Medicare Advantage Plans in Bernalillo County for 2025
In Bernalillo County, choosing the right Medicare Advantage plan will likely involve navigating various options and benefits. You could choose the best plan by understanding the types of Medicare Advantage Plans Bernalillo County could offer, like HMOs, PPOs, and SNPs, assessing their potential costs, and learning how to enroll.
You may want to consider plans that may offer additional benefits, such as the SCAN Health Plan, which could potentially enhance your healthcare coverage.
Key Takeaways
- Bernalillo County will likely offer a diverse range of Medicare Advantage plans that could cater to various needs and preferences.
- SCAN Health Plan in Bernalillo County will likely provide extensive benefits that could go beyond standard Medicare, including prescription drug coverage, and dental, vision, and hearing aid coverage.
- Medicare Advantage enrollment in Bernalillo County is accessible during set periods, with plans offering varying costs and coverage options compared to Original Medicare, and holding Star Ratings that could aid in quality assessment.
Compare Plans in One Step!
Enter Zip Code
Discovering the Potential Bernalillo County Medicare Advantage Plans in 2025
Bernalillo County will likely offer a variety of Medicare Advantage plan types. From health maintenance organizations (HMO) plans focused on local networks to preferred provider organizations (PPO) plans offering more freedom, this county could provide a broad spectrum of options.
Special Needs Plans (SNPs) cater to those with specific health needs or eligibility criteria, while Private Fee-For-Service (PFFS) plans set the payment amounts for healthcare services. There’s even a blend of HMO and PPO features in HMO-Point of Service (HMO-POS) plans.
Navigating the Potential Benefits of SCAN Health Plan in Bernalillo County
Among the variety of Medicare Advantage plans in Bernalillo County, the SCAN Health Plan might stand out. This plan may not only provide comprehensive healthcare coverage but could also provide cost-saving opportunities.
SCAN could potentially offer tiered formularies for prescription drugs to lower copays at preferred pharmacies, possibly providing affordable healthcare.
But that’s not all. SCAN may even go beyond standard Medicare by potentially offering additional benefits such as:
- Dental benefits
- Vision coverage
- Hearing aid coverage
Understanding SCAN’s Prescription Drug Coverage
Prescription drugs will likely form a significant part of healthcare expenses. However, with some of the SCAN Medicare Advantage plans, this burden could be significantly lightened.
Certain plans, backed by a Medicare contract, might bundle prescription drug coverage, possibly elevating benefits beyond Original Medicare and may even provide a viable alternative to a Medicare supplement. This could lead to better coverage and potentially lower out-of-pocket expenses for you with a Medicare supplement plan.
Certain SCAN plans may even feature Tier 6 brand-name drugs like Eliquis, Xarelto, and Jardiance at reduced costs. So, you could potentially continue your treatment without worrying about skyrocketing drug costs.
And if your plan doesn’t include prescription coverage, you may also enroll in Medicare Advantage Prescription Drug Plans (MAPDs) that might be offered by SCAN.
Your Guide to Medicare Advantage Plans Bernalillo County Enrollment
After navigating the Medicare Advantage plan landscape and exploring the potential benefits of SCAN Health Plan, the next step is enrollment. To join a Medicare Advantage plan, you must first Be enrolled in both Medicare Part A and Part B.
If you miss this period, there are many other opportunities for you to enroll with the Annual Enrollment Period, Individual Election Period, and Special Enrollment Period.
If you’re a first-time enrollee or looking to change your current Medicare Advantage plan, there are many opportunities to do so.
First-Time Enrollee? Here’s What You Need to Know
Stepping into the world of Medicare might feel overwhelming, but this guide could simplify the enrollment process. To enroll, you must have Medicare Part A and Part B, which are available for individuals aged 65 or older, those with disabilities, and those with End-Stage Renal Disease.
Most individuals qualify for premium-free Part A if they or their spouse, parent, or child have sufficient Medicare-covered employment history.
The Initial Enrollment Period for Medicare spans 7 months, starting 3 months before you turn 65 and ending 3 months after.
However, if you end up paying a premium for Part A, you’ll likely need to enroll during specific enrollment periods. If you have disabilities, you may be automatically entitled after receiving disability benefits for a certain duration.
Changing Your Medicare Advantage Plan: How and When
Sometimes, change is not just a part of life; it’s a necessity. In such cases, you might consider changing your Medicare Advantage plan during the contract renewal period.
You can switch plans during the Medicare Annual Enrollment Period, which runs from October 15 to December 7 each year.
But life doesn’t always stick to a schedule. Unforeseen circumstances might necessitate a plan change outside the Annual Enrollment Period.
