Page 17 - Cover Letter and Evaluation for Paul Stelter
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Medicare Advantage plans -- an overview
An introduction to Medicare Advantage plans
How do Advantage plans supplement Plan Selection Criteria
Medicare?
Advantage plans are sometimes referred to Before you enroll in an Advantage plan,
as replacement coverage. That means that make sure it meets your criteria. Below is a
the plan replaces Medicare for as long as list of things you should consider:
you remain enrolled in the plan. Advantage Does its network include my doctors?
plans are required to cover the same services This is probably the most important criterion
as does Medicare, but they may have for many people. If one of your doctors (or
different cost sharing. Some Advantage plans other medical providers) is not in your plan's
also provide additional services like dental network, you will pay more when you see
and vision benefits that Medicare does not that doctor.
cover. Is it a low-cost plan for my drugs?
What if I see a non-network doctor? When evaluating an Advantage plan,
In the case of an emergency, you will be compare its costs for your drugs to other
covered when you go out-of-network. plans' costs for your drugs. If the Rx drug
Otherwise, it will depend on the plan's rules. costs in the plan you want to enroll in are
Most Advantage HMO plans do not cover out- several hundred dollars higher, you may
of-network costs (again, except for want to look elsewhere.
emergencies). Advantage PPO plans do cover Does it have a large network?
out-of-network care, but you will have Large-network plans give you greater
higher cost-sharing for out-of-network flexibility in your choice of doctors and other
doctors' visits and treatments. providers, particularly if you need a referral
How can plans have zero premiums? to see a new specialist.
Medicare makes sizable monthly payments Is the plan's out-of-pocket limit low?
to Advantage plans for each enrollee. Those Medicare's recommended out-of-pocket (or
payments enable some plans to charge low OOP) limit for HMO plans is $3,400 (not
or zero premiums. . including Rx drug costs). PPO plans can have
What added benefits do they have? OOP limits of up to $7,500 for network
Advantage plans often provide some routine services, not including Rx drug costs.
dental and vision benefits (neither of which Premiums do not count toward OOP limits.
is covered by Medicare). Some plans also Does it have a good quality rating?
offer free health club memberships, Medicare uses a five-star rating to judge a
telephone hotlines for medical questions, plan's quality (five stars is best). The ratings
and wellness classes. A few plans even are based on more than 40 measures that
rebate some of your Part B premium. include customer satisfaction.
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