Medicare Advantage
Medicare Advantage (Part C) is an alternative choice to Original Medicare as it combines Medicare Parts A and B into one managed care (HMO or PPO) plan. It often includes prescription drug coverage, and may come with other benefits that aren’t included in Original Medicare.
To enroll in a Medicare Advantage Plan, you must first be enrolled in Original Medicare (Parts A and B.)
Benefits
Private insurance companies provide Medicare Advantage Plans as an alternative option to Original Medicare.
These plans offer similar coverage to Original Medicare but may include other advantages, incentives, and benefits; prescription drugs, vision, dental, and hearing coverage. Some plans even include health, wellness, and fitness services.
Cost
Many Medicare Advantage plans do not charge a monthly premium above the required $164.90 from Part B. Medicare Advantage plans also have maximum out-of-pocket limits, many going up to $11,300.
The Health Maintenance Organization (HMO) plan usually comes with reduced costs. However, it requires you to see providers within their network, and get referrals before seeing a specialist.
The Preferred Provider Organization (PPO) plan typically costs more but offers more flexible options for visiting providers, and may not require referrals to see specialists.
Other plans include:
- Private Fee-for-Service (PPFS) – With PFFS plans, you are not required to choose a primary care physician or get referrals for specialists. You can also typically receive care outside the plan’s network, but only if the provider accepts your plan’s terms and conditions. This plan will also choose how much they will pay the healthcare provider and how much you will pay.
- Special Needs Plans (SNPs) – SNPs are limited to serving individuals who have specific needs. To qualify for an SNP, you must meet one of the following requirements:
- You live in an institutional setting, like a nursing home
- You are eligible for Medicare and Medicaid
- You have a chronic or disabling condition
- Medicare Medical Savings Account Loans (MSA) – MSAs combine a high-deductible plan with a savings account. You must pay the high deductible before your plan will start providing coverage. However, the plan provider will also deposit funds into a savings account that you can use toward the deductible.
Enrollment
You can enroll for Medicare during one of several enrollment periods:
- Initial Enrollment Period – This begins three months before your 65th birthday, and ends three months after, lasting for a total of seven months. This marks when you first become eligible for Medicare, but you must be enrolled in Original Medicare (Parts A and B) first before you can enroll in a Medicare Advantage plan.
- Annual Enrollment Period – Begins October 15 and ends December 7. During this period, you can make several changes to your coverage. If you are enrolled in Original Medicare, you have the option of switching to a Medicare Advantage plan. If you are enrolled in a Medicare Advantage plan, you can also switch back to Original Medicare or to a different Medicare Advantage plan. You may also enroll in or change your Part D (Prescription drug plan) during this time.
- Special Enrollment Period – When you move outside your plan’s service area, or if you experience significant health changes and need to enroll in a different plan.
- Medicare Advantage Open Enrollment Period – Begins January 1 and ends March 31. If you are not satisfied with your Medicare Advantage plan, you can choose a new one, or you can switch back to Original Medicare.
Are you interested in enrolling in a Medicare Advantage plan but unsure which plan would meet your needs best? Give us a call and we will talk you through the options. (918) 280-8025.