Medicare Advantage Plans Bernalillo County 2025

In Bernalillo County, choosing the right Medicare Advantage plan involves navigating various options and benefits. Distill your choices by understanding the types of Medicare Advantage Plans Bernalillo County has to offer, like HMOs, PPOs, and SNPs, assessing their costs, and learning how to enroll.

Consider plans with unique benefits, such as the SCAN Health Plan, to enhance your healthcare coverage. Start with this article to confidently identify a plan that suits your needs without unnecessary expenses.

 

Key Takeaways

  • Bernalillo County offers a diverse range of Medicare Advantage plans, including 37 options with an average monthly premium of approximately $19.30, catering to various needs and preferences.

 

  • SCAN Health Plan in Bernalillo County provides extensive benefits beyond standard Medicare, including prescription drug coverage, wellness programs, and added dental, vision, and hearing aid coverage.

 

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Discovering Bernalillo County Medicare Advantage Plans 2025 Landscape

 

Medicare Advantage Plans Bernalillo County 2025 Discovering Bernalillo County's Medicare Advantage Plan Landscape

 

Bernalillo County, renowned for its rich history and cultural diversity, extends this diversity into its healthcare sector, offering 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, the county provides 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.

With such a vast array of choices, finding a plan that ticks all the boxes is no longer a far-fetched dream.

What’s more, the county boasts 37 Medicare Advantage plans, ensuring a wide selection of eligible individuals. With an average monthly premium of approximately $19.30, these plans strike a balance between comprehensive coverage and affordability.

This means the right coverage doesn’t have to break the bank. So, whether you’re a New Mexico native or a new resident, Bernalillo County Medicare Advantage plans 2025 offer a promising horizon for your healthcare journey.

 

Navigating the Benefits of SCAN Health Plan in Bernalillo County

 

Navigating the Benefits of SCAN Health Plan in Bernalillo County

 

Among the bouquet of Medicare Advantage plans in Bernalillo County, the SCAN Health Plan stands out. Imagine a plan that not only provides comprehensive healthcare coverage but also rolls out a red carpet of cost-saving opportunities.

That’s what SCAN offers. From tiered formularies for prescription drugs to lower copays at preferred pharmacies, SCAN sets the stage for affordable healthcare.

But that’s not all. SCAN goes beyond standard Medicare, adding a cherry on top with additional benefits such as:

  • Dental benefits

 

  • Vision coverage

 

  • Wellness programs

 

  • Hearing aid coverage

 

And with a local pharmacy network at your disposal, getting your prescriptions filled is as easy as pie. But let’s delve deeper into the prescription drug coverage and extra perks that make SCAN a preferred choice for many.

 

Understanding SCAN’s Prescription Drug Coverage

Prescription drugs often form a significant part of healthcare expenses. However, with SCAN’s Medicare Advantage plans, this burden is significantly lightened.

These plans, backed by a Medicare contract, bundle prescription drug coverage, elevating benefits beyond Original Medicare and offering a viable alternative to a Medicare supplement. This means better coverage and potentially lower out-of-pocket expenses for you with a Medicare supplement plan.

Delving into the specifics for 2025, SCAN plans feature Tier 6 brand-name drugs like Eliquis, Xarelto, and Jardiance at reduced costs. So, you can continue your treatment without worrying about skyrocketing drug costs.

And if your plan doesn’t include prescription coverage, you can enroll in Medicare Advantage Prescription Drug Plans (MAPDs) offered by SCAN. It’s like having a safety net, ensuring you get the medication you need when you need it.

 

Extra Health Perks with SCAN

With SCAN and Blue Cross, healthcare coverage is more than just doctor visits and hospital stays. It’s about holistic well-being. That’s why healthcare service corporations like SCAN offer extra health perks, putting the ‘care’ back into healthcare.

For instance, routine eye exams come with $0 copays, taking a load off your mind and ensuring your vision stays sharp.

Oral health is a crucial part of overall health, and SCAN understands that. Members can access preventive dental services, including dental deep cleanings, at $0. So, you can flaunt your healthy smile without fretting over dental bills.

It’s these little extras that make SCAN not just a healthcare plan but a healthcare partner.

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Your Guide to Medicare Advantage Plans Bernalillo County 2025 Enrollment

 

Your Guide to Medicare Advantage Enrollment in Bernalillo County

 

Now that we’ve navigated the Medicare Advantage plan landscape and explored the benefits of SCAN Health Plan, let’s move on to the next milestone – enrollment. To join this healthcare caravan, you must first Be enrolled in both Medicare Part A and Part B.

