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What is Medicare Part C

Many people see television ads telling them they need Medicare Part C.  In this post we answer the question; What is Medicare Part C and do you actually need it.

Medicare Advantage (Part C), gives Medicare beneficiaries an alternative coverage option to Original Medicare.  Medicare A & B provide coverage for essential health care benefits such as; doctor visits and hospitalization.  Part C (MA plans) take the place of your Medicare Part A & Part B benefits and are available through private insurance companies.  They also provide many value added benefits such as prescription coverage (Part D), dental, hearing, vision, OTC benefits and more.

More details about Part C:

All Medicare Advantage (Part C) plans are offered by private insurance companies.  MA/MAPD (Part C) carriers are regulated by CMS and must provide beneficiaries the same level of medical coverage that Original Medicare (A&B) provides.

Most Part C (MA/MAPD) plans offer a very competitive premium, many plans have a $0 premium as well as low out-of-pocket costs.  This gives people a very cost effective way to get the healthcare coverage they need.

If you opt for a MA/MAPD (Part C) plan, you should be aware of the plan’s provider network and confirm that your doctors are in-network with your selected plan.  Even if you choose a PPO plan, using an out-of-network provider can be a costly mistake.

Each year, during the AEP, you have an opportunity to either enroll in or out of your current Medicare plan.  The AEP starts on Oct. 15th and ends on Dec 7th.  If you are enrolled in a MA/MAPD, you have an extra opportunity to change your coverage options starting Jan 1 and ending March 31 each year; this is called the OEP.

Summary – Why Choose a Medicare Advantage Plan (Part C):

Part C (MA/MAPD) plans provide comprehensive coverage including additional benefits such as; dental, vision, hearing, prescriptions, OTC, rides to appointments and more. They also cover Medicare A & B charges for doctors and hospitals. Many plans include Part D, prescription drug coverage.  All you need is one card to cover your medical costs.

Because MA/MAPD plans have annual out-of-pocket maximums, beneficiaries can feel safe knowing the cost of their annual healthcare has a limit.  Plans also offer clear costs for services.  Some carriers offer coordination of care benefits which is a great way for all our providers to stay in the loop on your care needs.

There are several different plan options to suit your personal needs including; HMO, PPO, PFFS, DSNP, ISNP, etc.

A Medicare Advantage plan (Part C) is not for everyone:

It is important to consider many factors before choosing Medicare Part C coverage.  Some things to think about are; your personal healthcare needs as well as your budget. With careful research and an understanding of the plan’s features, you can make an informed decision that supports your health and well-being.

One of the most important points is to make sure our providers are in-network with the plan you choose.

Consider any medical conditions you may have an dhow often you will require medical attention.  It may be a better bet to join a Medicare Supplement and prescription drug plan depending on your personal health needs.  There are co-pays, deductibles and out-of-pocket maximums to think about with a Part C plan.

Make sure you are aware of the plans Star Ratings to be sure yo consider a good quality plan.

Remember; plans change every year.  Benefits are added and taken away.  That is why it is important to work with a knowledgeable, licensed Medicare agent to help you sort out all your plan options during the AEP or OEP enrollment periods.

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Sign up for Medicare Part D

Once you enroll in Medicare, it is very important to Sign up for Medicare Part D.  A skilled Medicare agent can make choosing the best Medicare Part D (prescription drug plan) reasonably quick and easy.  Anyone who does not have credible Part D coverage when they are eligible for Medicare is subject to a lifelong penalty.

What does Medicare Part D cover:

Medicare Part D plans are prescription drug coverage.  This coverage is available to eligible Medicare beneficiaries. Part D coverage is provided by private insurance companies that are contracted with the federal government. There are 2 ways to enroll in Part D coverage.  First, beneficiaries may enroll in a PDP, stand-alone prescription drug plan, in addition to traditional Medicare.  The second choice is to enroll in a Medicare Advantage plan, MAPD these plans include Part D coverage.

Who is eligible for Medicare Part D:

If you are enrolled in either Medicare Part A or Part B and live in the Part D plan’s service area, you are eligible to enroll in a plan.  Additionally, certain individuals with limited income and resources are eligible for “extra help”.  Extra help provides help paying for drug plan premiums, deductibles, coinsurance and other costs.  Click here to learn more about “Extra Help” and how to apply.

When can you enroll in Part D:

To avoid late enrollment penalties, timely Medicare Part D enrollment is imperative. There are two primary enrollment periods.

The IEP or Initial Enrollment Period is a 7-month period.  It starts three months before you turn 65, includes your birth month, and ends three months after your birthday. Please note; if you qualify for Medicare due to a disability, you may have different enrollment periods.

AEP or Annual Enrollment Period occurs each year from October 15th to December 7th. During the AEP, you can make changes to your existing Part D coverage, such as switching plans or adding coverage.

