Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare (Part A and Part B) that provides additional benefits through private insurance companies approved by Medicare. These health plans are generally going to be either HMOs and PPO’s.
Medicare Advantage Plans are required at a minimum to have at least the same benefits covered as Original Medicare, and generally include Part D as part of your benefits package (MAPD).
These plans require you to be enrolled in Medicare Part A & Part B, pay the Part B premium, live in the plan service area and they don’t ask any health underwriting questions. Because there are so many different kinds of Medicare Advantage Plans on the market today, let our office help you review your options.
Here are some key points about Medicare Advantage:
- Coverage: Medicare Advantage Plans are designed to be as good as original Medicare and often have more benefits.
- Potential for lower premiums: Medicare Advantage Plans often have lower premiums than Medigap plans.
- Cost-sharing: You’ll have cost sharing for medical services such as co-pays or co-insurance.
- Network-based: Medicare Advantage plans often have provider networks, meaning you’ll typically need to use doctors and hospitals that are in-network to receive full coverage. However, some plans may offer out-of-network coverage in certain situations.
- Plan types: There are different types of Medicare Advantage plans, including Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs). Each plan type has its own rules and requirements regarding network restrictions, referrals, and costs.
- Ability to change coverage: You can switch your coverage around every Annual Election Period or during a Special enrollment period. This gives consumers peace of mind knowing they can change coverage if needed.
How & when to enroll into a Medicare Advantage Plan?
You are eligible to enroll in a Medicare Advantage plan if you have Medicare Part A and Part B and reside in an area where there is a plan available and have a valid election period. Many people enroll during their Initial Enrollment Period (IEP) when the first start Medicare or switch to Medicare Advantage during the Annual Enrollment Period (October 15 to December 7) or use a Special Enrollment Period if you have qualifying circumstances.