Medicare Advantage

Medicare Advantage is also known as Medicare Part C. Medicare firms deal with insurance companies who provide a plan to meet the basic coverage of Original Medicare, but they include extra benefits. Those additional benefits usually include dental, vision, and hearing drug prescription coverage. Sometimes the extra benefits can be offered at no additional cost to you. This is possible since Medicare pays the insurance company a fixed amount for providing your healthcare coverage. However, all Medicare Advantage plans must follow rules set by Medicare, but may charge you out-of-pocket costs and have their own set of rules for how you will receive these services.

Medicare Advantage Benefits And Coverage

Beneficiaries who decide to get their coverage through Part C will get their inpatient care and services just like with Medicare Part A since it must cover all the same services as Original Medicare. Therefore, you will be covered for inpatient hospital care, skilled nursing facility, and home health care, whilst hospice care will remain under Original Medicare (Parts A and B).

Outpatient services and preventive care are under Part B generally, which includes doctor’s office visits, tests, x-rays, ambulance services, mental health services, durable medical equipment, vaccines, etc.

Alongside these basic benefits that should generally be provided Medicare Advantage plans usually provide extra benefits like dental, vision, hearing, gym memberships, and drug prescription coverage.

Medicare Advantage Eligibility

If you are eligible for Medicare, then you are eligible for a Medicare Advantage plan. You must be enrolled in Medicare Parts A and B before purchasing a Medicare Advantage plan. You also cannot forfeit Part B, or you will lose your Advantage plan. Also, the same rules are applicable as enrolling in Original Medicare so if you want Part C to plan you must be a U.S citizen or legally admitted citizen. Since 2021, people who are diagnosed with End- Stage Renal Disease are eligible to enroll in Medicare Advantage plans.

Medicare Advantage Cost

Costs for Medicare Advantage. plans can widely differ from plan to plan. Some plans’ monthly premiums can be as low as 0$ whilst others can cost hundreds of dollars. More expensive plans provide more benefits and a larger provider network.

However, those plans are usually determined by costs in the form of premiums, deductibles, copayments, and coinsurance. Some plans also may offer 0$ annual deductibles. However, the best way to find out how much your costs will be is to talk with private companies agents like Turning 65 Solutions which sells these plans.

Plan Types

There are several plan types of Part C that can be offered to Medicare beneficiaries. Some most popular offered plans are High Maintenance Organization, Preferred Provider Organization, Private Fee For Service, and Special Needs Plans. Some other types that can be offered are also Medicare Advantage plans for Veterans.

HMO plans

To get coverage with an HMO plan you must stay in the provider’s network. It means you can only go to doctors and hospitals accepting your plan. If you go out-of-network you. will not be covered at all. Also, you will need to choose your primary care doctor who will coordinate your every medical need, and get referrals from your PCP to see specialists.

PPO plans

PPO plans give you more flexibility than HMOs because they provide out-of-network coverage. However, you may pay higher out-of-pocket costs if you seek services in hospitals which doesn’t accept your network. With this plan, you don’t need to choose a primary care physician but you can if you want to. Also, you don’t need referrals to see specialists.

PFFS plans

PFFS Plans has a contracted network of providers, so you can see a list of the network providers who have agreed to treat patients within this network. If you go to a doctor, other health care provider, facility, or provider who is not a part of the plan’s network your plan may not cover your services, or your costs could be higher. Some PFFS plans include drug prescriptions; if not, you can always join Medicare Part D to get the drug coverage you need. The advantages of this type of plan are that you do not need to have primary care doctor and you do not need to get a referral from a primary care doctor to see the specialist.

SNP plans

SNP plans are meant for people who live in certain institutions (like nursing homes) or who live in the community but require nursing care at home, for people who are eligible for both Medicare and Medicaid, and for people who have specific chronic or disabling conditions (diabetes, ESRD, HIV/AIDS, chronic heart failure, or dementia). People who met these criteria can join an SNP at any time.

Dual-Eligible SNP is a type of plan that provides care for eligible people for Medicare and Medicaid.

MSA plans

Medicare Medical Savings Accounts plan is a type of plan which combines a high-deductible health insurance plan and medical savings account which can help pay your medical costs. Therefore, your MSA plan deposits money into your account which you can later use to cover these expenses.

Medicare Advantage for Veterans

There are several types of plans which are designed for people with VA benefits. With this plan, beneficiaries can get all the benefits of Original Medicare and Medicare Advantage combined.

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Enrolling in Medicare Advantage

There are set times when you can enroll in a Part C plan:

Initial Coverage Election Period (ICEP)

ICEP is a seven-month period that is your first opportunity to choose a Medicare health plan. It starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and you receive Social Security disability, you are eligible for Medicare in the 25th month after you begin receiving your Social Security benefits.

Annual Election Period (AEP)

Also known as open enrollment, the AEP is October 15 through December 7 each year. Once January hits, coverage for your selected Medicare Advantage plan will begin. During this time, you may also add, change, or drop current coverage.

Medicare Advantage Open Enrollment Period

During this period, you can switch from one Medicare Advantage plan to another. Or, you can end it to return to Original Medicare.

Special Election Period

Many factors can stimulate a special election period and they are unique to an individual. It’s best to speak with a licensed Medicare insurance agent to find out whether you qualify for a special election period. However, there are a few common situations, like if you move outside your Advantage plan’s service area, move into a nursing home, or qualify for additional aid, you could be eligible for this special election period. You can institute changes to your Medicare Advantage plan during this period or go back to Original Medicare.

We Can Help With Medicare Advantage Plans

If you’re interested in Medicare Advantage plans because of the low premium, call 830-217-6711 to see what’s available in your area. We look forward to hearing from you!