The Medicare "Part C" program, or Medicare Advantage is part of
the Federal Balanced Budget Act of 1997. The program
provides seniors with a number of Medicare
health care plans that are run by private businesses. This
new Part C does not eliminate traditional Medicare.
Regular Medicare is still available. However, if a person on
Medicare chooses one of these new plans, it will replace his or
her regular Medicare. It is very important to remember that no
one has to select a "choice" plan at all! Seniors can
keep their regular Medicare if they want. No one will be
switched to a new plan unless he or she selects
one and enrolls.
Prior to these changes, people with Medicare had only two choices,
traditional Medicare or the newer Medicare Health
Maintenance Organizations (HMO's). People with Medicare
now chan choose among Medicare Advantage plans. These
plans must be approved by the Federal Center for Medicare and
Medicaid Services ("CMS"), but the plans are run through private
In November 1999, all persons with Medicare received a letter
from CMS explaining the Medicare changes and the new options.
Currently in Milwaukee, only one of the "new" plans are available.
The only options in the Milwaukee area are traditional
Medicare and the Medicare Advantage HMO offered by United
Health Care. This may change in the future. Even
when new plans become available, no one will be automatically
switched. If a senior is already on regular Medicare,
this will continue unless the person chooses to switch.
If a senior is new to Medicare, he/she will receive regular
Medicare unless the person chooses a different plan.
In regular Medicare, a person has free choice of their doctors,
hospitals and nursing homes but there are some out-of-pocket
costs. Some of these costs can
be covered by purchasing a Medicare Supplement or "Medigap"
insurance policy. If a person chooses a different option, such as a
Medicare Advantage HMO, he or she will give up regular
Medicare and receive all of health care services through the HMO.
This means that all of his/her doctors, hospitals and nursing
homes must be part of the HMO plan in order to avoid most
out-of-pocket costs. He/she may also need to disenroll from the Medicare Supplemental
Policy, if the senior has one.
This will be a very important decision for seniors and should be
considered carefully. SeniorLAW has written information about
Medicare Advantage and can talk to seniors about their concerns.
For questions, call the Milwaukee County Benefit Specialist
at SeniorLAW, Legal Action of Wisconsin, 278-1222.
MEDICARE ADVANTAGE ELIGIBILITY
If you are eligible for both Medicare Part A and Part B, you
are also eligible for Medicare Advantage In order for you
to be eligible for free Medicare Part A benefits, you must be
one of the following: age 65 or older;
a federal employee who retired after 1982;
a railroad retiree;
a widow, spouse, or qualifying divorced spouse of a federal
employee or railroad retiree;
or a disabled individual. There are also other ways in
which you can
receive Medicare Part A. You may, however, have to pay a monthly
In order to receive Medicare Part B, everyone must pay a monthly premium.
Part B coverage is available to everyone who receives Part A benefits
and to almost anyone who is over 65. You will still, however, need to
pay the Part B premium with most of the Medicare Advantage plans.
You are eligible for a Medicare Advantage plan only if it serves
the geographic area where you live. If you are otherwise
eligible, you may not be denied enrollment based solely on your
health status. Individuals with end stage renal disease
(ESRD) are ineligible for the program. However, you will
not be kicked off of your Medicare Advantage plan if you develop
ESRD after enrollment.