Medicare Advantage Plans in Maryland
One of the Medicare options you have that is growing in popularity is the Medicare Advantage Plan, also known as Part C. There is a lot of misinformation about these plans and are too often given a bad reputation by those that simply don’t understand them, or simply can’t sell them. Medicare Advantage plans in Maryland have tons of great benefits, but there are a few rules about how you use them, and when you can enroll.
At Maryland Medicare Options, I am licensed and authorized to sell all types
of Medicare insurance plans including Medicare Advantage Part C plans.
A Part C plan is a great alternative to Original Medicare and typically covers at least what Original Medicare does, plus some great extras. Most plans have prescription drug coverage embedded into the plan, so you don’t have to spend any more on a separate drug plan, and you simply carry around one insurance card rather than two or three.
A Medicare Advantage Plan in Maryland works differently than Original Medicare. With Part C, the doctors, hospitals and providers work directly with the insurance carriers, determining what they’ll accept as payment towards services. These payments somewhat mirror what Medicare pays, but not always. To better understand how this works, we have to understand why these Advantage Plans exist.
Back in the 1980’s, researchers for the US government were studying the effects that the boomer generation would have on our healthcare system and they were alarmed by the potential underfunding of Medicare. So they set out to design an alternative that would benefit not only the Government, but the consumer and the private healthcare company. Advantage Plans launched in the mid-1980's.
The system they came up with is actually quite brilliant. Normally, the Government would be on the hook for 80% of your medical bills, which can be pretty overwhelming for an underfunded social program like Medicare. So they decided to incentivize seniors to get off of Original Medicare and move the responsibility over to a privatized healthcare company. The incentive for seniors comes in the form of lower monthly out-of-pocket premiums, more benefits and a more streamlined way of getting your insurance.
The Government was able to shift the financial responsibility of paying for your healthcare coverage (the 80%) by offering healthcare companies approximately $1,000 per month for every Medicare recipient that elects to have their Medicare insurance provided by a healthcare company rather than the US Government.
Of course, the healthcare companies can manage $12,000 per year on your behalf much better than the federal government, and they do quite a good job at it. These plans often have many features and benefits that Original Medicare does not.
Just some of the benefits you might find inside of a Medicare Advantage Part C Plan:
- Free Gym membership through Silver Sneakers or Silver & Fit
- Free Transportation to and from plan approved locations (like Dr’s offices / pharmacies)
- Free Over-The-Counter products (quarterly spending limits apply)
- Free Virtual eVisits with physicians (smart phone required)
- Free Post-Discharge Meals after an Inpatient stay
- Free Routine Podiatry / Chiropractic / Vision / Hearing / Acupuncture
- $$$ Towards the purchase of hearing aids
- $$$ Towards the purchase of contacts or glasses
- Comprehensive or Routine Dental services
- Personal Emergency Response (PERS) – bracelet / necklace to trigger medical response for falls
- Free Smoking cessation services
- 24 Hour Telephonic Nurse / Doctor helpline
Benefits vary from plan to plan. Not all benefits appear in all plans. Plans vary by county and may change each year. Contact me directly to hear about all the current plans in your area.
Not all plans will have all of these benefits. Each Advantage plan has its own set of benefits to cater to different clients.
Advantage Plan companies offer a variety of different plans to service many types of consumers. The available Maryland Advantage Plans include:
- HMO – Health Maintenance Organizations that require you to stay within a network of doctors, hospitals and health centers for non-emergency services. There are no networks for urgently needed or emergency services.
- PPO – Preferred Provider Organizations that require you to stay within a network of doctors, hospitals and health centers but allow you to visit providers outside of the network with different levels of coverage based on the network. There are no networks for urgently needed or emergency services.
- SNP – Special Needs Plans
- Institutionalized (I-SNP) For those residing in nursing homes or similar care facilities, these plans are designed around their needs.
- Dual Eligible (D-SNP) For those that qualify for Maryland state assistance such as Medicaid or SSI. They are dual eligible for both Medicare and Medicaid and have plans designed specifically for them
- Chronic – (C-SNP) For those with a chronic health condition such as heart disease, ESRD, COPD, each of these plans specializes in one specific chronic condition. Doctor approval is required to finalize enrollment into a C-SNP plan.
If I have a preexisting condition, can I be denied coverage?
No, you will be approved as long as you have Medicare Part A and Medicare Part B and you are enrolling during an appropriate enrollment period for your situation. There are no health questions to determine eligibility on a Medicare Advantage application.
