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Medicare Advantage Plans Coverage for the Disabled


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Disability is one way to qualify for Medicare at an age younger than 65. Medicare provides a wide range of health care services for the disabled. This article will help you understand how Medicare Advantage plans work for people with a disability.

How do Medicare Advantage plans differ from Original Medicare?

The major difference between Medicare Advantage plans and Original Medicare (Part A and Part B) is that Medicare Advantage plans are offered by private insurance companies. Original Medicare is administered by the federal government, which means that benefits are essentially the same for everyone with Medicare.

With Medicare Advantage plans, each insurance company determines premiums, cost-sharing, and any additional benefits beyond those provided under Part A and Part B, which all Medicare Advantage plans must include.

In other words, you don’t lose any coverage when you choose Medicare Advantage plans, but you may get extra benefits for things like routine vision and dental care. In addition, most Medicare Advantage plans include Part D coverage for prescription drugs, so you get all your Medicare benefits in one convenient plan.

On the other hand, many Medicare Advantage plans are structured as health maintenance organizations (HMOs) or preferred provider organizations (PPOs), which means you may have to use network providers (including doctors, hospitals, pharmacies, and home health agencies) or pay more out of pocket for your care.

What Medicare Advantage plans are best if I’m disabled?

It’s impossible to make a one-size-fits-all recommendation for Medicare Advantage plans, because not all plan types are available in all areas. Depending on where you live, you may have several different options, each of which may have a combination of benefits that work for you.

Generally speaking, there are four main types of Medicare Advantage plans:

  • HMOs, in which you must get all but emergency care from plan providers.
  • PPOs, in which you are free to see any provider that accepts your plan, but you may pay more out-of-pocket if you go out of network.
  • Private fee-for-service (PFFS) plans, in which the plan sets provider payments and cost-sharing amounts, but providers are not required to accept your plan.
  • Special Needs Plans (SNPs), which are limited to people with certain medical conditions or characteristics, and the plan is structured to provide optimal benefits to people with that particular condition or disability.

If your disability is one that fits the membership criteria for a Special Needs Plan, and one is available in your area, you may find this the most cost-efficient way to get your Medicare benefits.

Advantages of Medicare Advantage Special Needs Plans typically include:

  • Medicare Part D prescription drug coverage, with formularies designed to treat symptoms and health problems common to people with that particular condition.
  • A provider network which includes medical specialists in the diseases and conditions that affect plan members.
  • A primary care doctor or health coordinator to help you understand and manage your health care decisions.
  • Preventive and maintenance care to help you stay healthy and follow your doctor’s treatment plan.

If you qualify for a Special Needs Plan, you can join one at any time; you don’t have to wait for the Medicare Annual Enrollment Period to switch plans.

What else should I know about Medicare Advantage Plans for the disabled?

If your disability is end-stage renal disease (ESRD) the only Medicare Advantage plan you may be able to join is Special Needs Plan. Medicare Advantage plans are generally limited for people with ESRD.

Medicare Advantage plans cannot be combined with Medicare Supplement Plans. Most, though not all, Medicare Advantage plans include Part D coverage for prescription drugs. If yours does not, and you think you want that coverage, you’ll need to buy a separate stand-alone Part D Prescription Drug Plan. Note, however, that all Special Needs Plans must include Part D prescription drug coverage.

Each company sets its own premiums for Medicare Advantage plans, and this premium must be paid to the insurance company in addition to your regular Medicare Part B premium. If you see “zero premium” Medicare Advantage plans, this means you pay no additional premium above your monthly Part B premium.

Medicare Advantage plans are private plans, which means not all plan types and benefits may be available in every location. Be sure to read all plan documents carefully before you buy a plan to make sure you understand the benefits, cost-sharing, network restrictions, and exclusions.

Are you interesting in find a Medicare Advantage plan for the disabled? Enter your zip code on this page to begin searching.

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