How Do Medicare Advantage Plans and Medicaid Work Together?

Health insurance can be confusing for many Wisconsin seniors and their families. Here are a few tips on what you should know before talking to a Milwaukee health insurance agent.

What Is Medicare Advantage?

Medicare Advantage, or Part C plans, aren’t provided by the government. They’re actually offered by private companies that have been approved by Medicare. As a result, the quotes and services you receive may vary.

What does a quote for Part C cover? With this plan, Medicare pays your provider a fixed sum each month. This money goes towards the qualified health care services you use.

Insurers that offer Part C can set their own policy rules and prices. Two quotes with equal dollar amounts may offer distinctly different coverages.

Medicare Advantage laws change from time to time. For instance, in September 2016, the House of Representatives passed a bill that allowed end-stage renal disease patients to participate in Part C. It’s smart to work with a Milwaukee health insurance agent that provides updated quotes and information about current options.

What Is Medicaid?

The Medicaid program is designed to help certain people whose incomes or assets fall within qualifying limits. It can cover services like personal care or stays in a nursing home even if Medicare doesn’t.

Medicaid will never pay first for services that other plans also cover. For instance, if your Medicare or employer-provided health insurance plan covers a specialist consultation that Medicaid includes, Medicaid won’t offset that cost.

How Medicaid and Part C Interact

You may be a dual eligible, or someone who qualifies for Part C and Medicaid. In this case, the Medicaid may cover items that Medicare excludes.

For example, most Part C plans also include Medicare Part D, or prescription drug coverage. Even if you also qualify for Medicaid, Part D will pay for your prescriptions because Medicaid doesn’t pay first.

Suppose you qualify for a full Medicaid plan. You may also be eligible for something called Extra Help by default. This program helps you offset other costs related to prescription drugs, like policy deductibles and premiums.

Important Facts to Keep in Mind

Medicare Advantage Plans are still a form of Medicare. This means that they come complete with the rights you’d enjoy with Part A or Part B coverage.

When you’re searching for quotes, you have to remember that Medicare Advantage enrollment is resetricted. You can only join a plan, disenroll or make changes to your existing coverage during predetermined open enrollment periods.

Many people like the fact that they can switch between Part C and other forms of coverage. Because there are enrollment limits, however, you may also want to buy a supplemental Medicare plan, or Medigap, to cover periods when Medicare or Medicaid don’t provide for you.

Let us find you the right prescription drug plan for you for 2017. Use our free prescription RX Tool, or have a Milwaukee health insurance agent call you.

The health insurance market is confusing, and FHK Insurance is here to help. The annual Medicare Open Enrollment Period is coming up fast. This year it is from October 15 through December 7, 2016. Give us a call today at 414-228-7555, and we’ll help you through the tangle of plans to find one just for you!