BASIC MEDICARE RULES

Basic Medicare Advantage Rules

If you are deciding between Medicare Advantage and Medigap, you'll want to consider some of the rules before you enroll.

• You must be enrolled in both Medicare Part A & B and live in the plan service area. Some people think they can drop Part B if they enroll in Medicare Advantage. That is incorrect If you drop Part B while enrolled, you will immediately be disenrolled from your Medicare Advantage plan.

• Use network doctors and hospitals for the lowest out of pocket costs. Plans may have HMO or PPO networks. Most Medicare HMO plans do not cover anything out of network except emergencies. In PPO networks, seeing a provider outside the network will result in higher spending for you.

• Advantage plans may require prior authorization for certain procedures

• You may need to obtain a referral from your primary care physician before seeing a specialist on many HMO plans

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