Medicare Advantage Plans are health plans offered through a private insurer that has a contract with Medicare. Individuals eligible for Medicare may choose to enroll in these plans to get their medical coverage. These plans offer the same medical coverage as Original Medicare. Some plans offer additional benefits like dental, vision, hearing, transportation, gym memberships, over the counter, and Part B rebates.. You must be enrolled in both Medicare Part A and Part B to qualify for enrollment in a Medicare Advantage Plan. When you enroll in a Medicare Advantage Plan, Medicare services are covered through and paid for by the plan. Many Medicare Advantage Plans also include prescription drug coverage.
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“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.”Type your paragraph here.
WHEN CAN YOU ENROLL IN A MEDICARE ADVANTAGE PLAN
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Plan changes during the Annual Enrollment Period (AEP) will become effective January 1st. Plan changes made during the Open Enrollment Period will be effective the first of the month following the new plan enrollment.
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*It is illegal to sell a Medicare Supplement to an individual enrolled in a Medicare Advantage Plan.
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Your Medicare coverage will begin on the first of the month of your birthday, unless plan enrollment is later, then coverage will begin the first of the month after enrolling.
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MEDICARE ADVANTAGE PLANS (Medicare Part C)
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Medicare Advantage plans are available without Prescription Drug coverage. These plans are called MA plans (Medicare Advantage). Medicare Advantage plans that include prescription drug coverage are called MAPD plans (Medicare Advantage Prescription Drug). * Prescription Drug coverage is required for ALL Medicare participants, those not having CREDITABLE coverage may be assessed a penalty.
Medicare Advantage Plan Takeaways:
- Some Medicare Advantage plans offer Supplemental Benefits.
- Some Medicare Advantage plans offer Additional Benefits.
- Medicare Advantage Plans are a 1 year contract with Medicare (Jan 1st - Dec 31st).
- Plans can change annually or may not be offered the next year.
- Doctors may drop out of the network at any time.
- Specialists may drop out of the network at any time.
- Hospitals may drop out of the network.
- Plan changes may only be done during certain times of the year.
- Plan changes may be done through Special Enrollment Periods.
- You may be required to get referrals.
INITIAL ENROLLMENT (Turning 65)
YOU MAY ENROLL IN A MEDICARE ADVANTAGE PLAN
3 MONTHS BEFORE THE MONTH OF YOUR BIRTHDAY
THE MONTH OF YOUR BIRTHDAY
3 MONTHS AFTER THE MONTH OF YOUR BIRTHDAY (7 MONTH PERIOD)
ANNUAL ENROLLMENT PERIOD (AEP)
OCTOBER 1ST - 14TH PRE ENROLLMENT (PLAN BENEFITS PUBLISHED)
OCTOBER 15TH - DECEMBER 7TH ANNUAL ENROLLMENT PERIOD (AEP)
JANUARY 1ST - MARCH 31ST MEDICARE ADVANTAGE OPEN ENROLLMENT PERIOD (OEP)
APRIL 1ST - DECEMBER 31ST LOCK-IN PERIOD UNLESS QUALIFIED FOR AN SEP.
SPECIAL ENROLLMENT PERIOD (SEP)- An individual may be able to change their Medicare Advantage
Plan under certain circumstances such as:
Lose Employer Coverage
Move out of plan service area
Eligible for extra benefits through Medicaid or Low Income Supplement
Reside in a Skilled Nursing Facility or Long term Care facility
Qualify for a Chronic Care Plan
5 Star Plan available in the service area
Error by Federal Employee or Insurance Agent
Types of Medicare Advantage Plans
Health Maintenance Organization (HMO)
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. With an HMO plan, you pick a primary care physician. All your health care services go through that doctor. This means that you will need a referral before you can see most specialists. Visits to health care professionals outside of your network are not covered except in emergencies.
Preferred Provider Organization (PPO)
A type of health insurance plan that has a medical arrangement with doctors and facilities that provide services to participants at reduced rates. PPO's do not require referrals, and offer out of network care at additional costs.
Private Fee For Service Plans (PFFS)
A type of health plan that determines how much it will pay doctors or other healthcare providers and hospitals, and how much the participant will pay per service provided. Some PFFS's have a network, but participants can still seek out of network providers. Providers consider a plans payment terms for each service provided. Non network providers are not required to see a plan participant, even if previous treatment was provided.
Special Needs Plan (SNP)
A type of health plan designed to meet the needs of those who are eligible for additional help from Medicaid or a Low Income Subsidy, or individuals who are diagnosed with certain chronic conditions.