Medicare Advantage Plans

Medicare Advantage Plans, sometimes called Part C, are a type of Medicare insurance plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. 

They also offer more benefits than Original Medicare. In fact, most Medicare Advantage Plans also offer prescription drug coverage. 

How do Medicare Advantage Plans work? 

Medicare Advantage Plans cover all Medicare services and offer additional benefits Original Medicare does not. 

Each plan will have an out-of-pocket maximum (something Medicare does not offer) and may feature these additional benefits: 

  • Adult day-care services
  • Dental
  • Vision
  • Hearing
  • Fitness club memberships
  • Prescription drug coverage
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits

What your available plans offer will depend on where you live.

Types of Medicare Advantage Plans

The most common Part C plans are: 

  • Health Maintenance Organization (HMO) Plans – In HMO Plans, you generally must get your care and services from providers in the plan’s network except for emergency care, out-of-area urgent care, or out-of-area dialysis. In most cases you need to choose a primary care doctor and you must receive a referral to see a specialist.
  • Preferred Provider Organization (PPO) Plans – PPO Plans have network doctors, other health care providers, and hospitals. You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You are allowed to go to doctors, specialists, or hospitals that aren’t in the plan’s network, but it will usually cost more. You don’t need to choose a primary care doctor in PPO Plans nor do you need a referral to see a specialist.
  • Private Fee-for-Service (PFFS) Plans – With this Part C plan, the company you purchase the plan from determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care. If you join a PFFS Plan that has a network, you can also see any of the network providers who have agreed to always treat plan members. You can also choose an out-of-network doctor, hospital, or other provider, who accepts the plan’s terms, but your costs will usually be lower if you stay in the network. Be sure before you purchase this plan that your preferred doctor and hospital accept this plan because not all will. You don’t need to choose a primary care doctor or receive a referral to see a specialist.
  • Special Needs Plans (SNPs) – Special Needs Plans limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. These are usually people who live in certain institutions (like a nursing home) or who require nursing care at home, people who are eligible for both Medicare and Medicaid, or people who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia). For more information about these plans, talk to one of our licensed Medicare insurance agents.

When to join a Medicare Advantage Plan

You can join a Part C plan when you first become eligible for Medicare. Your initial enrollment period is a 7-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.

There are two other times each year after that you can join a plan, too. 

During the annual election period from October 15 to December 7 you can: 

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare drug plan to another Medicare drug plan.
  • Drop your Medicare prescription drug coverage completely.

During the Medicare Advantage Open Enrollment Period from January 1 to March 31 you can: 

  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Drop your Medicare Advantage Plan and return to Original Medicare. If you do this, you’ll also be able to join a Medicare Prescription Drug Plan.
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