The United States Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) organization manages Medicare. The agency's Advantage health plans are optional for Americans eligible to receive Medicare benefits. There are four Advantage Plan categories, including Medicare Health Maintenance Organizations (HMOs), Medicare Special Needs Plans, Preferred Provider Organizations (PPOs) and Private Fee for Service Plans.
Required Services
If you select a Medicare Advantage Plan, the healthcare service provider must provide you with the same coverage that is provided under Medicare's Part A and B insurance coverage. Part A covers hospital insurance while Part B covers medical insurance. You must receive access to hospitals for critical care needs as well as access to home healthcare and hospice. Under Part B of the plan you must receive outpatient care coverage like annual doctor check-ups, flu shots and cancer and diabetes screenings. HMOs and PPOs are not required to provide insurance coverage for cosmetic surgeries, hearing aids or long-term nursing home care.
Premiums
Healthcare insurance providers who participate in Medicare's Advantage Plan must provide benefits beyond those covered in Parts A and B of the basic plans. They can offer these benefits in the form of reduced premiums, deductibles or coinsurance payments. They can also provide reduced prescription drug coverage costs. Federal law required that Medicare offer prescription drug coverage in their plans effective January 1, 2006. If you elect to enroll in an advantage plan and the carrier provides prescription drug coverage, you must use the benefits associated with the advantage plan and drop Medicare's basic Plan D prescription drug coverage.
Eligibility
Typically you must be at least 65-years-old and a citizen or permanent resident of the United States before you become eligible to receive Medicare. You can also receive the benefits if you or your spouse worked a minimum of 10 years at a job that deducted Social Security and Medicare tax from your paycheck. Most jobs in the United States meet the criteria as the Federal Insurance Contributions Act (FICA) makes it mandatory that most employers withhold the two taxes separately. People who have serious medical conditions like end stage renal disease that requires dialysis or a kidney transplant are generally eligible to receive Medicare even if they are not 65-years-old. Finally, if you receive Social Security or Railroad Retirement benefits, you will likely be eligible to participate in Medicare's Advantage Plan.
Existing Plans
Prior to enrolling in an Advantage Plan you must enroll in Medicare's Parts A and B plans. Monthly Plan B premiums are paid to the agency. Some healthcare insurance providers might require you to pay them directly for additional services offered under their individual plans. Part B monthly premiums cost about $96 depending on your income.
Medigap Policy
Medicare's supplemental insurance, or Medigap policy, will become ineffective after you enroll in an Advantage Plan. There are as many as 12 different Medigap policies that are sold by private insurance carriers. The policy is designed to provide coverage that fills in gaps existing from the agency's original plan.
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