Medicare Advantage Plans

What is a Medicare Advantage Plan?

Medicare Advantage is the equivalent of Medicare Part C. These are health plans offered through private insurance companies and is another way to get your Part A and Part B coverage, may include Part D and some extra benefits not covered by Original Medicare. Some of these added benefits may be eye glasses, a dental plan, hearing aids, routine chiropractic and acupuncture services, transportation, worldwide emergency coverage, over-the-counter benefits and more.

Different Types of Medicare Advantage Plans

HMO: Also known as Managed-Care Plans. With this type of plan, you must choose a primary care physician, who will be the one to refer you to specialists that are within his medical group. You are restricted to see providers that are in-network with an approved referral or authorization, except in the case of an emergency. Seeing providers out-of-network or without an authorization may result in you having to pay 100% of the bills.

PPO: These plans allow you to see providers out-of-network paying a higher cost-share than you would seeing providers in-network. Referrals to see a specialist are typically not required.

PFFS: This type of plan usually has a network of contracted providers you can access without having an assigned primary care physician or needing a referral to see a specialist. You may also see providers out-of-network as long as they agree to accept the plan’s terms and conditions of payment and have not opted out of Medicare. You cost-share for seeing providers out-of-network may be higher.

HMO-POS: This is typically an HMO plan. The plan determines which benefits and services are covered outside of the network under the Point-Of-Service (POS) option. 

SNP: Special Needs Plans are HMO or PPO plans designed for a specific group of Medicare beneficiaries that provide an additional level of care. D-SNPs are for those with both Medicare and Medicaid, while C-SNPs are for those with specific chronic conditions, such as diabetes, hypertension, COPD, etc. You must meet certain requirements in order to qualify to join one ofthese plans. 

Requirements for Joining a Medicare Advantage Plan

In order to join a Medicare Advantage plan, you must:

  • Have Medicare Parts A and B
  • Reside in the plan’s service area
  • Join within a valid enrollment period or qualify for a special enrollment

How do I Sign Up for a Medicare Advantage Plan?

Once you meet the qualifications for joining a Medicare Advantage plan, you can sign up by going to Medicare.gov, calling the health plan or going to the plan’s website, or find a licensed insurance agent/broker to sign you up at no cost.

The benefits of working with a licensed insurance agent/broker are:

  • It’ll cost you nothing
  • Getting help shopping for a plan that fits your needs and saves you money
  • Get an annual assessment during the annual enrollment period to see if your plan is still the right for you
  • A broker can be a faster way to solve an issue or answer questions versus calling the plan’s member services

Do you have any questions regarding your Medicare options or need assistance shopping for a plan? Don’t hesitate to contact me.