Medicare Advantage State Information
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.
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Medicare Advantage Insurance Plans
While most of our clients sign up for a Medicare Supplement plan to go with their original Medicare, another alternative is to sign up for a Medicare Advantage plan.
These are health plan options approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called "Part C" or "MA Plans." Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. They are not supplemental insurance.
About Medicare Advantage Plans
There are 5 basic types of Medicare Advantage Plans, though not all types are available in all areas:
Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Private Fee-for-Service (PFFS) Plans
Special Needs Plans (SNP)
Medical Savings Accounts (MSA)
People who have a serious chronic illness, who live in an assisted living facility, or who are on Medicaid may benefit from a Medicare Advantage Special Needs Plan (SNP).
You can enroll in a Medicare Advantage plan when you are first enrolling in Medicare Parts A and B, or during the Annual Election Period between November 15th and December 31st.
Why Some People Choose a Medicare Advantage Plan Over Original Medicare Plus a Medicare Supplement Plan
To enroll in a plan you must voluntarily drop out of Medicare and sign up with the insurance company that offers the plan. The two main reasons people sign up for Medicare Advantage plans are:
There are no health questions asked. All Medicare beneficiaries, including people on Medicare due to a disability, are guaranteed acceptance regardless of health conditions (except End Stage Renal Disease, and to qualify for certain Special Needs Plans).
Medicare Advantage plans often have low premiums - $0 premium plans may be available in your area.
Some plans include dental and vision benefits in addition to coverage for hospital stays, doctor visits, diagnostic tests, inpatient and outpatient services, skilled nursing, and more. Some plans even include free health club memberships.
Disadvantages of Medicare Advantage Plans
Medicare advantage plans also have some disadvantages, which is why more people choose a Medicare Supplement plan instead:
Typically the list of doctors and hospitals you can use are restricted. This can be particularly problematic if you are want to visit a specialist or say a cancer treatment center that is not on the list.
If you do choose to go to a doctor outside your network, you will no longer have Medicare Parts A and B to fall back on, and will be responsible for 100% of all costs.
Most Medicare Advantage plans require you to pay a co-pay each time you see a doctor, receive medical treatment, or visit a hospital.
The government is reducing funding for Medicare Advantage, causing many plans to pull out of the marketplace or raise their premiums.
Not all Medicare Advantage Plans work the same way, so find out the plan's rules before joining. For complete information on the plans and pricing available in your area, call us at 1-800-247-9889 or complete our online quote request form.
How to Sign Up for a Medicare Advantage Plan
Enrolling in a Medicare Advantage Plan is easy. Call us at 1-800-247-9889, or fill out our form to get a free Medicare Advantage quote and consultation. We can answer your questions and handle your enrollment entirely over the phone.
Important Medicare Advantage Dates to Remember
Annual Election Period begins, running through December 31. During this period, anyone who is enrolled in Medicare may enroll for the first time in a Medicare Advantage Plan; or change from one Medicare Advantage Plan plan to another; or return to Original Medicare from a Medicare Advantage Plan. The plan effective date will be January 01.
This is the last day you can enroll in a Medicare Advantage Plan for the next calendar year unless you qualify for an exception.
Beginning in 2011, the Annual Enrollment Period will run from October 15 through December 7 of each year.
For more information about Medicare Advantage plans available in your area, give us a call at 1-800-247-9889.
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