MEDICARE ADVANTAGE PLANS
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Medicare Advantage Plans

Medicare Advantage plans are offered by private health insurance carriers. Sometimes referred to as Medicare Part C, these plans help you get additional health coverage that is not available with Medicare Part A and Part B alone. They can help you save on out-of-pocket costs, and place an overall cap or maximum limit on these costs. You can choose to have Medicare Part A and Part B, or a Medicare Advantage plan. You cannot enroll in both types of plans.

Medicare Advantage plans differ from Medigap in that they do not supplement Medicare Part A and Part B. Instead, you get both your Medicare Part A and Part B benefits and your additional benefits within the same plan. This could make plan management easier and more convenient. Think of Medicare Advantage plans like the health insurance you may have previously had through your employer at one point. You typically get medical services through a network of providers.

You can first enroll in Medicare Advantage during the Initial Enrollment Period. Initial Enrollment is the 7 months surrounding your 65th birthday – starting with 3 months before you turn 65, continuing the month you turn 65, and ending 3 months after you turn 65. Individuals who are under 65 may be eligible to enroll if they are disabled.

You can also enroll in a plan during the annual Open Enrollment Period, which begins on October 15 and ends on December 7 in 2017. Open Enrollment is also the time to switch plans or make changes to your coverage if you choose to do so. If you miss the Open Enrollment Period, you can enroll during the Special Enrollment Period. You qualify for Special Enrollment if you have a life change, such as moving to a new state or losing coverage, such as employer-based health insurance.

Lastly, all Medicare Advantage plans are given star ratings on a scale of 1 being the worst and 5 being the best. If you previously did not have a 5-star plan available in your state, and one suddenly becomes available, you can enroll in this new plan at any time, regardless of the current enrollment period.

Medicare Advantage: Coverage and Costs

Medicare Advantage plans can vary in coverage. Generally speaking, most Medicare Advantage plans cover out-of-pocket costs, such as Medicare Part A and Part B deductibles, copayments, and coinsurance. Additionally, many Medicare Advantage plans can include prescription drug coverage, dental insurance, and vision benefits. These benefits are not available with Medicare Part A and Part B. Remember, Medicare Advantage replaces Medicare Part A and Part B, and generally offers more coverage than having Part A and Part B without a Medicare Advantage plan. You can choose to have Medicare Part A and Part B, or have a Medicare Advantage plan.

Below are the four basic types of Medicare Advantage plans:

Medicare Advantage Plan Type

Description

HMO (Health Maintenance Organization)

  • Features a flat monthly premium with no deductible.
  • You must use a doctor within the plan’s network, and prescriptions may be subject to plan approval.

PPO (Preferred Provider Organization)

  • Offers a wide network of physicians and hospitals in your area for you to choose.
  • Using a doctor or facility outside the network is permitted, but can result in a higher cost.

PFFS (Private Fee-for-Service)

  • Allows you to use any doctor or facility approved by Medicare that accepts PFFS plans.
  • Rates for medical services are set by the plan, and you are responsible for paying any costs above what is set by the plan.

SNP (Special Needs Plan)

  • For people with chronic health conditions, except for end-stage renal disease.
  • Plan benefits, including providers and prescriptions, are tailored to the individual’s needs.
  • Medicare Advantage premiums can start at $0* per month in 2017. These plans tend to only include very basic coverage, or primarily your Medicare Part A and Part B benefits. On average, premiums tend to be around $39** per month in 2017, but can greatly vary from state to state and carrier to carrier.

Quick Facts:

  • Generally speaking, the less coverage you purchase, the lower your monthly premium.
  • Rates can vary across carriers and the state you live in.
  • All plans by law must meet the same standard of coverage, no matter the carrier or the state.
  • Medicare Advantage Plans can be purchased during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday - the 3 months before you turn 65, the month you turn 65, and three months after you turn 65 - or during the Open Enrollment Period, which begins on October 15 and ends on December 7 in 2017. You may still be able to enroll in a plan if you miss these enrollment periods if you experience certain life changes, such as moving, or if a highly rated 5-star plan becomes newly available in your state. Those who are under 65 years old may be eligible to enroll in a Medicare Advantage plan if they are disabled.

To start comparing Medicare Advantage plans, please submit your zip code.

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