What is Medicare Advantage?
"Ever wondered about those TV commercials featuring 'Medicare Advantage Joe'? Or perhaps you've heard friends raving about the perks of their plan. Whether you're a curious viewer or a newcomer to the world of Medicare, our article is your compass to navigate the realm of Medicare Advantage. Unravel the mysteries, discover the benefits, and debunk the myths surrounding these plans. Join us as we dive into the realm of Medicare Advantage – it's time to demystify your healthcare choices!"
Medicare Advantage
Medicare Advantage, also known as “Part C”, is a bundled alternative to way to receive Original Medicare benefits. (If you missed the article on Original Medicare check it out here.) These plans are offered by private insurance companies that are contracted with Medicare to provide the Part A and Part B benefits and can also include Part D (prescription drug) benefits. Medicare Advantage plans MUST provide all of the same benefits as Medicare Part A and Part B, and many plans offer additional benefits as well.
Medicare Supplement (also known as Medigap) plans are not the same as Medicare Advantage plans. You cannot be enrolled in both a Medicare Advantage and Medigap plan at the same time. While Medigap plans have a high monthly premium and little to no copays, Medicare Advantage plans have low and often $0 premium with manageable copays and coinsurance when you receive a medical service.
Types of Medicare Advantage Plans
There are several types of Medicare Advantage plans. They can be defined by network type, such as:
HMO (Health Maintenance Organizations)
Generally, must get care from doctors, providers, and hospitals in the plan’s network.
In most cases, you have to get a referral to see a specialist.
Emergency and urgently needed services are covered in and out of network.
Maximum out of pocket and copays tend to be lower than PPO plans.
To avoid Part D penalty, you must get a plan with drug coverage as a stand-alone plan cannot be added.
PPO (Preferred Provider Organization)
Generally, you can see doctors both in and out of the plan’s network. Cost sharing is typically higher out of network and the doctor must agree to accept payment from the plan.
There is no referral required to see a specialist.
Maximum out of pocket and copays tend to be higher than HMO plans.
To avoid Part D penalty, you must get a plan with drug coverage as a stand-alone plan cannot be added.
PFFS (Private Fee For Service)
You can go to any Medicare-approved provider or facility that accepts the plan’s payment terms, agrees to treat you, and hasn’t opted out of Medicare.
There is no referral required to see a specialist.
You’ll need to show your plan membership ID card each time you go to a health care provider. Your provider can choose at every visit whether to accept your plan’s terms and conditions of payment.
Medicare Advantage Eligibility
To be eligible for a Medicare Advantage plan, you need to be enrolled in both Part A and Part B.
Initial Enrollment Period
Your first opportunity to enroll in a Medicare Advantage plan will be during the Initial Enrollment Period. When you are first eligible for Medicare, or when you turn 65, and you enroll into both Part A and Part B, there is a window of 7 months to choose a plan. This window begins 3 months before your Part A & B effective date, the month of, and 3 months after.
If you delay your Part B, then you will have a window of 3 months PRIOR to your Part B effective date to choose a plan.
Annual Enrollment Period
Every year during October 15 through December 7, there is an opportunity to enroll for the first time or switch to a new Medicare Advantage plan. This is called the Annual Enrollment Period. If you are eligible for Medicare and regardless of the plan you have, you can make plan changes during this time.
Medicare Advantage Open Enrollment Period
Unlike the above, Annual Enrollment Period, this Open Enrollment is only for members of Medicare Advantage plans. From January 1 - March 31 you may replace your current Medicare Advantage Plan with another one or cancel your current Medicare Advantage Plan and go back to Original Medicare only.
If you go back to Original Medicare only, it is highly encouraged you enroll into a Medicare Supplement and stand-alone Medicare Drug Plan.
There are some qualifying events that way allow you to enroll or make changes through out the year.
Call us at 321-261-4681 and speak with an Independent Broker who can help determine what options are most suitable for you.
Extra Benefits
What are some of these extra benefits that come with Medicare Advantage plans? Listed benefits are not all available on every plan. Schedule an appointment so we can go over the benefits available in your area.
dental
vision
hearing
over-the-counter
fitness plan
transportation
grocery allowance
Find Information on Medicare Advantage at Medicare.gov
Benefits will vary by plan and plan area.
Many clients want the same plan as a their cousin, sister, best friend, etc., and are often surprised to find out how much the copays additional benefits will vary from one plan area to another.
Need Help Finding the Best Medicare Advantage Plan For You?
Our licensed advisors are here to help you select the right options for your needs, budget, and lifestyle. Together we’ll come up with a plan that suits you.