The Basics of Medicare Dual Special Needs Plans

Medicare Advantage Plans are an “all-in-one” alternative to Original Medicare. Beneficiaries still have Medicare when they join a Medicare Advantage Plan, but they receive their benefits from their Medicare Advantage Plan and not through Original Medicare. In essence, Medicare Advantage Plans contract with the federal government to provide and administer Medicare benefits to enrollees.

What is Medicare Advantage?

Medicare Advantage, or Medicare Part C, is a government-funded alternative to Original Medicare, which includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Advantage plans are offered by private insurance companies approved by Medicare and are designed to provide all the benefits of Original Medicare while often including additional perks such as prescription drug coverage, dental care, vision care, and more. These plans offer a one-stop solution for comprehensive healthcare coverage.

How Does Medicare Advantage Work?

Medicare Advantage plans work by partnering with private insurance companies to administer your Medicare benefits. When you enroll in a Medicare Advantage plan, you still retain your Medicare eligibility, but your healthcare services are managed and covered by the plan you choose. Medicare pays a fixed amount to the insurance company for your care, and the plan is responsible for coordinating your healthcare services, often through a network of doctors and hospitals.

Key Features of Medicare Advantage

Dental

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Hearing & Vision

The majority of our plans offer hearing and vision benefits. In addition to a routine eye exam, our vision benefit also includes a yearly allowance to help pay for glasses or contacts. Our hearing benefit includes hearing aids for a copay.

Prescriptions

Most plans have a $0 copay for Tier 1 preferred generic drugs and a $0 prescription deductible. You can get a 100-day supply of your medications at a reduced cost at mail order and retail pharmacies.

Fitness Benefit

Explore over 26,000 gyms with the ability to change your fitness location anytime and have 2+ memberships at one time. Benefits also include live virtual classes at home or on-the-go, a fitness tracker and social activities within local communities.

Over-the-counter card

Our OTC card is included in most plans and gives you an allowance every quarter to purchase health and wellness related over-the-counter items at retail locations or via phone, web, and mail with no shipping cost to you.

Learn about the types of Medicare Dual Special Needs Plans

Dental

$0 copays on most covered dental services

Vision

$0 eye exam plus eyewear allowance

Hearing

$0 hearing exam plus savings on thousands of brand-name hearing aids

Prescription drugs

$0 copays on hundreds of prescription drugs, at your pharmacy or by mail

$0 Monthly Premium

No worries about monthly payments

Meal benefits

Medicare Advantage's largest national provider network

Fitness Membership

Explore over 26,000 gyms with the ability to change your fitness location

Telehealth

Medicare Advantage's personal videodoctor
See if You Qualify Find plans in your area

Learn about the types of Medicare Dual Special Needs Plans

Health Maintenance Organization (HMO) plans

Members of HMO plans typically choose a primary care doctor and need a referral to see a specialist. Services are generally provided within a network of healthcare providers.

Preferred Provider Organization (PPO) plans

In PPO plans, members pay less if they use doctors, hospitals, and other healthcare providers that belong to the plan’s network. They can use out-of-network providers but may pay more out-of-pocket.

Special Needs Plans (SPs)

SNPs are tailored for beneficiaries with specific diseases, conditions, or characteristics.

Private Fee-for-Service (PFFS) plans

Combines a high-deductible insurance plan with a bank account. Medicare deposits money into the account, and beneficiaries can use the money to cover health care costs.

Medicare Medical Savings Account (MSA)

Combines a high-deductible insurance plan with a bank account. Medicare deposits money into the account, and beneficiaries can use the money to cover health care costs.

Making an Informed Decision

Choosing the right Medicare Advantage plan requires careful consideration of your healthcare needs, budget, and preferences. Here are some steps to help you make an informed decision:

  • Assess Your Healthcare Needs: Consider your current health status, medications, and any specific healthcare services you require.
  • Compare Plan Options: Research and compare Medicare Advantage plans available in your area, paying attention to their network, costs, and additional benefits.
  • Consult with a Medicare Specialist: Speak with a Medicare specialist or counselor who can provide personalized guidance based on your unique situation.
  • Review the Plan’s Star Ratings: Medicare assigns star ratings to Medicare Advantage plans, reflecting their quality and performance. Higher-rated plans may offer better service and outcomes.
  • Check for Changes Annually: Keep in mind that plan benefits and costs can change from year to year. Review your plan during the Annual Enrollment Period to ensure it continues to meet your needs.

Medicare Advantage, or Medicare Part C, is a versatile and increasingly popular healthcare option that offers comprehensive coverage and additional benefits beyond Original Medicare. Understanding its fundamental principles, key features, advantages, and considerations is crucial when evaluating your healthcare choices. By carefully assessing your healthcare needs and preferences, comparing available plans, and staying informed about changes in your plan, you can make the right decision for your health and well-being. Medicare Advantage can be an excellent option for individuals seeking comprehensive and convenient healthcare coverage in today’s evolving healthcare landscape.

Learn more about Medicare Advantage eligibility

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How Does Medicare Advantage Work?

Medicare Advantage plans work by partnering with private insurance companies to administer your Medicare benefits. When you enroll in a Medicare Advantage plan, you still retain your Medicare eligibility, but your healthcare services are managed and covered by the plan you choose. Medicare pays a fixed amount to the insurance company for your care, and the plan is responsible for coordinating your healthcare services, often through a network of doctors and hospitals.

Learn More about the Medicare Advantage plans