Medicare Advantage and Medicare Rules
Medicare Advantage plans are required to follow Medicare’s rules. Medicare will pay a fixed amount for your coverage each month to the company that is offering your Medicare Advantage plan. All companies must follow rules set by Medicare.
It’s important to keep in mind that each Medicare Advantage plan can charge different out-of-pocket costs and have different rules for how you will get your services.
Examples of this are requiring you to get a referral to see a specialist or having to go to specific doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care.
The rules can change each year so the plan will notify you about any changes before the start of the next enrollment year.
Don’t forget that you have the option each year during Open Enrollment to keep your current plan, choose a different plan, or switch back to Original Medicare.
IMPORTANT: Read the information that you get from your plan!
If you’re enrolled in a Medicare Advantage plan, review the “Evidence of Coverage” and “Annual Notice of Change” that your plan sends you each year. The “Evidence of Coverage” gives you details about what the plan covers, how much you will pay, and more.
The “Annual Notice of Change” includes any changes in coverage, costs, provider networks, service area, and more things that would be effective in January. If you don’t these important documents by the time Open Enrollment begins, contact your plan immediately.
Do you want more information of Medicare Advantage plans and their rules? Our Mentors can assist you!
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