How to choose a Medicare Part D Plan:

This is an extremely important part of your Part D enrollment.  If you choose the wrong plan, it can be a very costly mistake.  Each plan offers different coverage options. Selecting the right Part D plan is crucial, as each plan may have different premiums, coverage options, and their own network of pharmacies. Please consider the following when making a plan choice:

Make a list of all the medications you are currently on.  You may want to add in anything that your doctor will prescribe in the following months. Be sure to include the dosage and the frequency  that you take them.  This helps to find plans that cover your medications.

An insurance agent can show you a comparison of the best plan options for your needs.  If you  do not have an agent, use the Medicare Plan Finder tool on the official Medicare website. Be aware of all costs including; premiums, deductibles, copayments, and coinsurance costs.  You need to consider the total cost of each plan option.

Look at the plan’s formulary.  This is a list of drugs covered by each plan. Double check that your medications are on the list and make a note of any restrictions on your prescriptions.

Be sure the pharmacy you use is a preferred in-network. If it is not see if there are alternative pharmacies close by that are preferred in-network so you can receive the best pricing.

Check the plan’s star ratings.  This is  system based on overall service and coverage.

How to enroll in Part D:

Once you choose the best Medicare Part D plan to meet your prescription coverage needs, you have a few ways to enroll.

1.  Online: A licensed Medicare agent may be able to enroll you using an enrollment link from their quoting engine or you can enroll by going to either Medicare.gov or the website of the carrier of the plan you selected.

Click here to view a demo of how to use Sunfire to run a quote

2.  Fill out a paper application.  If you are working with an agent, they will help you fill out the necessary paperwork and send the application in for you.  If you do not have an agent, you can submit the application using the instructions provided by the carrier.

3.  Enroll over the phone.  You can call the plan carrier or call 1-800-633-4227 (1-800-Medicare).

Beware of late enrollment penalties:

If you miss your Initial Enrollment Period or do not have creditable prescription drug coverage for over 63 days, you may wind up with a late enrollment penalty. This penalty is added to your Part D premium and remains in effect for as long as you have Part D coverage.  Please note; if you receive extra help, this penalty does not apply.

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Humana HMO Network Change

There is a Humana HMO network change for the Medicare Advantage insurance plans . Humana is now partnering with two different companies that provide durable medical equipment (DME) for Medicare Advantage beneficiaries. These changes will streamline providers and offer them all one source of DME, making it easier to connect people with the products they need. It is also to save Humana, and therefore the beneficiaries of their Medicare Advantage plans, money. The designated durable medical equipment providers will need to transition their existing rentals to providers that are now in-network with Humana. They will have 90 days to do so.

The press release from Humana stated that the two DME companies that they are now partnered with are AdaptHealth Corp. and Rotech Healthcare Inc. Their goal will be to help their Humana Medicare Advantage HMO beneficiaries achieve their best health at home with durable medical equipment. This is a more unified approach to sourcing DME and will allegedly provide a higher level of service to the beneficiaries who need these vital pieces of equipment for their quality of life.

Humana HMO Network Change – Impacted Items

The following bulleted lists are from the Humana press release and give a succinct grouping of what DME rentals must be transferred and which can remain un-transferred.

These DME groupings should be submitted to the designated DME provider (e.g. AdaptHealth Corp. for the Southeast Region) under this network change.   Respiratory supplies are included.   Beds and support services transferred.   Mobility aids, including wheelchairs and standard power mobility also transfer.

What’s Not Changing

Additionally, DME suppliers who focus on the following areas are not imp acted by this change.  Prosthetics, custom orthotics, and diabetic shoes remain unchanged.  Mastectomy items and wigs, hearing aids, custom power wheelchairs also remain unchanged.   And finally, there is no change to ostomy, urology and diabetic supplies.

With these changes in mind, what does an agent need to do now? Agents are free to reach out to their clients on a Humana Medicare Advantage HMO plan who use DME and notify them on the coming changes. Providers must take note of these changes and submit referrals accordingly when sourcing DME. These changes are effective on July 1st of 2023. The carrier itself, Humana, will be notifying its members of the coming changes as well.

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Anthem 2022 OTC catalog

If you are a member of an Anthem Medicare Advantage plan, information about the Anthem 2022 OTC catalog will e useful.  It is important to note that; all Medicare Advantage plans do not offer an OTC benefit.  Members can confirm the benefits offered by their plan either by checking the summary of benefits provided for their plan or calling the member services number listed on the back of your membership card.

What is an OTC (Over The Counter) benefit:

An OTC benefit is a specified amount provided to members of participating plans that covers approved over the counter(non prescription) health related items.  This benefit covers things such as; OTC pain relievers, antacids, band aids, oral care and vitamins, as well as various other non-prescription health items.

Please keep in mind; This benefit is provided on a quarterly basis.

On the first day of each quarter, your benefit amount is loaded to your card and available for use.   Any unused OTC benefit amount rolls over to the next quarter.  All unused OTC benefits expire on December 31 of the benefit year.

