Understanding Basics of Medicare Advantage

June 28, 2021
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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, sometimes called Medicare 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, usually including a prescription drug plan. Medicare Advantage plans are an alternative to Original Medicare.

Medicare Advantage plans are also sometimes called MAPD plans or Medicare Advantage Prescription Drug plans if the plan offers 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 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 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?

Medicare Advantage plans offer additional benefits not included under Original Medicare, such as vision, dental, hearing and gym membership coverage.

For example, New Hanover Health Advantage’s Medicare Advantage and Prescription Drug plans (MAPD) include:

• Prescription drug coverage

• Worldwide emergency coverage

• Non-emergency medical transportation

• $0 preventive dental benefits

• Routine eye exams and 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 PPO or HMO networks. PPO stands for preferred provider organization. HMO stands for Health Maintenance Organization. New Hanover Health Advantage offers a type of HMO called HMO-POS, which stands for Health Maintenance Organization – Point of Service.

The main difference between an HMO-POS and HMO Medicare Advantage 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. 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’s usually for a higher cost.

With New Hanover Health Advantage, you generally get your care and services from doctors, other healthcare providers, or hospitals in the plan’s network, which include the trusted providers and world-class specialists in New Hanover, Brunswick, and 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 in each plan.

Who’s Eligible to Enroll with New Hanover Health Advantage?

To be eligible for New Hanover Health Advantage, you must be entitled to Medicare Part A and 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 Kathryn “Katie” Sarkorh at 910-667-3271 or visit NewHanoverHealthAdvantage.com for more information.



H6306_21_11352_M_ACCEPTED 06/28/2021




Categories: Your Health

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