Collin County Living Well Magazine Fall 2014 | Page 20

Basics for Medicare Patients II
By Tucker Thompson

W

hat are some of the differences between traditional Medicare Supplements and Medicare
Advantage Plans?
Medicare Supplements––Freedom to choose any hospital or
doctor that accepts Medicare. No networks. No referral for a
specialist is required. No authorization for hospital and medical services. Supplement plans co-insurance and Medicare
deductibles vary with which plan you choose.
Medicare Advantage Plans [HMOs, PPOs, SNPs] you have
to use physicians and hospitals in their network. HMO’s members have to use their Primary Care Physician first regardless
of your health or condition before you can see a specialist in
their network. You must have prior authorization for hospital
and medical services in their network except emergencies.
Co-pays and deductibles vary with the plans. Out-of-pocket
costs vary from $2,500 to $10,000 with these plans.

The Advantage Plan becomes your primary insurance.
Medicare should not be billed while you are a member of a
Medicare Advantage Plan because the Advantage Plan pays
the bills. Only carry and present your Medicare Advantage
Plan membership card to prevent errors in billing!

What are Medicare Advantage Plans?

Yes, almost always! Treatments, procedures, services,
surgeries and or drug therapies will not be paid by your
Advantage Plan or Medicare unless you have gotten prior
authorization from your Medicare Advantage Plan, primary
care physician, or specialist. An exception will be made for
Emergency Services.

Part C Medicare Advantage Plans include Health Maintenance Organizations [HMO] Plans, Preferred Provider Organization [PPO] Plans, Private Fee-for-Service [PFFS] Plans,
Special Needs Plans [SPN]. Medicare pays an amount of money every month to these private health plans, whether or not
you use their services. You are still in Medicare and in most
cases continue to pay Part B and sometimes Part A premiums.

Which cards do I show?

If you enroll in a Medicare Advantage Plan, you only
show this membership card, NOT your Medicare card.

What is a “Network”?

Network means hospital, facilities, and providers contracted by Medicare Advantage Plans to provide services
and supplies to its members. Make sure the hospital and
doctors you like are in the network before signing up!

With Medicare Advantage Plans, do I
need prior authorization for hospital
and medical services?

Tucker Thompson, the author, has worked in the insurance field for over 21 years. His time is spent helping individuals review or enroll for new medical, Medicare Supplements, Medicare Advantage Plans, Medicare Prescription
Drug Plans, Life and Long Term Care polices.

New

Medicare choices in 2014
could mean better coverage for less money!

You can apply to change Medicare supplement policies
any time of the year!

Senior Life Division

Medicare Plans
Medicare Supplements
Health Insurance
Long-Term Care Policies
Life Insurance

Benchmark Financial Services is a local company with a Senior Life Division dedicated
to helping seniors review & find Medicare healthcare and prescription plans that best
fit each individual’s needs. With a strong commitment to offer independent,
unbiased advice, we are licensed with over 30 national companies and are not
“employed” by any of these companies whose plans we might recommend.

local [phone] or toll free [phone]
18

Collin County Living Well Magazine • Fall 2014

Your Local Agent:
Tucker Thompson

Certified Senior Advisor