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SeniorLAW Publications on Medicare Advantage [Medicare Part C]




SeniorLAW Publications on Medicare Part D



 
 
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Medicare
Advantage

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 businesses.

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 premium.

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.

SeniorLAW
Important! The information on this website is not intended as legal advice or representation.   No attorney-client relationship is created between SeniorLAW / Legal Action of Wisconsin and any person obtaining information from this website.   Public benefits laws change frequently.   We strive to keep this website up to date but cannot provide a guarantee that this information is accurate as of the time you are reading it.
 
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