That’s where the Special Enrollment Period comes into play, allowing you to switch plans if you experience certain life events like moving to a new service area or losing current coverage.
Once enrolled in a Medicare Advantage plan during a Special Enrollment Period, your coverage starts the following month.
Special Needs Plans (SNPs): Tailored Care in Bernalillo County
Healthcare is not a one-size-fits-all scenario. Due to this, the Special Needs Plans (SNPs) in Bernalillo County could cater to individuals with specific eligibility criteria or health conditions, potentially offering tailored benefits and provider choices.
SNPs could come with three options:
- Dual-eligible SNPs (D-SNP) for those with both Medicare and Medicaid
- Institutional SNPs (I-SNP) for those in long-term care facilities
- Chronic Condition SNPs (C-SNP) for those with chronic conditions.
Some of these plans may do more than just cover healthcare costs; they could provide a network of specialized healthcare providers and may even offer tailored clinical case management to improve health outcomes.
But remember, SNPs might require members to use the plan’s network providers except in emergencies or for out-of-area dialysis. So, if you meet the eligibility criteria, SNPs could be a great way to receive customized care.
The Role of Star Ratings in Choosing a Medicare Advantage Plan
When choosing the best Medicare Advantage plan, including Medicare Advantage HMO options, you may want to consider the plan’s star ratings.
The CMS Star Ratings system could be a critical resource for comparing the quality of Medicare health and drug plans. From screenings for breast and colorectal cancer to diabetes care and customer service, these ratings could provide a holistic view of a plan’s performance.
In Bernalillo County, about 38% of Medicare Advantage plans are rated 4 stars or higher, indicating superior quality and performance. These higher-rated plans may attract beneficiaries through additional benefits stemming from increased federal payments.
So, when you’re choosing your Medicare Advantage plan, make sure to check its star rating.
Alternatives to Medicare Advantage: Exploring Medigap Policies in Bernalillo County
If you’re looking beyond Medicare Advantage, some Medigap policies could serve as an effective alternative. Offered by private insurance companies, some of these policies could serve as secondary insurance to Original Medicare and may cover costs not fully covered by Original Medicare.
So, if you’re worried about unexpected healthcare costs, Medigap policies could be your safety net.
Some plans may even provide extended coverage for excess charges and foreign travel emergency costs.
So, if you’re seeking more provider flexibility and comprehensive coverage, exploring Medigap policies could be a fruitful endeavor.
Ensuring Access to Your Preferred Providers
Whether it’s a doctor you’ve trusted for years or a specialist recommended by a friend, being able to continue seeing your chosen provider under your plan could bring peace of mind.
To ensure that your preferred providers are in-network, you could:
- Visit the plan’s website and utilize their searchable directory.
- Use Medicare’s Find Doctors tool.
- Contact your preferred providers directly to confirm their participation in your plan.
Remember, choosing in-network providers might not only ensure cost-effective care but could also improve coordination and quality of healthcare services.
Addressing Common Concerns: Prior Authorization and Out-of-Network Coverage
Prior authorization will likely be a process where approval from the plan may be required before a service is rendered. This could potentially ensure coverage for the service under the plan’s benefits and could even assess medical necessity.
If the service was performed without prior authorization, then the payment may be denied. However, providers cannot bill the member if the claim was denied due to a lack of preauthorization.
If you use out-of-network providers, you may face higher out-of-pocket costs. So, understanding these requirements and potential costs could help you navigate your healthcare journey.
Summary
Bernalillo County will likely offer a myriad of Medicare Advantage plans, each could be tailored to meet specific needs. This guide has explored the potential benefits of the SCAN Health Plans and delved into some of the essentials of Medicare Advantage enrollment.
Whether you’re considering a Special Needs Plan, the CMS Star Ratings, or exploring alternatives like Medigap policies, the choice ultimately lies in your hands.
Frequently Asked Questions
→ What does Medicare pay for in an Advantage plan?
Medicare Advantage plans must cover services under Part A and Part B, while some plans may also offer additional benefits like vision, hearing, and dental services.
→ What is the difference between government Medicare and Medicare Advantage?
The main difference between government Medicare and Medicare Advantage is that while government Medicare may only cover medically necessary services and supplies, Medicare Advantage plans bundle Part A and Part B benefits and may even include additional coverage for prescription drugs, dental, vision, and hearing care. It’s essentially a matter of choosing between basic coverage offered by the government or more comprehensive coverage through a private plan.
→ What are the potential benefits of SCAN Health Plan in Bernalillo County?
Some of the SCAN Health Plans in Bernalillo County could potentially offer cost-saving opportunities, comprehensive coverage, and additional benefits like dental, vision, and hearing aid coverage.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.