Medicare Advantage Plans
Want More from Medicare?
Many folks aren’t aware that Original Medicare isn’t free and doesn’t cover everything.
However, you have alternative options that you’re entitled to know about. One of those options is Medicare Advantage.
What Is Medicare Advantage?
Medicare Advantage is also known as Part C of Medicare (sometimes referred to as MA or MAPD plans). They take the assignment of responsibility for your payment.
Private healthcare providers offer these plans to you in network opportunities. You can decide what network you want to be in; what doctors or hospitals are important for you to see.
Why Is it a Popular Option?
Your friends or relatives may like Medicare Advantage because it has a low to no premium, and offers additional benefits.
This is true—many plans have built-in benefits and other perks.
Who Qualifies?
To be eligible to join a Medicare Advantage plan, a person must meet a few criteria:
- Be enrolled in both Parts A and B
- Live in the plan’s service/coverage area
- Not have end-stage renal disease (ESRD)
What Are the Different Types of Plans?
The most common types of Advantage plans are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS), and Special Needs Plans (SNPs). The Senior Benefits Advisor can help you identify which type of plan is right for your health needs.
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How Each Plan Works
HMO Plans
HMO plans function within a small network and require a primary care doctor. This means that you have a select collection of healthcare providers you can visit at the reduced in-network cost. You also have to see your primary doctor before you’re covered for specialist care. The trade-off of having more restrictions is that HMOs will be cheaper for you than PPOs.
PPO Plans
PPO plans cover a sizable network, without a required primary care doctor, and with limited coverage for out-of-network care. It’s like a larger version of an HMO plan. However, these plans are a bit more costly for their greater flexibility.
PFFS Plans
PFFS plans are the most costly option, but an ideal choice for those who travel frequently. You are allowed to bring your plan to any healthcare provider, regardless of network. As long as they accept your plan, you’re covered.
SNPs
SNPs are limited to those that have both Medicare and Medicaid: low income, disabled, or who are faced with a chronic condition. If you’re eligible for both programs, you can join an SNP and receive very affordable coverage and convenient benefits tailored to your health needs.
When Can You Enroll?
You can join, switch, or drop a Medicare Advantage Plan with or without drug coverage during certain times:
- Initial Enrollment Period: When you first become eligible for Medicare, you can enroll in a plan.
- Open Enrollment Period: From October 15 to December 7 every year, you can join, switch, or drop a plan. Your coverage will begin on January 1.
- Medicare Advantage Open Enrollment Period: From January 1 – to March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different one or switch to Original Medicare (and join a stand-alone Medicare drug plan) once during this time.
The Senior Benefits Advisor is here to help YOU navigate all the options and make the best decision for you.
As a Knoxville-based Medicare advisor, I’m here to answer your questions, identify solutions, and compare cost and coverage details. With my expert guidance, you can comfortably and confidently decide which plan is best for you.