Typically, do not require a referral to see a Specialist.Normally, do not require a Primary Care Physician.

Have broad network with nation-wide coverage.Cover eligible services for providers and facilities outside the network (at a lower amount than in-network).Cover eligible services for providers and facilities inside the network.Generally, require pre-authorization for procedures.Typically, require a referral to see a Specialist.Normally, require a Primary Care Physician.Out-of-Network expenses are mostly out-of-pocket.In-Network, Out-of-Pocket expenses are limited.As a rule, uses a network of providers/facilities within a specified geographical area.Covers eligible services from providers and facilities inside the network only, except in an emergency.Two Types of Medicare Advantage Plans: HMO or PPO HMO – Health Maintenance Organization: In general, requires a referral to see a Specialist.Normally, working with a Primary Care Physician is necessary.As a rule, working within a network is mandatory.Usually includes extra benefits not provided by Original Medicare.Provides predictable out-of-pocket costs.By selecting a Medicare Advantage plan, the insurance company becomes your primary insurance, and by doing so, it has very distinct advantages and disadvantages, such as: Advantages: This is a great option for reducing the exposure to Medicare’s 20% co-insurance. With that said, Medicare Advantage plan premiums (paid to the insurance company) vary, but there are many $0 premium plans to choose from. If a person enrolls in a Medicare Advantage plan, they must continue to pay their Original Medicare Part B premium to the Social Security Office. Worldwide Emergency Assistance Outside the U.S.They generally have additional benefits and services Medicare does not cover, such as: Medicare Advantage plans, at a minimum, include all benefits, services, and coverages outlined in Original Medicare. Enrolling in a Medicare Advantage plan requires a person to first enroll in Original Medicare Part A & Part B and to reside in the plan’s service area. They combine Original Medicare, Part A, Part B, and generally Part D into one plan. Medicare Advantage plans are Medicare approved insurance plans offered through private health insurance companies. One of the options a Medicare beneficiary has as a resource to tackle Original Medicare’s Co-Insurance, Co-Pays, and Deductibles is using a Medicare Advantage plan, also known as Part C. Worldwide Emergency Assistance Outside The U.S.Routine Vision Exams & Corrective Lenses.Any late penalties incurred from not obtaining Part B Coverage when first eligibleĪ Partial List of Services NOT Covered by Medicare Part B:.20% Co-Insurance – The Covered Medical Expenses Medicare does not pay.Annual Deductible – The amount changes annually.Medicare Part B Monthly Premium – The amount changes annually.Anyone eligible for Medicare Part A is qualified for Medicare Part B by enrolling and paying a standard monthly premium (premium tiers based on Modified Adjusted Gross Income two years prior to enroling). Medicare Part B beneficiaries receive coverage for medical expenses that are important for outpatient health care. 20% Co-Insurance – The portion of Covered Medical Expenses that Medicare does not pay.Inpatient Hospital & Skilled Nursing Co-Pays.Monthly Premium – $0 If Medicare Taxes were paid for 10 years.Home Health Care – Conditioned Home Health Services.Nursing Home Care – Provided if Custodial Care is not the only care required.For hospitals purchasing the blood, the cost of the first three units is the beneficiary’s responsibility. It also does not cover the cost of blood unless the hospital receives blood from a blood bank without a charge. Medicare Part A insurance DOES NOT cover a private hospital room, private-duty nursing, or personal care items such as shampoo, telephone, and television. These include a semi-private room, nursing services, meals, medications required during inpatient treatment, and other related services and supplies from the hospital. Medicare Part A beneficiaries receive coverage for hospital expenses that are critical for inpatient care. Part B – Outpatient / Physician Services.

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