And don’t worry about missing the bus; there are ample opportunities for you to hop aboard, thanks to the Annual Enrollment Period, Individual Election Period, and Special Enrollment Period.

But what if you’re a first-time enrollee? Or perhaps you’re looking to switch lanes and change your current Medicare Advantage plan?

We’ve got you covered. Let’s delve deeper into these scenarios and equip you with the information you need to navigate this journey confidently.

 

First-Time Enrollee? Here’s What You Need to Know

Stepping into the world of Medicare can feel like stepping into a labyrinth. But fear not, for we have the compass to navigate this maze. First, let’s talk eligibility. Medicare Part A and Part B 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.

Now, let’s talk timing. The Initial Enrollment Period for Medicare spans 7 months, starting 3 months before you turn 65 and ending 3 months after.

But what if you have to pay a premium for Part A? In that case, you need to enroll during specific enrollment periods. And if you’re a person with disabilities, you may be automatically entitled after receiving disability benefits for a certain duration.

So, keep these factors in mind and step into the Medicare world with confidence.

 

Changing Your Medicare Advantage Plan: How and When

Sometimes, change is not just a part of life; it’s a necessity. Perhaps your healthcare needs have evolved, or your current plan isn’t ticking all the boxes. In such cases, you might consider changing your Medicare Advantage plan during the contract renewal period.

And there’s a sweet spot for making this shift – 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. And the best part?

Once enrolled in a Medicare Advantage plan during a Special Enrollment Period, your coverage starts the following month. So, you can quickly benefit from your new plan selections.

 

Comparing Costs: Medicare Advantage vs. Original Medicare in Bernalillo County

 

Comparing Costs: Medicare Advantage vs. Original Medicare in Bernalillo County

 

The decision between Medicare Advantage and Original Medicare is crucial. Cost plays a significant role in this decision. Let’s look at the numbers. In Bernalillo County, Medicare Advantage plans offer:

  • A range of monthly premiums from $0 to an average premium of $49.81, with the option to access at least one $0 premium option

 

  • An average out-of-pocket limit of $4,928 to $5,466 per year

 

  • An average drug plan deductible of $156.00 per year for plans that include Part D coverage

 

On the other hand, Original Medicare includes:

  • Part A, with a potential premium up to $505 per month for those who pay and a Part A deductible of $1,632 for inpatient hospital stays

 

  • The standard monthly Part B premium is $174.70, and Part B also has an annual deductible of $240

 

  • Unlike Medicare Advantage plans, Original Medicare doesn’t feature an out-of-pocket maximum, potentially leading to significant out-of-pocket expenses.

 

Weighing these costs can help you make an informed decision.

Special Needs Plans (SNPs): Tailored Care in Bernalillo County

 

Medicare Advantage Plans Bernalillo County 2025 Special Needs Plans (SNPs): Tailored Care in Bernalillo County

 

Healthcare is not a one-size-fits-all scenario. And Special Needs Plans (SNPs) in Bernalillo County understand this. They cater to individuals with specific eligibility criteria or health conditions, offering tailored benefits and provider choices.

SNPs come in three flavors:

  • 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.

 

These plans do more than just cover healthcare costs; they provide a network of specialized healthcare providers and tailored clinical case management to improve health outcomes. At an average monthly premium of approximately $28.55, these plans are affordable, too.

But remember, SNPs require members to use the plan’s network providers except in emergency situations or for out-of-area dialysis. So, if you meet the eligibility criteria, SNPs can be a great way to receive customized care.

 

The Role of Star Ratings in Choosing a Medicare Advantage Plan

Choosing the best Medicare Advantage plan, including Medicare Advantage HMO options, is like picking a star from the night sky – a star that will guide your healthcare journey. And just like stars, Medicare Advantage plans have ratings, too.

The CMS Star Ratings system is 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 provide a holistic view of a plan’s performance.

Think of these ratings as a lighthouse guiding you to the right plan. In Bernalillo County, 38% of Medicare Advantage plans are rated 4 stars or higher, indicating superior quality and performance.

And while there are no 5-star rated Medicare Advantage plans available for 2024, 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

Sometimes, the path less traveled can lead to unexpected treasures. If you’re looking beyond Medicare Advantage, Medigap policies might be your treasure. Offered by private insurance companies, these policies serve as secondary insurance to Original Medicare, covering costs not fully covered by Original Medicare.

