage and Prescription Drug plans (MAPD) that will be effective Jan. 1, 2022 include:
- Prescription drug coverage
- An Over-the-Counter (OTC) Monthly Allowance
- Meals Post Discharge from the Hospital
- Mail Order Pharmacy
- Worldwide emergency coverage
- Non-emergency medical transportation
- $0 preventive dental benefits
- Routine eye exams and glasses coverage
- $300 fitness club allowance
- Hearing aid discount
- Low maximum out-of-pocket cost
- Monthly premiums of either $0 or $45, depending on which plan you choose
How do Medicare Advantage and Medicare Advantage Prescription Drug plans work?
Insurance companies tend to set up Medicare Advantage programs as either Preferred Provider Organizations (PPOs) or Health Maintenance Organizations (HMOs). New Hanover Health Advantage offers a type of HMO plan called a Health Maintenance Organization – Point of Service or HMO-POS.
The main difference between an HMO Medicare Advantage and an HMO-POS plan is the flexibility of getting care outside of network. With an HMO-POS Medicare advantage plan, you can seek care outside of the network. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network and pay more if you use hospitals and providers outside of the network.
What Medicare Advantage Plans does New Hanover Health Advantage Offer?
New Hanover Health Advantage offers two high-quality HMO-POS plans: New Hanover Health Advantage Select (HMO-POS) and New Hanover Health Advantage Platinum (HMO-POS). This allows plan members to seek care outside of the traditional HMO network under certain circumstances or for certain treatment. Though you can go out-of-network for certain services, it is usually at a higher cost.
With a New Hanover Health Advantage plan, you generally get your care and services from doctors, hospitals or other healthcare providers in the plan’s network, which include the trusted providers and world-class specialists in New Hanover, Brunswick, Pender counties and surrounding areas.
Since each Medicare Advantage plan is different, research specific plans offered in your area to find out what is covered under each plan.
Who is Eligible to Enroll with New Hanover Health Advantage?
To be eligible for a New Hanover Health Advantage plan, you must be entitled to Medicare Part A, enrolled in Medicare Part B and live in New Hanover, Brunswick or Pender counties.
If you need help understanding more about Medicare Advantage or have questions regarding a New Hanover Health Advantage plan, connect with our local sales team at 910-667-NHHA (910-667-6442) or visit NewHanoverHealthAdvantage.com for more information.