Medicare part D 에대한 질문사항 - ASK미국

y**ngshinja**** 님 답변 답변일 7/22/2010 11:01:03 PM

안녕하세요. 유나이티드 헬쓰케어 메디케어 제네랄 에이전트 제영신입니다.

선생님의 에이전트가 말한 플랜은 메디케어 파트 C (메디케어 어드밴티지)를 말하는 것입니다. 메디케어 어드밴티지는 메디케어와 계약이 된 사보험회사에서 운영하는 메디케어 플랜입니다. 가입자가 메디케어 파트C를 선택하게 되면, 가입자는 정부와 계약된 사보험회사에서 운영하는 플랜으로 들어가게 되며, 의료서비스에 대한 모든 규정은 사보험회사의 규정을 따르게됩니다.

메디케어 어드밴티지의 장점은 추가 보험료 없이 처방약, 비젼, 치과, 피트니스 프로그램, 해외 이머전시 보상규정등이 포함되어 있어 건강하거나, 소득이 적으신 분들에게 좋은 베네핏을 주고 있습니다. 그러나 대부분 HMO 형태로 구성되어 있기 때문에, 지정된 병원, 의료진을 이용해야 하고, 지정된 지역에서만 서비스가 가능한 단점이 있습니다.

메디케어 가입자가 메디케어 어드밴티지 HMO/PPO 플랜을 선택하게 되면, 파트D를 따로 가입할 수가 없습니다. 둘 중에 한가지만 선택해야 합니다.

l**e88**** 님 답변 답변일 7/23/2010 9:30:25 AM

Medicare Advantage (Part C) 에대한 설명을 찾아올립니다

Medicare Advantage (Part C)
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are health plans offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, the plan provides all your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage.

Medicare Advantage plans always cover emergency and urgent care. Medicare Advantage Plans must cover all the services that Original Medicare covers, except hospice care. (Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan.)

Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most plans also include Medicare prescription drug coverage.

Medicare Advantage Plans must follow rules set by Medicare. However, each plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan).

You usually pay one monthly premium to the Medicare Advantage plan, in addition to your Part B premium.

Different Types of Medicare Advantage Plans
Health Maintenance Organization (HMO) Plans
Preferred Provider Organization (PPO) Plans
Private Fee-for-Service (PFFS) Plans
Medical Savings Account (MSA) Plans
Special Needs Plans (SNP)
Other less common types of Medicare Advantage Plans include:

Point of Service (POS) Plans—Similar to HMOs, but you may be able to get some services out-of-network for a higher cost.
Provider Sponsored Organizations (PSOs)—Plans run by a provider or group of providers. In a PSO, you usually get your health care from the providers who are part of the plan.

l**e88**** 님 답변 답변일 7/23/2010 9:30:55 AM

What You Pay in a Medicare Advantage Plan
Your out-of-pocket costs in a Medicare Advantage Plan depend on:

Whether the plan charges a monthly premium in addition to your Part B premium.
Whether the plan pays any of the monthly Part B premium. Some plans offer this option, usually for an extra cost.
Whether the plan has a yearly deductible or any additional deductibles.
How much you pay for each visit or service (copayments).
The type of health care services you need and how often you get them.
Whether you follow the plan’s rules, like using network providers.
Whether you need extra coverage and what the plan charges for it.
Whether the plan has a yearly limit on your out-of-pocket costs for all medical services.
How to Join a Medicare Advantage Plan
Not all Medicare Advantage Plans work the same way, so before you join, find out the plan’s rules, what your costs will be, and whether the plan will meet your needs.

Contact the specific plans you’re interested in to get more information about their benefits and costs. Once you choose a plan, you may be able to join by completing a paper application, calling the plan, enrolling on the plan’s Web site. Get started comparing Medicare Advantage plans in your area.

Compare Medicare Health Plans in Your Area
More about Medicare Advantage Plans
As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year.
If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.
Related LinksYour Medicare Benefits
Medicare & You Handbook

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