Medicare

What is Medicare?

Medicare is a federal health insurance program, typically available to people age 65 and older or those with qualifying medical conditions. There are four separate Medicare programs, each providing different types of coverage. Parts A and B are known as “Original Medicare” and provide coverage for hospital stays (Part A) and outpatient services and supplies (Part B). Medicare Part C – also known as Medicare Advantage – provides alternative coverage to Original Medicare. Part D provides coverage for medications.

Please visit medicare.gov for general information about Medicare.

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So How is Medicare Advantage different?

Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide health coverage. Medicare Advantage plans must cover everything included by traditional Medicare plans, but may offer more benefits and/or lower copays.

One Medical now accepts several Medicare Advantage plans in New York. For example, we are in network with Humana’s New York Medicare Advantage HMO plans to better serve our Medicare-eligible members.

Advantages of Medicare Advantage HMO Plans:

  • Low monthly premiums
  • Medicare Advantage plans have an annual limit on your out-of-pocket expenses
  • Medication coverage (Part D) is often included as part of your Medicare Advantage plan
  • Plans may cover services that Original Medicare doesn’t, such as routine vision, dental, and hearing care

What is Medicare Special Needs Plans (SNPs)?

Medicare SNPs are a type of Medicare Advantage Plan that provides membership to people with specific characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

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Who can join a Medicare SNPs?

  1. People who have both Medicare and Medicaid,
  2. People who have diabetes
  3. People with chronic heart failure
  4. People with dementia
  5. People with mental health condition such as depression

Those with these specific condition can join Medicare SNP at any time.

As is common with HMO plans, Medicare Advantage patients must see doctors,
hospitals, and specialists that are in their chosen network. This is different from traditional fee-for-service Medicare plans in which patients have broader
physician choice but often higher costs.

Eligible patients who select a Medicare Advantage HMO can then select their
primary care provider (“PCP”) with MedEx Health Network, Inc.

If you have any questions, please call one of our advisors at 909 475-7371.

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