Medicare Advantage- MA only
Part B monthly premium rebate: some $0 premium Medicare Advantage plans are able to rebate all or a portion of your Medicare Part B premium ($148.50 in 2021) back to you as part of your monthly Social Security check. The amount varies according to plan and area or county that you live in. Most plans do not offer prescription drug coverage or are Medicare advantage only with the exception of a few insurers that offer the Part B give back with plans that have prescription drug coverage. Many of these plans are catering to Veterans that use their prescription benefits through the military.
Medicare Advantage with prescription drugs - MAPD
Medicare advantage plans that include (Part D) prescription drug coverage. – These are the most popular medicare plans many are $0 premium plans and have dental, vision, hearing, gym membership, transportation, prescription and other added benefits that attract people to the plan.
Some plans may have a low monthly premuim with additional coverage that could be worth the small monthly premium such as a better network. Plans vary according to area or county that you are living in. Most plans are either an HMO or PPO network.
Medicare Advantage plans. HMO or PPO networks.
A Medicare Advantage Health Maintenance Organization (HMO) plan is a Medicare approved health plan that provides you with access to a network of doctors and hospitals that coordinate your care, with an emphasis on prevention. An HMO has the most restrictive network where your care may not be covered if you go outside the HMO network without obtaining prior approval.
Do I need to choose a primary care doctor? Yes, In most cases.
Do I have to get a referral to see a specialist? Yes, In most cases. Certain services, like yearly screening mammograms, don't require a referral.
A Preferred Provider Organization (PPO), is a type of Medicare Advantage plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network. You can use doctors, hospitals, and providers outside of the network for an additional cost. A PPO has a more flexible or open network of doctors and hospitals than an HMOor an HMO-POS(Point of Service). Normally having to get a referral to see a specialist or listing your (PCP)primary care physician is not necessary. An HMO POS is a Medicare Advantage Plan that is a Health Maintenance Organization with a more flexible network allowing Plan Members to seek care outside of the traditional HMO network under certain situations or for certain treatment. A Member may pay some additional fees for using the POS (out-of-network) option. You generally get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis). However, you may be able to go out-of-network for certain services usually for a higher cost.
Special Needs Plans (SNP) Options.
Chronic condition or dual eligible plans. The chronic condition plans have special needs benefits for conditions such as Cardiovascular Disorders, Chronic Heart Failure and Diabetes. Many of these are zero premium plans. However, you must qualify for the plan with a special needs report submitted by your doctor. These plans might have discounts for prescriptions and added services for covered chronic conditions.
Dual eligible plans are for those who qualify for medicare and medicaid. These plans offer added benefits for those that qualify for medicare and also have a financial need and qualify for medicaid. The beneficiary who qualilfies for a Dual elegible plan can change a plan once per quarter.
The Special Needs plans (SNP) vary according to the area or county that you live in and also the carrier that is offering the benefits.
Medicare plan quality and CMS Star Ratings
Each year, the Centers for Medicare and Medicaid Services (CMS) rate the quality of Medicare Part D and Medicare Advantage plans using various measures. In the end, an overall Star Rating is calculated for each Medicare plan. A summary rating of prescription drug plan quality and a separate summary rating of health plan quality are calculated where appropriate.
Star Ratings are also awarded for various discrete aspects of Medicare Part D and Medicare Advantage plans. New Medicare Part D or Medicare Advantage plans naturally do not have any historical information, so they will not have any Star or quality ratings for the first year.
- Overall Star Rating
- Summary Rating of Prescription Drug Plan Quality
- Summary Rating of Health Plan Quality