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Medicare Advantage Plans Fort Worth texas


Medicare Advantage Plans

Medicare Advantage Plans, also referred to as Medicare Part C, are structured differently than traditional Medicare. The design of a Medicare Advantage Plan works much better in large metropolitan areas, due to the size of the population, and therefore the size of the Provider Network. Medicare Advantage is also known as an MA Plan, and a Medicare Advantage Plan, with prescription drug coverage, is referred to as an MAPD Plan.

Medicare Advantage Plans offer members the same amount of coverage as original Medicare Part A and B, and typically offer additional benefits such as Part D Drug Plan, Silver Sneakers, Vision, Hearing, etc. You must have Medicare Part A and B, to get Medicare Part C.

 

Medicare Advantage Plans: (HMO)

  • Must use a Doctor In-Network
  • Requires a referral from your Primary Care Physician (PCP) to see a Specialist
  • Emergency Room Only Coverage, outside of your service area. (While traveling or on vacation)
  • All Plans are rated on a 1 to 5 Star Rating
  • Plan eligibility is based on County of Residence
  • Each plan is different / no nationwide consistency
    • Plans vary between Advantage Plan providers
    • Plans vary within the same Provider, from city to city
  • Typically, small Advantage Plan providers offer plans in smaller markets / cities
  • Typically, larger Advantage Plan providers offer plans in larger markets / cities
  • Silver Sneakers included with Humana- RenewActive included with UnitedHealthcare Plans –
  • Accepted at 24 HR Fitness, L.A. Fitness, YMCA, Curves, Golds Gym, Local Recreation Centers, and many others nationwide.
  • Denver and Dallas offer two Advantage plans:
    • $0 Premium Plan
    • Plan with Lower Co-Pays and lower MOP
  • Is my Doctor In-Network?
    • Go To: myuhc.com
    • Select “Find a Provider”, at the bottom of the first of 4 boxes .
    • Select “Medical Directory”
    • Choose third box “Medicare Plans”
    • Enter Zip Code
    • Select ‘No Preference’
    • Type doctor name in toolbar
    • PPO Plans (Preferred Provider Organization)
  •        – no referrals needed
  •        – can get care at any doctor nationwide that accepts the plan

Key Factors of any Advantage Plan

 

  • Premium – Typically $0 in large markets
  • MOP (Max out of Pocket) – Maximum Amount of Co-Pays Per Year: NOT a deductible!
    • Range from $2800 to $6700 ($6700 Max allowable by Law)
  • Co-Pays (amount paid for specific services):
    • Standard Co-Pays:
      • PCP – $0 to $30 Per Visit
      • Specialist – $30-$60 Per Visit
      • Hospital – Amount per Day (typically $200-$350 Per Day)
      • 5-7 Days Max, typically
      • Days 7-100 = $0 Co-Pay
      • Example: $250 Day x 6 days = $1500 Max Co-Pay for Hospital stay.
      • Days 7-100 – $0 Co-Pay
      • Usually includes Vision and Hearing coverage (Medicare does NOT cover)
    • Other Co-Pays exist, however the above is the most common
  • Network Size- How many doctors in your area that accept UnitedHealthcare or Humana

Blue Sky Medicare offers 2020 UnitedHealthcare and Humana Medicare Advantage Plans in the counties listed below:

 

Colorado

Denver: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson.

Plan 1- AARP MedicareComplete SecureHorizons  $49/month 0 deductible $3000 max out of pocket

Plan 2- AARP MedicareComplete SecureHorizons Zero Premium(most popular) 0 Deductible $3900 max out of pocket

Essential Plan- Ideal for Tri Care for Life clients- 0 premium includes SilverSneakers

Dual Complete (DSNP)- Clients who receive Medicare AND Medicaid

 

Outside Denver:

El Paso, Fremont, Pueblo and Teller counties

Plan 1- $39/month 0 deductible $3200 max out of pocket

Plan 2-0 premium 0 deductible $4500 max of of pocket

Essential Plan- Ideal for Tri Care for Life clients- 0 premium includes Silversneakers

