A Medicare Advantage plan is a private insurance plan that you can join as a substitute for Medicare. Medicare Advantage is also recognized as Part C of Medicare. These plans typically have networks and some may compel you to get referrals to visit a specialist.
Medicare Advantage plans are different from Medigap plans. They’re 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.
You must stay enrolled in both Parts A and B while enrolled in your Medicare Advantage plan. It usually works like this:
- You’ll show your Advantage plan ID card at the time of medical treatment.
- Your providers will invoice the plan instead of Original Medicare.
- You pay copays for medical services as you go, up to the plan’s out-of-pocket maximum, which is $7,550 per calendar year. This limit differs by plan and doesn’t include Part D spending.
Each plan includes its own summary of benefits that informs you what your copays will be for various medical services. It’s common to pay $50 to see a specialist, but you may pay just $10 to go to a primary care doctor. As you can expect, surgeries and hospital stays will have higher copays.
Medicare Advantage 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 you are eligible for depend on where you live and your plan providers. These benefits will vary.
Medicare Advantage Networks
In exchange for lower premiums, you agree to abide by certain rules. Most Medicare Advantage plans have PPO or HMO networks. Medicare HMO plans represent nearly 75% of all Medicare Advantage 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
Click on each plan to learn more!
Medicare Advantage 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.
What’s the Best Medicare Advantage Plan?
The right Medicare Advantage plan will vary based on many factors. What’s best for your neighbor may not be best for you. Choosing the right health insurance is a critical decision, so get help from an experienced agent at Cornerstone Senior Advisors. Call us at (316) 260-3331 for a free consultation!