Click here to download the 2022 Anthem OTC catalog

There are a few different ways to order your OTC items:

1.  Shop for OTC items in one of the 4,700 Walmart, Neighborhood Market stores or in one of the other participating retail locations.  To find a participating retailer near you; you can either go to www.healthybenefitsplus.com or you an download the Healthy Benefits mobile app.  You can download the mobile app by going to either the Apple app store or Google play.
   1. Once you have installed the app, you can:
      Check the balance on your OTC card
      Review your recent orders
      Download a copy of your card
      Scan items in the store to see if they are eligible OTC items
      Order either a new OTC card or catalog

If you prefer not to leave your home; you an order items either online or over the phone:

1.   To order your items online;  just go to www.HealthyBenefitsPlus.com/AnthemBCBSOTC and click on the get started link.  Once you set up your account, click the buy at Walmart.com button, choose your OTC items and place your order.  Your order is delivered, at no cost, to your home.  If your order cost is over your benefit limit, you must add another form of payment for the overage amount.
2. If you would rather order over the phone; call 1-866-413-2582 (TTY: 711) and speak with customer service representative.  Be sure to have your OTC card and product name as well as the  item Id number ready before you call.

Additional Anthem 2022 OTC catalog information:

1.  This OTC benefit is solely for the use of the member.
2.  Both sales tax and shipping costs are added to your order total and deducted from your benefit amount.
3.   Items will arrive either by FedEx, UPS or individual courier from Walmart.
4.   If your order is damaged, lost or stolen; you can request a replacement by calling customer service at 1-833-235-2107 (TTY: 711)

Please note:  the prices of some catalog items are subject to change due to price changes after the catalog is printed.

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Compare Medicare plans

Medicare beneficiaries will feel confident with their choice when they have the option to Compare Medicare plans.

Most people feel overwhelmed when the time comes to enroll in a Medicare plan.  There are a lot of options available whether you are new to Medicare or changing plans during one of the election periods. 

There are couple options when it comes to choosing how to get your Medicare coverage:  

The First option is to take Original Medicare; this means Part A and Part B. If you decide to do this, you have the ability to add a Medicare supplement plan/Medigap plan as well as drug coverage or Part D.  These plans provide additional coverage when paired with original Medicare.   Medicare supplement plans pay the additional 20% of your Medicare approved costs that Medicare does not pay.  These plans do not require you to choose a network of providers and are offered by Medicare approved, private insurance companies.  You can use them with any provider who participates with Medicare.  You do not need referrals to see any doctor or specialist.  

Another option is to choose a Medicare Advantage Plan/Part C.  A Medicare advantage plan includes both Part A and Part B coverage. They take the place of your original Medicare coverage. These plans are offered by Medicare approved private insurance companies.  The Plans also require that you use a provider who participates in your plan’s specific network.  These companies offer either HMO or PPO plans.  Most of them also offer prescription drug coverage as part of the plan. 

CLICK HERE TO COMPARE MEDICARE PLANS

 You may be eligible to receive help paying for your Medicare coverage if you have limited income:

If you are within the eligible income level you may qualify for Medicaid.  Medicaid is both a federal and state program that provides help with medical costs.  There are also MSP programs sponsored by the state government that can help you pay medical expenses.  These programs help pay medical expenses such as; premiums, co-pays and prescription costs as well as deductibles.

Medicare also works with other types of health care coverage you may have such as, employer, union or veteran’s benefits.

There are many things to think about when it comes to your health.

We understand the importance of finding the right health care coverage to fit your individual needs and budget.  We are always happy to help you find the best plan for you.  You can reach us either by phone (203)796-5403 or by email at teal@croweandassocites.com.

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A number of our clients want to know how a Medicare Advantage plan works and how it is different from Medicare A and B and/or a Medicare Supplement plan.  The fact is that Medicare Advantage plans are very different from standard Medicare A and B and a Supplement.

A Medicare Advantage plan is offered by a private insurance company.  The plan takes over for Medicare A and B and is your primary insurance.  When you have an advantage plan, you show the advantage plan card.  The provider you see will then bill the advantage plan instead of billing traditional Medicare.  This is not a good or bad thing.  It is simply a different way to obtain you health and drug coverage.   Your own unique health care needs will determine if you should go with a Medicare Advantage plan or a Medicare Supplement with a drug card.  Here is a quick overview of the strengths and weaknesses of an Advantage plan.   Read our Medicare Guide for more information CLICK HERE FOR MEDICARE GUIDE

Wikipedia also provides a good summary of Medicare Advantage plans along with multiple government links CLICK HERE FOR ARTICLE

Medicare Advantage Plans – Possitives

• $0 monthly premium on most plans
• Drug Benefit is included with the plan
• Preventative care is covered in full with no copays
• Works very well for those with VA coverage
• Extras such as Dental, Vision, Silver Sneakers, Etc…
• A number of plans and companies to choose from in most areas

Medicare Advantage Plans-  Negatives

• The plans have networks that you need to use.  Some plans allow in and out of network but the cost go up if you go out of network.
• You pay copays for services.  Copays are higher for more expensive services such as Hospitalization or major medical tests.
• There are pre authorization requirements for some services

If you doctor does not participate or if you are receiving high volume care, you may be better off with a Medicare Supplement Plan.