Managed Medicare plans are an alternative plan to get coverage for Part A, Hospital Insurance and Part B, Medical Insurance. 

They work in place of original Medicare coverage and offer coverage for services not covered by the original Medicare. Most managed Medicare plans include Part D and Drug coverage. They set a limit on what you will have to pay out of your pocket for each year.

What is a Managed Medicare Plan

Managed Medicare plans are known as Medicare Advantage Plans and can also be referred to as Medicare Part C. The Medicare Advantage Plan is offered to people who are 65 years or older, younger people who have a disability or people with end stage renal disease and who meet the qualifying criteria. Medicare Advantage is offered by a private insurance company instead of the federal government. 

The Medicare Advantage Plan provides the benefits included in Part A, the hospital and Part B, as well as additional benefits.

Different Types of Medicare Advantage Plans

Health Maintenance Organization (HMO) Plans

This type of Medicare Advantage Plan limits its coverage to care from the providers who are employed by or have a contract with the Health Maintenance Organization. This Managed Medicare will generally not cover the out of network care except in an emergency. 

Preferred Provider Organization (PPO) Plans

This type of Medicare Advantage Plan is designed for individuals and families. The plan involves networks of medical professionals,  health care facilities and practitioners that are contracted to the Preferred Provider Organization. 

Health Maintenance Organization Point of Service (HMO-POS)

This type of Medicare Advantage Plan has added point of service benefits that will give you flexibility when you are in need of medical care. This Medicare Advantage Plan gives you access to a Health Maintenance Organization provider network with additional access to certain doctors and hospitals.

Private Fee-for-Service (PFFS) Plans

This type of Medicare Advantage plan (Part C) determines how much you will spend when you receive medical care and the providers decide whether to accept patients on this Medicare Advantage Plan. 

Special Needs Plans (SNPs)

This type of Medicare Advantage plan limits the membership of the patients with specific diseases or characteristics. This Medicare Advantage Plan tailors the benefits, provider choices, and drug formularies to best meet the specific needs of the patients they serve.    

Who is Eligible for Medicare Advantage Plans?

You will need to have both Medicare Part A and Part B to be eligible for the MedicareAdvantage Plan. You will need to met the below requirements: 

• Being 65 years or older 
• Having a disability or receiving 2 years of a Disability benefit  
• Being diagnosed with ESRD 

Different Medicare Advantage options :

• Medical Savings Account combines the use of a health care savings account with a high deductible catastrophic health plan.  
• Private Fee-For-Service Plans contract with a network of providers, lìke coordinated care plans, or allowing an individual to use any doctor or hospital as long as the provider accepts the plans terms and conditions. 
• Special Needs Medicare Advantage Plans are designed for patients who live in certain institutions and have one or more specific chronic or disabling conditions. 

Benefits of Medicare Advantage

Medicare Advantage Plans cover almost all of the hospital and medical coverage services. In all types of Medicare Advantage Plans the patients are always covered for emergency and urgent care. Benefits include:   

• Automate rules-based decisions and optimized workflows
• Easily adjust to stay compliant with CMS requirements
• Connect Care Managers, UM nurses and Member Services to elevate collaboration
• Implement individualized care plans and close gaps in care
• Arrange Special Supplemental Benefits for the Chronically Ill services efficiently
• Leverage rich data to easily produce reports, including ODAG and CDAG
• Hospitalization 
• Some home healthcare services 
• Hospice care 
• Doctors visits 
• Prescription drug coverage
• Preventive care
• Dental
• Vision 
• Hearing 

Some of the Medicare Advantage benefits can also include: routine vision, dental, hearing services and prescription drug coverage.  

How do Medicare Advantage Plans Work?

Medicare Advantage Plans pay a fixed amount each month to the company who offers you coverage for your Medicare Advantage Plan. The plans will need to follow the rules set by the Medicare but they can change different rules for how you get services. 

The rules may change each year but the plan must notify you about the changes before the start of the next year.  If you do chose to stay with the plan you will have the same rights and protections. 

Covered Services in Medicare Advantage Plans

Medicare part A

The service covers the inpatient hospital stays, which includes care in a skilled nursing facility, hospice care, and some home health care.   

Medicare part B

The plan covers 2 types of services: 

• Medically necessary services: Services or supplies needed to diagnose or treat medical conditions and meet accepted standards of medical practice. 
• Preventive Services: Health care to prevent illness or detect it at an early stage.   

Medicare part C

The service will provide coverage for Part A, the Hospital Insurance and Part B, Medical Insurance. Medicare Advantage plans may offer additional coverage for vision, hearing, dental, health and wellness programs and Part D, prescription drug coverage.

Cost for Medicare Advantage Plans

The cost of the Medicare Advantage Plans will depend on the plan chosen. The price will vary by location. InfoMC Health strives to directly improve healthcare delivery, reduce costs and optimize outcomes. More information can be found here or contact us directly today!