So, if you’re worried about unexpected healthcare costs, Medigap policies can be your safety net.

But what do these policies offer? In Bernalillo County, you can select from standardized Medigap plans labeled A through N.

Some plans even provide extended coverage for excess charges and foreign travel emergency costs. With premiums ranging from $26 to $827 per month, these plans cater to a variety of budgets.

So, if you’re seeking more provider flexibility and comprehensive coverage, exploring Medigap policies can be a fruitful endeavor.

 

Ensuring Access to Your Preferred Providers

A good healthcare plan is like a well-tuned orchestra – every element, from coverage to cost, must harmonize perfectly. And one crucial element in this orchestra is access to preferred providers.

Whether it’s a doctor you’ve trusted for years or a specialist recommended by a friend, being able to continue seeing them under your plan can bring peace of mind.

So, how do you ensure your preferred providers are in-network? Simple. Here are a few steps you can take:

  1. Visit the plan’s website and utilize their searchable directory.
  2. Use Medicare’s Find Doctors tool.
  3. Contact your preferred providers directly to confirm their participation in your plan.

Remember, choosing in-network providers not only ensures cost-effective care but also improves coordination and quality of healthcare services.

Maximizing Your Health Coverage: Additional Benefits Worth Considering

When it comes to healthcare coverage, it’s not just about the basics. The little extras can make a big difference. Many Medicare Advantage Plans in Bernalillo County have a good understanding of this.

They value and prioritize it. They offer additional perks, like $0 gym memberships and access to multiple fitness facilities. Some even include wellness offerings like a Fitbit® device. So, you can stay fit while saving money.

And that’s not all. Some HMO plan options provide transportation benefits, covering the cost of getting to and from medical appointments. This means you can focus on getting better, not on arranging transportation.

Plus, a quarterly Over-The-Counter (OTC) allowance allows you to purchase everyday healthcare items, reducing your out-of-pocket expenses. Indeed, these additional benefits can help you squeeze the most out of your health coverage.

 

Addressing Common Concerns: Prior Authorization and Out-of-Network Coverage

Navigating healthcare can sometimes feel like sailing in stormy waters, with concerns about prior authorization and out-of-network coverage rocking the boat. But with the right knowledge, you can weather these storms.

Prior authorization is a process where approval from the plan is required before a service is rendered. This ensures coverage for the service under the plan’s benefits and assesses medical necessity.

But what if the service is performed without prior authorization? In such cases, the payment may be denied. However, providers cannot bill the member if the claim is denied due to a lack of preauthorization.

Now, let’s talk about out-of-network coverage. If you use out-of-network providers, you may face higher out-of-pocket costs. So, understanding these requirements and potential costs can help you sail smoothly through your healthcare journey.

Summary

From the bustling streets of Albuquerque to the tranquil trails of the Sandia Mountains, Bernalillo County is a place of diversity and vitality. This vibrancy extends to its healthcare sector, offering a myriad of Medicare Advantage plans, each tailored to meet specific needs.

We’ve navigated the landscape of these plans, explored the benefits of SCAN Health Plan, and delved into the essentials of Medicare Advantage enrollment.

Whether you’re considering a Special Needs Plan, pondering the CMS Star Ratings, or exploring alternatives like Medigap policies, the choice ultimately lies in your hands. Your healthcare journey is as unique as you are, and the right plan is the one that resonates with your individual needs and lifestyle.

So, don’t just choose a plan; choose a healthcare partner who’ll walk with you on this journey, ensuring a healthier and happier future.

 

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 also offering additional benefits like fitness programs, 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 only covers medically necessary services and supplies, Medicare Advantage plans bundle Part A and Part B benefits and may 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 is the most highly rated Medicare Advantage plan?

The most highly rated Medicare Advantage plan is… Our top-rated Medicare Advantage plans offer the best coverage and benefits for your healthcare needs.

 

→ How many Medicare Advantage plans are available in Bernalillo County?

In 2024, there are 37 Medicare Advantage plans available in Bernalillo County.

 

→ What are the benefits of SCAN Health Plan in Bernalillo County?

SCAN Health Plan in Bernalillo County offers cost-saving opportunities, comprehensive coverage, and additional benefits like dental, vision, wellness programs, and hearing aid coverage. It provides a wide range of benefits to its members.

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 ZRN Health & Financial Services, LLC, a Texas limited liability company

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Speak with a licensed insurance agent

 1-833-641-4938
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Mon-Fri : 8am-9pm EST

Russell Noga
( Medicare Expert )

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.