Dual Complete- (DSNP)- Clients that receive Medicare AND Medicaid

 

Southern California-

Los Angeles, San Diego, Riverside, Orange, San Bernadino and Kern counties

 

North Carolina-

Charlotte

Raleigh

Greensboro

 

Arizona

Phoenix: Maricopa county

MedicareComplete Plan 2- 0 premium 0 deductible – $4000 max out of pocket

Tucson: Pima county

MedicareComplete- 0 premium 0 deductible- $2800 max out of pocket

 

Texas

 

Dallas: Collin, Cooke,Dallas, Denton, Ellis, Fannin, Grayson,Johnson, Kaufman, Parker, Rockwall,Tarrant, Van Zandt and Wise

Plan 1- 0 premium 0 deductible $3200 max out of pocket

Plan 2- $73/ month 0 deductible $3900 max out of pocket- includes dental coverage, lower copays

Essential Plan- 0 premium- Ideal for TriCare for Life members, includes Renew Active (similar to SilverSneakers)

 

San Antonio: Atascosa, Bexar, Comal, Guadalupe, Kendall, Wilson.

MedicareComplete- 0 premium 0 deductible $3900 max out of pocket- dental coverage

Essential Plan-ideal for clients with Tri Care for Life

 

Austin: Bastrop, Hays, Travis, Williamson.

MedicareComplete Focus- 0 premium 0 deductible $4900 max out of pocket

 

Houston: Austin, Brazoria, Fort Bend, Hardin, Harris, Jefferson, Liberty, Montgomery.

MedicareComplete Plan 1- 0 premium 0 deductible $3400 max out of pocket

 

Corpus Christi: Aransas, Kleberg, Nueces, San Patricio.

Brownsville: Cameron, Hidalgo, Willacy.

El Paso: El Paso

In Texas, call Steve at 214-842-4930 for more info

 

 

TriCare for Life Colorado silver sneakers

UnitedHealthcare Essential

The Essential Plan is zero premium Medicare Advantage Plan WITHOUT Part D drug coverage, ideal for clients who have Part D already (TriCare for Life), but want additional benefits like hearing, vision and SILVERSNEAKERS. You must have Medicare Part A and B to enroll.

Denver- Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson counties

Colorado- El Paso, Fremont, Larimer, Pueblo, Teller and Weld

Dallas- Colin, Cooke, Dallas, Denton, Ellis, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Parker, Rockwall, Tarrant, Van Zandt and Wise.

San Antonio- Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson

Other Counties- Aransas, Bastrop, Bell, Cameron, El Paso, Falls, Hays, Hidalgo, Hill, Kleberg, Maverick, McLennon, Nueces, San Patricio, Starr, Travis, Victoria, Webb, Willacy and Williamson.

San Antonio- Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson

Humana offers a similar plan for residents of Arizona, Georgia, Florida, Missouri, North Carolina, South Carolina, Virginia, Oregon, Colorado and Washington.

Humana or The Essential plan will NOT result in you losing your Tri Care for Life coverage, but you must be enrolled in Medicare Parts A and B. Call Steve at 303-501-3125.

 

Medicare Advantage Plans are available in other parts of these states, from other insurance companies, which I do not represent.

Medicare Advantage Plans are regulated by CMS, Center for Medicare and Medicaid Services. Therefore, the above information is as specific as I am permitted to share, however, I would be happy to discuss the details of Medicare Advantage Plans in your area and email you the enrollment guide with all the plan copays etc.

Steve Schrader- 303-501-3125

MedicareSteve1@gmail.com

 

History of Medicare Advantage Plans:

  • 1997 – Medicare Choice Plus introduced
  • 2003 – Renamed Advantage Plan
  • 2005 – 5 Million people on Advantage Plans nationwide
  • 2019 – 20 Million people on Advantage Plans nationwide