Medicare Advantage is also known as Medicare Part C
With a Medicare Advantage plan you get your insurance coverage through a private insurance company. These plans must cover all services that Original Medicare covers and often includes Part D prescription drug plan coverage. Medicare Advantage plans available are based on the county that you reside.
Often Medicare Advantage plans have a network of providers that you must use except in emergency situations. The list of providers to go to within a plan can change throughout the year. Each Medicare Advantage plan has an annual maximum out-of-pocket limit, which is the most you could incur in medical bills each calendar year.
I simplify the comparison of Medicare Advantage plans by ensuring your providers are accepted, checking medication costs, and locating the plan that would have the lowest costs to you in your situation.
Types of Medicare Advantage Plans
There are a few types of plans. The main two are HMO and PPO.
- HMO (Health Maintenance Organization) is a type of plan where you can use only doctors and hospitals that are a part of the plan’s network. A referral is needed on most HMO plans.
- PPO (Preferred Provider Organization) is a type of plan that allows you to use doctors and hospitals in and out-of-network. A referral is not needed to see a specialist on a PPO plan.
Other Tips to Know:
- You must have Medicare Part A & Part B in order to have a Medicare Advantage plan.
- When considering a Medicare Advantage plan be sure to review the costs for items including, but not limited to inpatient hospital costs, outpatient surgical costs, emergency room visit, cancer radiation and chemotherapy treatments.
- Consider complementing a Medicare Advantage plan with a Hospital Indemnity Plan to protect your savings.
Enrollment Periods for Medicare Advantage Plans
- You can enroll in a Medicare Advantage plan within a 7-month period that is 3 months before your 65th birthday and ends 3 months after your 65th birthday.
- If you have delayed starting Medicare Part B (due to having other creditable coverage), you can enroll in a Medicare Advantage plan within 3 months of starting Part B.
- Annual Enrollment Period, which is from October 15th thru December 7th. The plan chosen during this enrollment period would start January 1st.
- Open Enrollment Period, which is from January 1st thru March 31st. If you have a Medicare Advantage plan currently, you can make a one-time change for the calendar year to another Medicare Advantage plan. You can also choose to disenroll from a Medicare Advantage plan during this period of time and return to Original Medicare, which if this is done you are allowed to add a standalone Part D prescription drug plan.
- Special Election Period is another option and covers several situations that are unique. Some of these include moving outside your Medicare Advantage plan service area, moving into or out of a skilled nursing facility, being eligible for or losing Medicaid. There are many other special election periods, contact to learn more. During this period of time you can enroll into a Medicare Advantage plan or return to Original Medicare.