Welcome to the next chapter of your healthcare journey! As you embark on the path to Medicare enrollment, you'll come across the option of joining Medicare Advantage. IntuneHealth is here to guide you on what you need to know about this Medicare option. So, grab a cup of coffee or tea, settle into your favorite chair, and let's simplify Medicare Advantage together.

Understanding Medicare Plans

Medicare is a health insurance program for people ages 65 and older. It provides various options to ensure recipients get the care they need. You have three main options for receiving Medicare coverage: Original Medicare, Original Medicare with Medicare Supplement (Medigap), or Medicare Advantage. If you are considering Medicare Advantage, remember that it is an alternative to Original Medicare.

Original Medicare:

• Coverage: Original Medicare offers Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). It does not include Part D (prescription drug coverage).
• Provider: Directly from the federal government.
• Payment: The government pays for your Medicare benefits when you use its services.
• Note:

Medicare Supplement:

• Coverage: You need Original Medicare coverage (Part A and Part B) to join; Medigap is a supplement that helps pay your out-of-pocket costs. For prescription drug coverage, you also need to buy a Part D plan.
• Provider: Private insurance companies fill “gaps” in Original Medicare coverage. You cannot have both Medigap and a Medicare Advantage Plan.
• Payment: Medicare pays the approved parts of coverage, then Medigap pays the amount left over according to the terms of your plan.

Medicare Advantage:

• Also known as: Part C, or an MA Plan.
• Coverage: You must have Part A and Part B coverage to join an MA Plan; most plans include Part D. Most MA Plans offer additional benefits, such as dental, vision, hearing aid, gym memberships, and more. This extra coverage is a big reason why many older adults choose MA Plans — plus, you receive that $0 monthly premium.
• Provider: MA plans do not come directly from the government; Medicare approves private companies to offer them.
• Payment: Medicare pays these private companies to provide your benefits.

Breaking Down Medicare Advantage Plans

There are several types of MA Plans to choose from, each designed to cater to your unique healthcare needs. Some of these include:

1. Health Maintenance Organization (HMO) Plans

• In-network vs. out-of-network coverage: HMOs primarily use the plan's network for care. Exceptions exist for emergencies, urgent care, and temporary out-of-area dialysis.
• Monthly premiums: Many HMO plans have a $0 monthly premium.
• Part D coverage: Most plans offer it. To receive this coverage, you need to enroll in an HMO plan that provides it. If you join an HMO plan that doesn't offer it, you are not allowed to join a different Medicare prescription drug plan.
• Primary care doctors: You need to choose one for most plans.
• Referrals to see a specialist: You usually need one for specialists and specific diagnostic tests.

2. Preferred Provider Organization (PPO) Plans

• In-network vs. out-of-network coverage: If you choose a PPO Plan, you will have lower costs with in-network care and higher costs for out-of-network care.
• Monthly premiums: Most plans charge a premium alongside the monthly Part B premium.
• Part D coverage: Most plans offer it. To receive this coverage, you need to enroll in a PPO plan that provides it. If you join a PPO plan that doesn't offer it, you are not allowed to join a different Medicare prescription drug plan.
• Primary care doctors: You don’t need to choose one.
• Referrals to see a specialist: You don’t need one.

3. Private Fee-for-Service (PFFS) Plans

• In-network vs. out-of-network coverage: Flexible to choose any provider that accepts the PFFS plan payment terms. If you enroll in a PFFS plan that includes a group of providers, you can receive care from any participating provider who has committed to serving plan members. You can also choose an out-of-network doctor or hospital, but it might cost you more money.
• Monthly premiums: Most plans charge a premium alongside the monthly Part B premium.
• Part D coverage: Coverage depends on the plan. If your plan doesn’t include it, you will need to join a separate Part D plan.
• Primary care doctors: You don’t need to choose one.
• Referrals to see a specialist: You don’t need one.

Medicare Advantage Plan Eligibility Requirements

To enroll in an MA Plan, you must:

• Be enrolled in both Medicare Part A and Part B.
• Be enrolled in only one MA Plan.
• Live within the plan's coverage area.
• Have your Medicare card number available when enrolling.

When navigating Medicare Advantage, please remember:

• It’s important to pair your MA Plan with a health care provider who specializes in preventive primary care, like IntuneHealth, to help keepyou healthy by covering entire costs or through low This is called value-based care (VBC). However, MA Plans vary, and not all of them offer VBC providers. Make sure to inquire about this directly with the health plan you’re considering!
• IntuneHealth offers access to doctors who practice VBC primary care, meaning they are paid to help keepyou healthy by preventing health issues before they become serious.
• If you move out of your plan's coverage area or have a qualifying life event, you can change policies through a Special Enrollment Period.
• If your plan leaves Medicare, you can change to another Medicare plan or rejoin Original Medicare.
• If you have a Medigap policy and decide to enroll in an MA Plan for the first time, you need to discontinue your Medigap policy. You will not be able to use it with your new plan.
• Some MA Plans offer out-of-network, non-emergency coverage, but it will likely cost more.

Navigate Your Medicare Journey with IntuneHealth

Your path to excellent health care doesn't stop when you pick a Medicare plan. If you choose an MA Plan, it’s crucial to choose a primary care provider who takes a VBC approach to health care, such as IntuneHealth. Ask the health plan you’re considering if they have in-network PCPs who practice VBC.

IntuneHealth is a new approach to primary care for people 65+ on a Medicare Advantage plan. We specialize in caring for older adults and offer proactive, preventive care to keep you healthy — including walk-in visits and same-day appointments for patients — so you can spend more time living your best life. Make sure you book a one-on-one tour of your local center or call us today at 1 (844) 646-8863!