What are Medicare Advantage plans, and how do they differ from Original Medicare ?

Medicare Advantage plans, also known as Part C plans, are offered in Cliton by private insurance companies approved by Medicare. They provide all the benefits of Original Medicare (Part A and Part B) and often include additional coverage, such as prescription drug coverage (Part D) and dental or vision services. Unlike Original Medicare, Medicare Advantage plans have a network of healthcare providers and may require members to use in-network doctors and facilities for non-emergency care

Are all Medicare Advantage plans in Clifton the same?

No, Medicare Advantage plans can vary significantly from one insurance company to another. Different plans may offer different benefits, premiums, copayments, and networks of healthcare providers. It's essential to compare available plans in your area to find one that best fits your healthcare needs.

Can I join a Medicare Advantage plan in Clifton if I have pre-existing conditions?

Yes, you can join a Medicare Advantage plan in Clifton, regardless of any pre-existing conditions. Insurance companies that offer Medicare Advantage plans are required to accept all Medicare-eligible individuals in the area they serve, regardless of health status or pre-existing conditions.

Are prescription drugs covered under Medicare Advantage plans ?

Many Medicare Advantage plans include prescription drug coverage (Part D) as part of their benefits. These plans are known as Medicare Advantage Prescription Drug (MAPD) plans. However, not all plans offer prescription drug coverage, so it's essential to review plan details carefully to ensure it meets your specific medication needs

Can I switch from Original Medicare to a Medicare Advantage plan and vice versa?

Yes, you can switch from Original Medicare to a Medicare Advantage plan during the Annual Enrollment Period (AEP), which typically runs from October 15th to December 7th each year. Similarly, you can switch from a Medicare Advantage plan back to Original Medicare during the same period. Additionally, there is a Medicare Advantage Open Enrollment Period (MA OEP) from January 1st to March 31st, during which you can switch to another Medicare Advantage plan or return to Original Medicare.

Affordable Care Act

Health insurance Marketplace

The health insurance marketplace, also known as the health insurance exchange, is a platform created under the Affordable Care Act (ACA) in the United States. It serves as an online marketplace where individuals, families, and small businesses can compare and purchase health insurance plans.

The primary goal of the health insurance marketplace is to provide accessible and affordable health insurance options to those who do not have employer-sponsored coverage or qualify for government programs like Medicaid or Medicare. It offers a range of private health insurance plans that comply with the ACA's regulations and standards. Here are some key aspects of the health insurance marketplace:

1. Plan Selection: The marketplace offers a variety of health insurance plans categorized into metal tiers – bronze, silver, gold, and platinum – based on the level of coverage and cost-sharing. Each plan must cover essential health benefits, including preventive care, hospitalization, prescription drugs, maternity care, and mental health services.

2. Open Enrollment Period: The marketplace has an annual open enrollment period during which individuals can enroll, renew, or change their health insurance plans. This period typically runs from November 1 to December 15, although some states may have extended deadlines. Outside of this period, individuals can only enroll if they qualify for a Special Enrollment Period due to certain life events, such as marriage, birth of a child, or loss of other coverage.

3. Subsidies and Financial Assistance: The marketplace offers financial assistance to make health insurance more affordable. Eligible individuals and families with low to moderate incomes may qualify for premium tax credits, which reduce the monthly cost of their insurance premiums. Additionally, cost-sharing reductions can help lower out-of-pocket expenses like deductibles, copayments, and coinsurance for those with lower incomes.

4. Medicaid Expansion: The health insurance marketplace also facilitates enrollment in Medicaid, a government program that provides health coverage to low-income individuals and families. Some states have expanded Medicaid eligibility criteria under the ACA, allowing more people to qualify for this program. The marketplace helps determine eligibility and provides a seamless application process for Medicaid enrollment.

5. Navigators and Assistance: The marketplace has trained individuals called navigators who can provide free assistance to consumers in understanding their health insurance options, comparing plans, and completing the enrollment process. They can help individuals determine their eligibility for subsidies, explain the coverage details, and guide them through the application process.

6. Small Business Health Options Program (SHOP): The marketplace includes a separate program called SHOP, which is designed for small businesses with fewer than 50 employees. SHOP allows employers to offer their employees a range of health insurance plans and potentially qualify for tax credits to offset the cost of providing coverage.

The health insurance marketplace plays a vital role in expanding access to affordable health insurance for millions of Americans. It provides a transparent and user-friendly platform for individuals, families, and small businesses to compare and purchase health insurance plans, ensuring that more people have access to essential healthcare services.

Affordable Care Act

What is the Affordable Care Act ?

The Affordable Care Act (ACA), also known as "Obamacare," is a comprehensive healthcare reform signed into law by President Barack Obama on March 23, 2010. Here's an overview of the law and its key components:

Patient Protection

Pre-existing Conditions: Insurance companies can no longer deny coverage to people with pre-existing health conditions.
Children’s Coverage: Allows children to stay on their parents' insurance plans until age 26.
Lifetime and Annual Limits: Eliminates lifetime and annual dollar limits on essential health benefits.

