Medicare Advantage: A Case Study

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Recommended: Similarities and differences between Medicare and Medicaid managed care plans

Medicare Part C is also known as Medicare Advantage. Medicare Part C allows Medicare recipients obtain a private health insurance plan. The plans the induvial enrolled in must be Medicare approved. These individuals must pay the Medicare Part B premium. Other health care packages such as vision, dental, hearing, and prescription coverage may be included. The same networking restrictions apply to the Medicare Advantage plan as it does to regular private insurance plans. If the individual wants to upgrade to Medicare Advantage they can only do so October 15th- December 7th. If the individual wants to go back to the Original Medicare they can only do so January 1st – February 14th. To qualify you must have both Medicare Parts A and Part B. There is one restriction on an individual cannot have end stage renal failure. Parts C and D are completely optional. The eligibility requirements are they must have Medicare Parts A and B and enroll during …show more content…

Individuals can enroll in Part D, October 15th –December 7th. There is a coverage gap with Medicare Part D, this is also known as the Donut Hole. Each year the coverage gap limit is set ($3,310.00 in 2016). Medicare recipients who receive “extra help” from Medicare are exempted from the gap and do not have to pay. When the individual has entered the Medicare Gap, they are responsible for paying a portion of their medication. If the individual buys name brand medication, they have to pay 45% of their medication cost out of pocket. This money is added to their out of pocket costs. When the individual is purchasing generic medications, in 2016 the generic prescription 42% if covered by Medicare and the individual pays 58% of the cost. Each year Medicare decreases the amount the individual is required to pay. Once the decrease reaches the 25% cut off in the year 2020. Again the percentage of what the individual pays helps get them out of the Medicare

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