Medicare Advantage Plans, Fee-for-Service Plans, and Private Coverage” that states that Medicare Advantage plans are the only medical plans “designated to be Medicare Part C plans”. The only conclusion that can be drawn from this instruction is that Medicare Advantage is the only plan qualified to be Medicare Part C plan and is also “designated to be Medicare Part C plan”. It is interesting to note that CMS created this additional language to help Medicare recipients understand what plans are not “Medicare Part C plans” and it is specifically written to avoid conflicts with federal law and to avoid confusion. Medicare Part C and Private Coverage At the present time, it is not a requirement for an HMO to be licensed to enroll Medicare beneficiaries. Some HMOs may advertise that they are Medicare approved or Medicare certified. In actuality, no law or regulation exists requiring an HMO to be licensed to enroll Medicare beneficiaries. The reason this is important is that HMOs are required to comply with Federal and State laws which are very different from each other. Moreover, some private health insurers that are willing to cover their Medicare subscribers are in violation of State laws by providing coverage to Medicare beneficiaries. Moreover, HMOs offering “Medicare Part C coverage” are not Medicare approved, Medicare certified or Medicare approved by Medicare. Likewise, Medicare-approved and Medicare-certified HMOs and insurance companies are not Medicare approved, Medicare certified or Medicare approved by Medicare. Medicare Advantage Plans and Other Medicare HMOs and Private Plans Some Medicare Advantage plans do not have a capitated plan; they do have a risk-based premium. Likewise, Medicare Advantage plans are not required to have a contracted primary care physician for enrollees. Moreover, “the contracts between Medicare and Medicare Advantage plans do not require (Medicare Advantage plans) to be located in a given geographic region.” This allows Medicare Advantage plans to contract with Medicare-certified and Medicare-approved HMOs and insurance companies to enroll Medicare beneficiaries and provide for the provision of Medicare Part C and private coverage. The Medicare Advantage plan contracts with the Medicare-approved or Medicare-certified HMO or insurance company to provide the service and pay the Medicare Part B and Medicare Part D coinsurance. The Medicare Advantage plan will then bill Medicare for the medical service, the coinsurance for Medicare Part B and the coinsurance for Medicare Part D. Medicare does not provide payment to the Medicare Advantage plan for this service. Instead, Medicare will pay the Medicare Advantage plan for the covered medical service. Likewise, Medicare Advantage plans are not required to provide a deductible to enrollees. However, the Medicare Advantage plan contracts with the Medicare approved or Medicare-certified HMO or insurance company to pay the Medicare Part B deductible. The Medicare Advantage plan will pay Medicare Part B, including the Medicare Part B deductible. Enrollment in Medicare Part C Plans and Medicare Advantage Plans In order to be eligible for enrollment, you must be 65 years of age and enrolled in Medicare. Medicare Part C coverage is one of the types of Medicare Advantage plans available. Therefore, anyone 65 years of age or older is eligible for Medicare Part C. In some cases, Medicare Part C benefits are also available to individuals with disabilities. It is important to note that some HMOs are Medicare approved and Medicare approved by Medicare that may not be considered “Medicare Advantage Plans.” It is very important to understand that no law or regulation exists to require an HMO to have a Medicare approved or Medicare approved by Medicare. It is only important to determine if the plan is a Medicare-approved or Medicare-certified HMO or insurance company. In summary, Medicare Advantage Plans are an excellent option for most Medicare beneficiaries because you can still retain your current physician, you can keep your current plan of care, you have a variety of plan options, the cost of Medicare Advantage Plans is less than Original Medicare, the cost of Medicare Advantage Plans are competitive with other healthcare plans, your Medicare Advantage Plan is portable and you can change from one Medicare Advantage Plan to another. Medicare Advantage Plans are designed by Medicare to provide for the provision of Medicare Part C and private coverage. Medigap plans, Medicare supplement policies, Medicare supplemental policies, Medicare prescription drug plans, private Medicare supplement policies, private Medicare supplement