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Medicare Advantage PLANS
Medicare Advantage plans are Medicare plans offered by managed care organizations. Oxford Medicare Advantage is a Medicare Advantage plan being offered by Oxford Health Plans. Many Medicare beneficiaries are relying on Medicare Advantage plans for their primary healthcare coverage. The reason is that many healthcare companies have been able to provide members with 100% of their traditional Medicare benefits, plus many other benefits without charging a monthly plan premium. The amount and availability of these benefits will vary by plan, so you will need to compare plan benefits carefully. Click here, to find out about the Oxford Medicare Advantage benefits available in your area.


Evaluating Medicare Advantage plans

Choice of doctors. In general, you must see doctors who have agreed to participate in a plan's network. Emergency or urgently needed care situations and out-of-area renal dialysis services are the exceptions.

Monthly premiums. Several Medicare Advantage plans do not charge a monthly plan premium. Others do charge a monthly plan premium. In either case, you must continue to pay your monthly Part B premium, which is deducted from your Social Security check.

Availability of additional benefits. Depending on the plan, members might receive a prescription drug allowance, along with vision, hearing, and podiatry benefits. Some plans also offer a full range of annual preventive care benefits, including annual physical exams.

Out-of-pocket costs. Members generally pay a copayment each time they visit a doctor. Some plans also offer 100% hospitalization coverage, as medically necessary.

Out-of-area coverage. Many plans offer 100% coverage for emergency and urgently needed care anywhere in the United States. Others cover emergency and urgently needed care worldwide.


Signing up for a Medicare Advantage plan

Starting in 2006, there is a new law that governs when and how often you can change the way you get Medicare and what choices you can make when you make the change. Even if you just switch from one Medicare Advantage plan (like Oxford Medicare Advantage) to one of the other Medicare Advantage plans we offer, it still counts as making a change.

Here are the new rules:

  1. From November 12, 2005 through May 15, 2006, anyone with Medicare will have two chances to switch from one way of getting Medicare to another.
  2. From January 1, 2006 until June 30, 2006, anyone with Medicare (including Members of Oxford Medicare Advantage) has another chance to make a change in the way they get Medicare.

However, you are limited in the type of plan you can join. For example, if you don't have Medicare prescription drug coverage when you make this change, you can only choose to join another plan that doesn't offer Medicare prescription drug coverage, or you can choose to return to the Original Medicare Plan without prescription drug coverage. If you have Medicare prescription drug coverage, you can't use this chance to drop it.

  1. Generally, you can't make any other changes during the year unless you meet special exceptions, such as if you move or if you have Medicaid coverage. Later in the year, from November 15 through December 31, anyone with Medicare can switch their way of getting Medicare to another way for the following year.
  2. Other than making one change between November 15 through December 31, no one with Medicare is allowed to make any changes in the way they get Medicare during the last six months of the year (from July 1 through December 31) unless they meet one of the following exceptions:
    • An exception that applies only to people who turn 65 in the current year: If you turn 65 in the current year and you join a Medicare Advantage plan (such as Oxford Medicare Advantage) during the current year, you are allowed to make a one-time switch to Original Medicare at any time during the 12-month period after the date that you join the plan.
    • An exception that applies only to peoples who are in an institution: If you are in an institution (like a skilled nursing facility or a rehabilitation hospital) at the time you leave a Medicare Advantage plan (like Oxford Medicare Advantage), you are allowed to switch from one way of getting Medicare to another.
    • An exception that applies only to people who were first eligible to join a plan in the current year: If you became a member of a Medicare Advantage plan in the current year and it was the first time you were eligible to join a Medicare Advantage plan, you will be allowed to switch from one way of getting Medicare to another. However, you will only be allowed to leave that Medicare Advantage plan under this exception if you leave within six months of the date you became eligible to join a Medicare Advantage plan but not later than December 31 of that year.
    • Under certain conditions, you may be allowed to make a change regardless of the time of the year and any previous changes you may have made. Please call your current Medicare Advantage plan if you need to know if you might be able to use one of these circumstances to leave your plan. These conditions include:
      • Permanently moving out of our service area,
      • Joining a retiree plan offered by our current or former employer,
      • Being eligible for Medicaid, and
      • Being eligible for the Program of All-inclusive Care for the Elderly (PACE).

In most cases, your disenrollment date will be the first day of the month that comes after the month we receive your request to leave. For example, if we receive your request to leave during the month of February, your disenrollment date will be March 1.

To find out which Medicare Advantage plans are offered in your area, you can log on to Medicare Compare at www.medicare.gov or call your state's health insurance assistance program.

The numbers are as follows:
Connecticut: 1-800-994-9422
New Jersey: 1-800-792-8820
New York: 1-800-333-4114

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