About Medicare Advantage Plans
Medicare Advantage, otherwise known as Medicare Part C, is another way to receive Medicare coverage. Medicare Advantage plans are offered by private health insurance companies. If you enroll in a Medicare Advantage plan, you will still have Medicare, however you will now receive the Medicare benefits — Medicare Part A (hospital insurance), and Medicare Part B (medical insurance) — directly from the private insurance company that offers the Medicare Advantage plan as opposed to Original Medicare.
Medicare Advantage Plans Are Affordable
Medicare Advantage Plans tend to be very affordable. In many cases after paying your Medicare Part B premiums to the private insurance company who offers the Medicare Advantage Plan you will have no additional monthly premium to pay.
Types of Medicare Advantage Plans
There are multiple types of Medicare Advantage plans including
Health Maintenance Organizations (HMOs) – Typically you can only utilize providers that are in the HMOs network except in the case of urgent or emergency situations. In addition, you must get a referral from your primary care physician to see a specialist
Preferred Provider Organization (PPO) – With PPOs you will pay less if you use network doctors and providers, and more if you utilize care from doctors and providers outside of the network.
Private Fee For Service Plans (PFFS) – Similar in structure to original Medicare. You can go to any doctor, hospital, or other provider so long as they have agreed to accept the plans payment terms.
Special Needs Plans (SNP) – Provide specialized healthcare for specific groups such as 1) those who qualify for both Medicare & Medicaid 2) live in a nursing home or 3) have chronic medical conditions
HMO Point of Service Plans – A type of HMO that allows you to receive care from doctors and provides outside the network, but for a higher copay or coinsurance
Medical Savings Accounts (MSA) – These plans combine a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.
Medicare Advantage Eligibility
To be eligible to purchase a Medicare Advantage Plan you must:
- Be enrolled in Medicare Part A & Part B
- Live in the plans service area
- Not have end stage renal disease (ESRD)
- Be a US citizen or lawfully present in the United States
When Can I Enroll, Drop or Change Plans
You can enroll in a Medicare Advantage Plan:
- When you first become eligible for Medicare you can sign up during your Initial Enrollment Period
- If you have Medicare Part A coverage and you get Part B for the first time during the General Enrollment Period
- During the Annual Enrollment Period (AEP) Between October 15–December 7 anyone with Medicare can join, switch, or drop a Medicare Advantage Plan
Coverage Changes after December 7th.
- Between January 1 – February 14, if you’re enrolled in a Medicare Advantage Plan, you can leave that plan and switch to Original Medicare. If you make this switch you will have until February 14 to also join a Medicare Part D (Medicare Prescription Drug Plan) . Your coverage will begin the first day of the month after the plan gets your enrollment request.
‘What is Medicare Advantage’ Video
Top Medicare Advantage Plans
The top six Medicare Advantage organizations in terms of enrollment size (as of February 2016) include:
- United Healthcare
- Kaiser Foundation
Other information you might be interested in: Top rated Medicare Advantage Plans by state.