Understanding Medicare Advantage Plans
Medicare Advantage Plans, or Medicare Part C, can be used to substitute Medicare Part A and B, as well as offer prescription drug coverage.
This is a private insurance plan that you can join as a substitute for Medicare. These plans typically have networks and some may compel you to get referrals to visit a specialist.
Advantage plans are different from Medigap plans.
They are intended to be a lower-premium option than Medigap.
Members receive their benefits from a private insurer instead of Original Medicare. When you need to find the best Medicare Advantage plan, our agents are on your side. We’re here to break it down for you and guide you through your options.
How Do Medicare Advantage Plans Work?
You must first enroll in Medicare Part A and B before you’re eligible to tack on an Advantage plan. When you join a Medicare Advantage plan, Medicare pays a monthly fee to the plan to provide your Part A and B benefits. By paying this fee, Medicare assumes all of your medical risk, so some plans can offer you a $0 premium — Medicare is already paying them on your behalf.
Benefits.
Medicare Advantage plans have to provide the benefits that Original Medicare does, such as surgery, inpatient medical care, lab tests, home health care, etc.
But these plans also sometimes offer:
Fitness memberships
Adult day-care services
Over-the-counter drugs
Dental, hearing, and vision
Nutrition programs
Transportation to doctor visits
And more
The benefits will vary and depend on where you live and your plan providers.
Networks.
In 2020, the Medicare Part D deductible is $435. So, each insurer can charge up to a $435 deductible from you before your benefits come through. The insurer may choose to charge a lower deductible as well.
If a company waives the deductible, you’ll usually see higher premiums and copays.
Types of Plans.
Types of Medicare Advantage Plans
There are many different types of Medicare Advantage plans that suit a variety of different needs. You can buy the following plans through us:
PPO Plans
HMO Plans
MSA Plans
PFFS Plans
Advantage for Veterans
Special Needs Plan
Enrollment Periods.
If you’re eligible for Medicare, you’re eligible for a Medicare Advantage plan. But, there are set times for when you can enroll:
Initial Coverage Election Period (ICEP)
ICEP is your first chance to select a Medicare health plan. This seven-month period begins three months before the month you turn 65 and ends three months after the month you turn 65. If you’re under 65 and you get Social Security disability, you’re eligible for Medicare in the 25th month after you start receiving your Social Security benefits.
Annual Election Period (AEP)
The AEP, aka open enrollment, runs from October 15 to December 7 every year. Once January comes, coverage for your chosen Medicare Advantage plan will ensue. During the AEP, you can also add, switch, or drop current coverage.
Medicare Advantage Open Enrollment Period
During this time, you can switch to another Medicare Advantage plan if you wish. Or, you can cancel your plan to return to Original Medicare.
Special Election Period
Many things can spur a special election period and they’re specific to an individual. You should speak with a licensed Medicare insurance agent to see if you qualify. There are a few common scenarios, like if you move out of state, move into a nursing home, or qualify for additional aid, you may be eligible for this special election period. You can implement changes to your Medicare Advantage plan during this period or revert back to Original Medicare.