Medicare Advantage
Medicare Advantage, also commonly known as Medicare Part C, is considered an alternative to Original Medicare (Part A and B) that provides coordinated benefits and a network of quality providers.
Medicare Advantage: Start Here
Medicare Advantage combines all of the benefits of Original Medicare, reducing your costs for the care you receive. It does this by coordinating a network of healthcare providers in specific areas who agree to the plan. You may then visit anyone in the network for the fully covered treatment promised by your plan.
Medicare Advantage plans may also include additional benefits, such as limited dental, vision, and hearing coverage, and many include Part D prescription drug coverage as well. Other additional benefits may include:
- Gym memberships/discounts
- Health and wellness programs
- Transportation to doctor visits
When Can I Enroll?
To enroll in Medicare Advantage, you must also first be enrolled in both Parts A and B. You also will not be able to have a Medicare Supplement (Medigap) plan while enrolled in a Medicare Advantage plan. This is because Medicare Supplements are only meant to supplement your Original Medicare coverage, while Medicare Advantage is another option you can choose besides Medigap that is considered an alternative to Original Medicare.
Before enrolling, though, you need to be aware of the enrollment periods that will allow you to enroll in Medicare Advantage or switch plans. Let’s discuss those below:
- Initial Enrollment Period: This period starts three months before your 65th birthday month and ends three months after. During this period, you will be able to enroll in Medicare for the first time.
- Annual Enrollment Period: This period lasts from October 15 to December 7 every year. To use this period, you must already be enrolled in Medicare. You will be able to switch Medicare Advantage plans or drop Medicare Advantage to go back to Original Medicare. You can also switch from Original Medicare to go to Medicare Advantage.
- Medicare Advantage Open Enrollment Period: This period is from January 1 to March 31. You must already be enrolled in a Medicare Advantage plan to use this period. During this period, you can switch from one Medicare Advantage plan to another, or drop Medicare Advantage to stay with Original Medicare coverage.
Special Enrollment Period: This period does not occur during a specific time of the year, but only occurs due to a special circumstance. For example, you can be eligible for a Special Enrollment Period if you moved out of your current Medicare Advantage plan’s service area and no longer have coverage. This period will allow you to find a new Medicare Advantage plan.
Types of Medicare Advantage Plans
Medicare Advantage provides low-cost coverage across five different types of plans. Each plan has its own benefits and structure to provide you with what you need.
Health Maintenance Organization
Health Maintenance Organization (HMO) Advantage plans provide a decent network at a relatively low cost. It is available to anyone with Original Medicare and is the lowest-cost option available without special qualifications.
The lower cost of an HMO plan is due to its network. HMOs have a smaller network than other options, specifically Preferred Provider Organization (PPO) plans. Though this network limits some of your healthcare options, people who choose it are more than willing to take it on for the sake of a lower monthly premium.
You must choose a primary care doctor with an HMO. This means, before you can receive any specialist care, prescriptions, etc., you must talk with your primary care doctor. It is often an extra step, but also an excellent way to keep close track of your health.
Preferred Provider Organization
The other direct option to an HMO is a PPO plan. Of these two most common Medicare Advantage plans, PPOs are the most flexible. HMOs keep their prices low by coordinating a smaller network of providers and requiring a primary care doctor. PPOs cost a bit more but remove these limitations.
There is no need for a primary care doctor with a PPO. This means, if you feel you need specialist care, you can go straight to them. Overall, the network is also notably larger, meaning you have more options for lower-cost, higher-coverage care.
You also have some slight coverage if you venture out-of-network. HMOs will cover none of the cost of out-of-network care, while a PPO may cover a small portion.
Private Fee-For-Service
Private Fee-For-Service (PFFS) plans are not nearly as common as the other Advantage plans. These plans will choose what you will pay and what they will pay for your approved services. You also want to check with your doctor or other healthcare providers if they will accept your PFFS plan’s terms and conditions.
Special Needs Plans
There are three special needs plans (SNPs)—Dual-Eligible SNPs (D-SNPs), Chronic SNPs (C-SNPs), and Institutional (I-SNPs). D-SNPs are limited to those enrolled in both Medicare and Medicaid and provide substantial cost assistance to make the plan affordable. C-SNPs are limited to those with chronic, life-threatening illnesses. They provide benefits catered to your condition at little-to-no cost. I-SNPs are designed for those who need or are currently living in an institutional setting, such as a skilled nursing facility, for 90 days or more.
Medical Savings Account
These plans combine a savings account with a high deductible to pay for your healthcare costs. Medicare will deposit money into the savings account so you can use it to pay towards your deductible and healthcare costs. However, keep in mind that the amount that is deposited is usually less than the deductible, and you cannot deposit money into the account either.
If there is any funds leftover in the account, they will roll over for the next year.
Medicare Advantage Costs
Many Medicare Advantage plans do not have a premium, and if it does, it will likely be minimal. The same principle applies to its potential deductible.
This means that Advantage plans are extremely low-cost. For in-network care, your plan will cover 80-100% of the cost. If you venture out of network, you will potentially pay the entire cost of the item or service.
You should also know that you still have to pay your Original Medicare premiums and deductibles. As of 2022, if you have worked and paid Medicare taxes for less than 30 quarters, your monthly premium for Part A will be $499. If you have worked and paid taxes between 30 and 39 quarters, your monthly premium will be $274.
As of 2022, the average Part B monthly premium is $170.10.
Find a Medicare Advantage Plan Today!
Affordacare Insurance will make sure that you understand your options and find the plan that suits your needs. Call us today to find out more information about the Medicare Advantage plans available to you and the coverage they provide.
