If you are 65 years old, younger than 65 with a disability, or have end-stage rental disease, you are eligible for the U.S. federal health insurance program known as Original Medicare. Ever since its beginning in 1965, Medicare has provided medical services to millions of people for free or at a reduced cost.
Original Medicare is divided into parts. Part A is hospital insurance which pays for inpatient hospital stays, skilled nursing facility stays, some types of surgery, hospice care, and other forms of home health care. Part B is medical insurance which pays for medical services and supplies that are certified as medically necessary for treating a health condition.
In 1997, a law named the Balanced Budget Act created what is called Medicare Part C. Its purpose was, and still is, to provide more options for Medicare coverage through private insurance plans such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), or other private plan insurance providers. These Medicare Part C plans are also known as Medicare Advantage plans.
Enrolling in a Medicare Advantage plan is not mandatory for individuals who are eligible for Medicare; it’s an alternative to Original Medicare. If you decide to enroll in a Medicare Advantage plan, you receive all your health care and Medicare coverage through the policy you choose. From the date your plan begins, you get all your Medicare Plan A and Plan B coverage, as well as any additional coverage provided, through the plan’s provider.
Medicare Advantage Plans Must Follow CMS Guidelines
In the United States, according to federal law, Part C providers must provide their beneficiaries with all services and supplies that Original Medicare Parts A and B cover. They must also provide any additional benefits proclaimed in their Part C policy. Medicare Advantage policies can provide additional benefits that are approved by the Centers for Medicare & Medicaid Services (CMS). These must be services that are not covered by Original Medicare Parts A and B. In some policies, the additional benefits may also include the reduction of premiums, deductibles, and coinsurance payments found in Original Medicare (Parts A and B) coverage.
Your Medicare Advantage plan may cover additional services such as hearing exams, vision care, dental care, or fitness plans, for example. As a Medicare Advantage enrollee, you are also required to adhere to all the plan regulations that have been set by CMS. For example, your policy does not cover services you receive outside your provider network unless it is an emergency or something urgent, therefore, you must receive services inside the plan’s network for them to be covered by your policy.
Any person eligible for Original Medicare is eligible for Medicare Advantage. Even if you have a Medicare Advantage plan, you remain in Medicare and possess the same rights and protections that it offers to all Medicare beneficiaries. You have the right to join a Medicare Advantage plan even if you have a pre-existing condition, with the exception of end-stage renal disease.
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