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CMS, the Center for Medicare and Medicaid Services, requires that insurance agents providing Medicare Part D Prescription and Medicare Advantage Plans to people on Medicare, first receive from the Medicare beneficiary the Government form below or have an approved teleconference call with you. After I receive the Scope Of Appointment form from you either by fax, mail or email, or we complete the call, then I can provide you with detailed Medicare Part D prescription and Medicare Advantage Plan information.
The choices available for Medicare recipients that are on over age 65 Medicare and Disability Medicare can be very good and very confusing. The information below and in this Medicare section along with our having confidential discussions, can help find good solutions that fit your needs.
There is no charge to the individual for using the services of a licensed health insurance agent—the commission is entirely paid by the carrier. The carrier is prohibited from selling the policy any cheaper if an individual does not use an agent.
Medicare Advantage Plans
Medicare Advantage plans are private health plans that generally provide all the coverage of Original Medicare and more. Plus, many Medicare Advantage plans offer lower copayments and cover additional items and services not covered by Original Medicare.
In addition, some plans may include Part D, or prescription drug coverage. These plans are referred to as Medicare Advantage with Prescription Drug (MA-PD).
How do they work?
To be eligible to enroll in a Medicare Advantage or Part C you must be eligible for Medicare Part A and continue to pay your Medicare Part B premium each month, unless it is otherwise paid for under Medicaid or by another party. Medicare then pays the Medicare Advantage plan a specific dollar amount to cover your care each month you are enrolled in the plan. You may not be eligible to enroll in a plan if you have end-stage renal disease (ESRD).
Coverage under a Medicare Advantage plan replaces your Original Medicare coverage. Sometimes you do not have to pay any additional monthly plan premium, for a Medicare Advantage plan. With low to no premiums, your out-of-pocket costs (like those paid to see a doctor or to be admitted to the hospital) under Medicare Advantage plans may be lower than your expenses would be with Original Medicare programs.
Medicare Advantage Plan Types
A Medicare HMO plan covers care you receive through a network of local doctors* and hospitals that coordinate your care. Your doctor may already participate in this type of plan. Another type of HMO plan, referred to as a Point of Service plan, allows the use of non-plan or non-preferred providers, but the services rendered by these providers may cost you more.
Medicare PPO plans allow you to choose between in-network and out-of-network providers. These plans provide reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary. For services received outside of the network, you will generally have higher copayment and coinsurance costs.
* In most cases, if you obtain routine care from out-of-network providers, neither Medicare nor the Medicare Advantage HMO plan will be responsible for the costs.