policies, Medigap, Medigap, Medicare supplement, Medicare supplement and Medigap all refer to any form of Medicare Advantage Plans. If you have any questions regarding Medicare Advantage Plans or Medicare Parts A, B, C or Medicare Part D or Medicare Part C, Medicare supplements, Medicare supplements or Medigap, please contact Bill at (561) 466-6474. Bill Borden, CFA, CLU is licensed as a Health Insurance Agent in the State of Florida. He is not an agent for any health insurance company, however, he is an agent for various companies who provide coverage for individuals who need their own insurance for: Medicare Advantage Plans, Medicare Supplement Plans, Medicare Supplement Plans, Medicare Supplement Plans, Medigap, Medicare Supplement Plans and Medigap. If you or a loved one is currently enrolled in Medicare, you should consider obtaining a Medigap policy. Medigap insurance policies are designed for you to pay for any Medicare deductibles or co-insurance that you may be responsible for on your Medicare Part B and Medicare Part D plans. Medigap insurance policies offer a great way to keep the costs of Medicare Part B and Medicare Part D premiums and deductibles at a minimum. You should always check with a Medicare approved or Medicare approved by Medicare licensed broker before applying for any Medicare Supplement plans. Medigap Policies There are several different Medigap policies to consider. The basic Medicare Supplement insurance policy is the Medigap Standard. Medicare Supplement policies are basically designed to pay the Medicare Part A premium (Hospital and Skilled Nursing), Medicare Part B and Medicare Part D premiums and coinsurance. Medigap Standard policies are usually the least expensive policy to provide coverage to Medicare beneficiaries. The other types of Medicare Supplement Policies are the Medigap Plan F and the Medigap Plan F+C and these policies require additional Medigap supplemental policies to provide coverage. Medigap Plan F and Medigap Plan F+C Policies In most cases, Medigap Plan F and Medigap Plan F+C plans provide the same level of coverage to Medicare beneficiaries. As such, you should review both policies carefully. Since Medicare Supplement policies are guaranteed issue, you are not required to pass a physical exam. However, Medigap Standard policies are not guaranteed issue and can require a Medical Exam. As such, you will have to pass a Medical Exam in order to obtain a Medigap Standard policy. If you or a loved one is receiving a Medicare check and you need a Medigap policy, call Bill at (561) 466-6474. Your healthcare provider may refer you to a Medicare Supplement licensed independent agent to help you get an affordable Medicare Supplement policy, especially if your health condition is so serious that you cannot obtain insurance coverage on your own. You should not consider Medicare Supplement plans as your primary healthcare insurance. You must look at the policy in depth to understand exactly what it offers. Remember, Medicare Supplement Plans are designed to cover the cost of Medicare Part A, Medicare Part B and Medicare Part D expenses. You can shop for a Medicare Supplement Plan with confidence when you know the kind of plan you want to obtain. You need to consider the following: 1. Whether you need a Medicare Supplement policy with a prescription drug benefit and also whether it has an additional Medigap policy to provide coverage for any extra medical expenses that you may incur in the future.2. The amount you are currently paying each year to get Part A, Part B and Part D Medicare coverage.3. Your age and gender and whether or not you are a Medicare-eligible retiree with Medicare Supplement coverage and the cost of your current plan.4. If you have an existing medical condition or family history of medical issues, you need to determine whether Medicare Supplement plans cover any prescription drugs, hospital stays, out of hospital nursing facility stays, etc. You should get a quote for your Medicare Supplement plan and compare the quotes before deciding on the plan you want to purchase. Most people over the age of 65 will need to check the different companies to see which Medicare Supplement plan they need to buy and the level of coverage that is available for their specific medical needs. While Medicare Supplement Plans are not designed to pay for Medicare deductibles or co-insurance, Medicare supplements, Medicare supplements or Medigap policies, Medigap policies are designed to cover the Part A premium, Medicare Part B and Medicare Part D premiums and coinsurance. You should always compare the prices for Medicare Supplement plans and compare Medig