Medicare Advantage

Medicare Part C (Medicare Advantage plan) covers all the services that Parts A and B, and may also include prescription drug coverage plus extra benefits like vision, hearing, dental and preventive services.

Medicare Advantage plans are provided by private companies approved by Medicare.  Medicare pays a fixed fee to the plan for your care.  Then the plan pays the doctors and hospitals.  You help share the costs by paying copays.

Where you live (based on your ZIP code) often determines which Medicare Advantage Plans are available to you.  You still pay Part B premium, in addition to a monthly premium (unless it has a $0 premium).

Who can join a Medicare Advantage plan?

Most people who have Medicare Part A and Part B and live in the plan’s service area can join a plan, who do not have End Stage Renal Disease.  Call an agent to join.

Medicare Advantage enrollment and election periods

Initial Enrollment Period (IEP)- Seven month window, anytime within the three months before your 65th birthday month, the month of your birthday and three months after.

Annual Election Period (AEP)- Oct. 15 – Dec. 7 also referred to as “Annual Enrollment Period.”  It allows you to make changes for the upcoming year, with an effective date of January 1 of the following

Medicare Advantage Disenrollment Period- (January 1st thru February 14th), you may disenroll from your Medicare Advantage plan and switch back to Original Medicare. If your Medicare Advantage plan included drug coverage, that will also end, but you may enroll in a stand-alone Medicare Prescription Drug Plan during this period.

Special Enrollment Periods (SEP)

Special Enrollment Periods are opportunities to make plan changes outside of the standard enrollment periods.

  • If you didn’t sign up for Part A and/or Part B (for which you pay monthly premiums) when you were first eligible because you’re covered under a group health plan based on current employment.
  • Moving permanently outside your plan’s service area grants a SEP.
  • Qualifying for any limited-income assistance creates a continuous SEP.

SEPs are generally 60 days, but may vary. You may use your SEP to:

  • Join a different Medicare Advantage plan
  • Switch to only Original Medicare
  • Switch to Original Medicare and purchase a Medigap policy.
  • Insurance companies may require that you undergo underwriting unless you have a Guaranteed Issue opportunity.

Medicare Advantage Plan Types

HMO Health Maintenance Organization

Plans must cover all Medicare Part A and Part B expenses. The beneficiary can only go to the doctors, specialists, or hospitals on the plan’s provider list (except in an emergency).

HMO-POS HMO Point-of-Service

An option that is available in some HMO plans that allow the beneficiary to use doctors and hospitals outside the plan for an additional cost.

PPO Preferred Provider Organization

Plans in which the beneficiaries pay less if they use doctors, hospitals, and providers that belong to the network.  If they use doctors, hospitals, and providers outside of the network there will be an additional cost.

PFFS Private-fee-for-Service

A type of Medicare Advantage Plan in which the beneficiary may go to any Medicare-approved doctor or hospital that accepts the plan’s terms and conditions of payment. The insurance plan, rather than Medicare, decides how much it will pay and what the beneficiary will pay for each service they recieve.

SNP Special Needs Plan

Private insurance plans that provide Medicare benefits, including drug coverage.  People eligible for Medicare and Medicaid, those living in certain LTC facilities, and those with severe chronic or disabling conditions may qualify to join.

Want help comparing plans?

An agent can help you understand plan options and plan rules, such as how and when you may disenroll and other plan details.

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