Can my coverage be cancelled if I get sick?
No, this is against the law. Once you have the plan, your coverage cannot be terminated based on your health. The only way the plan can terminate your coverage is if you fail to pay your Medicare Part B monthly premiums or the plan’s monthly premium if one is required, or if you move out of the plan’s service area (which is typically from one county or state to the next).
What if I move out of the plan’s service area, what happens then?
Medicare offers you a 63 day window in which you must obtain coverage from a different insurance plan. This is called a Special Election Period or SEP. There will be no medical questions and you cannot be denied coverage. Most clients stay with the same company, but if the company you are currently with does not offer a plan in the county to which you are moving, then you must select one of the available plans in the new area. It’s best to discuss your options with your Medicare Broker prior to moving.
If I join a Medicare Advantage Plan in Maryland, can I later go back to original Medicare and buy a Medicare Supplement Plan?
Yes. There are several ways this can happen and it is a very complex and sometimes confusing answer with lots of rules, regulations and timelines.
The first way this can happen is if you join a Medicare Advantage Plan for the very first time, you have a 12 month “free look” or “trial period” in which Medicare allows you to test-drive the plan. If during this 12 month trial period you decide you want Original Medicare, then you simply switch to Original Medicare and purchase a Medicare Supplement Plan and a Medicare Prescription Drug Plan. If you utilize this option, there are no medical questions to answer and you will be approved no matter what. After 12 months, you will need to be fully underwritten and you can be denied coverage based on your health history.
The second way this can happen is during the Annual Open Enrollment period or AEP. This happens between October 15th and December 7th of each year and changes made during this period will take effect on January 1st. During this time, you will have coverage from your Medicare Advantage Plan until the 1st of the new year. To qualify, you must go through medical underwriting with your Medicare Supplement Plan company and be approved. Once approved, you can then apply for a Medicare Prescription Drug plan. Both will start on January 1st. Please note that if you apply for a Prescription Drug Plan (PDP) prior to being approved for a Medicare Supplement Plan, the mere act of submitting your PDP application will automatically cancel your current Medicare Advantage Plan coverage. It's best to allow an experienced broker to facilitate these changes.
The third way to do this switch is during the Open Enrollment Period which his January 1st through March 31st. This is another period where you can apply for a Supplement Insurance plan and a prescription drug plan, and once approved, drop your Medicare Advantage Plan. The changes will take effect on February 1st, March 1st, or April 1st depending on your date selection. You may go through medical underwriting and you can be denied coverage based on your health history.
The last way this can happen is through a Special Election Period, or SEP. These SEP reasons allow you to switch back to Original Medicare and obtain a Medicare Gap Plan without having to answer medical questions (it’s called a Guaranteed Issue). There are a few reasons this can happen, like moving out of the service area (county) of the plan if you move into a county that does not have that same exact plan. Moving from PG to AA county may not be enough, but moving from PG to Allegany will, because Allegany has very few, Medicare Advantage plans in their county.
Most Medicare Advantage Plans in Maryland Include Medicare Rx Drug Coverage
There are MA plans (Medicare Advantage) and there are MAPD (Medicare Advantage Prescription Drug) Plans. The MA plans do not cover Rx coverage, while MAPD plans do.
Whether you purchase a Medicare Supplement Plan or a MAPD Plan, your drug "rules" will be exactly the same, so you need to know what your potential costs will be. This cost chart should give you some general guidance as to the costs. Please note that most MAPD plans do not have a deductible (Stage 1), they simply set the Stage 1 deductible to $0.
MOVE WITH CAUTION
Because of the unforgiving timelines, complexities and rules surrounding this type of plan change, it’s best to work with a knowledgeable Medicare Insurance Broker to ensure a smooth transition.
All too often I meet clients that took steps to change or add coverage and they didn't quite understand the rules surrounding their decisions. This sometimes puts clients in a very difficult situation without much wiggle room. I'd prefer you speak to an experienced broker first, and create a plan in order to follow the Medicare rules without creating a bigger mess. Contact me anytime to ask questions or sign up for a plan.
Maryland Medicare Advantage Part C Disclosure: I do not offer every plan available in your area. Currently I represent 8 organizations which offer 39 products in your area. Please contact Medicare.gov, 1–800–MEDICARE, or your local State Health Insurance Program to get information on all of your options.
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