Insurance Exchanges and Subsidies

Health Insurance Marketplaces: Creates exchanges where individuals and small businesses can shop for and purchase private insurance coverage.
Subsidies: Offers subsidies to lower and middle-income individuals and families to make premiums more affordable.

Medicaid Expansion

Income Eligibility: Extends Medicaid to cover individuals and families with incomes up to 138% of the federal poverty level.
State Adoption: States have the option to adopt this expansion, and not all have chosen to do so.

Individual and Employer Mandates

Individual Mandate: Requires most Americans to have health insurance or pay a penalty. The penalty was effectively reduced to $0 starting in 2019 at the federal level, though some states have their individual mandates.
Employer Mandate: Requires larger businesses to provide affordable health insurance to their employees.

Cost Controls and Quality Improvements

Medicare Payments: Introduces changes to how Medicare pays providers to encourage efficiency and quality.
Preventive Services: Requires insurance plans to cover certain preventive services without charging a copayment, coinsurance, or deductible.

Taxes and Fees

High-Income Taxes: Includes additional Medicare taxes for high-income earners.
Industry Fees: Includes fees on health insurance providers, manufacturers of branded prescription drugs, and medical devices.

What are Medicare Advantage plans, and how do they differ from Original Medicare ?

Medicare Advantage plans, also known as Part C plans, are offered in Cliton by private insurance companies approved by Medicare. They provide all the benefits of Original Medicare (Part A and Part B) and often include additional coverage, such as prescription drug coverage (Part D) and dental or vision services. Unlike Original Medicare, Medicare Advantage plans have a network of healthcare providers and may require members to use in-network doctors and facilities for non-emergency care
Are all Medicare Advantage plans in Clifton the same?

No, Medicare Advantage plans can vary significantly from one insurance company to another. Different plans may offer different benefits, premiums, copayments, and networks of healthcare providers. It's essential to compare available plans in your area to find one that best fits your healthcare needs.
Can I join a Medicare Advantage plan in Clifton if I have pre-existing conditions?

Yes, you can join a Medicare Advantage plan in Clifton, regardless of any pre-existing conditions. Insurance companies that offer Medicare Advantage plans are required to accept all Medicare-eligible individuals in the area they serve, regardless of health status or pre-existing conditions.
Are prescription drugs covered under Medicare Advantage plans ?

Many Medicare Advantage plans include prescription drug coverage (Part D) as part of their benefits. These plans are known as Medicare Advantage Prescription Drug (MAPD) plans. However, not all plans offer prescription drug coverage, so it's essential to review plan details carefully to ensure it meets your specific medication needs
Can I switch from Original Medicare to a Medicare Advantage plan and vice versa?

Yes, you can switch from Original Medicare to a Medicare Advantage plan during the Annual Enrollment Period (AEP), which typically runs from October 15th to December 7th each year. Similarly, you can switch from a Medicare Advantage plan back to Original Medicare during the same period. Additionally, there is a Medicare Advantage Open Enrollment Period (MA OEP) from January 1st to March 31st, during which you can switch to another Medicare Advantage plan or return to Original Medicare.

Health insurance Marketplace

Affordable Care Act

What is the Affordable Care Act ?

What are Medicare Advantage plans, and how do they differ from Original Medicare ?

Are all Medicare Advantage plans in Clifton the same?

Can I join a Medicare Advantage plan in Clifton if I have pre-existing conditions?

Are prescription drugs covered under Medicare Advantage plans ?

Can I switch from Original Medicare to a Medicare Advantage plan and vice versa?

1038 Main Ave

Clifton, NJ, 07011

Operating Hours:

Mon-Fri: 9:00 am-5:00pm

Sat: 9:00 am-2:00 pm

Phone: 973-928-6171
Email: angelscarecommunityadvisors@gmail.com

Health insurance Marketplace

Affordable Care Act

What is the Affordable Care Act ?

What are Medicare Advantage plans, and how do they differ from Original Medicare ?

Are all Medicare Advantage plans in Clifton the same?

Can I join a Medicare Advantage plan in Clifton if I have pre-existing conditions?

Are prescription drugs covered under Medicare Advantage plans ?

Can I switch from Original Medicare to a Medicare Advantage plan and vice versa?

1038 Main Ave

﻿Clifton, NJ, 07011

Operating Hours:

Mon-Fri: 9:00 am-5:00pm

Sat: 9:00 am-2:00 pm

Phone: 973-928-6171 Email: angelscarecommunityadvisors@gmail.com

Clifton, NJ, 07011

Phone: 973-928-6171
Email: angelscarecommunityadvisors@gmail.com