Medicare Advantage plans are what we call "ONE of the TWO choices" when it comes to picking a Medicare product to compliment your Original Medicare.
You may have noticed that Medicare Advantage plans are often called "MA Plans" or "Part C" of Medicare. So, when you hear one of those phrases just know that it is referring to Medicare Advantage.
It is also important to note that Medicare Advantage does NOT equal "Medicare Supplement" plans (we have other sections highlighting Medigap/ Medicare Supplement plans).
With that being said, this section is going to talk all of the different types of Medicare Advantage plans whether it's an HMO, PPO, or an HMO-POS.
Medicare Advantage plans are a private alternative to Medicare that were popularized in the early 2000s.
Having a Medicare Advantage plan is not the same as having Original Medicare and Medigap.
Medicare Advantage plans have been gaining in popularity virtually every year, which is largely attributed to the additional benefits, and lower monthly premiums that these plans may provide.
Read/watch more below to find out if a Medicare Advantage plan may be right for you!
How Medicare Advantage Works
Medicare Advantage plans are another choice you can make to secure your medical coverage when you are new to Medicare.
It’s what is often referred to as a “bundled” approach to your health insurance.
You are simply choosing a provider for your care. That particular provider will have its own fee schedule and rules within the plan that you will need to adhere to.
Some Medicare Advantage plans are HMOs, some are PPOs.
Monthly premium charges can range from $0 to over $300 per month.
Coverage levels vary from plan to plan so you’ll need to spend some time with the documents to understand exactly what you are signing up for.
When can I first sign up for Medicare Advantage?
Many people are familiar with the fact that you can change Medicare Advantage plans sometime in the fall of each year.
However, we want to focus on the FIRST time you can sign up for a Medicare Advantage plan.
There are two times essentially when you can sign up for a Medicare Advantage plan.
That is (1) your initial enrollment period (IEP), which is when you turn 65 AND start Part B of Medicare. (2) at a special enrollment period (SEP), which typically occurs when you are leaving your employer coverage.
Click on the links below which highlight the differences between the IEP and the SEP.
HMO vs. PPO Advantage Plans
An HMO gives you access to certain doctors and hospitals within its network.
A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMO's network.
PPO plans, or "Preferred Provider Organization" plans, are one of the most popular types of plans. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.
**This is generic information – see YOUR plan details for accurate information.**
How to find the best MA plan for you
This is really what everyone wants to know when it comes to Medicare Advantage plans (and any plan for that matter).
If you have decided that Medicare Advantage is the route you would like to take, there are many factors that come in to play when finding the "best plan". The main things you will want to know are:
1. How will it cover the medications I take?
2. Are my doctors in the plans service network?
3. What are the costs of services you may need in the future?
The video to the left will highlight each of these topics thoroughly and show you exactly how we determine the "best" plan for our clients.
Medicare Advantage Additional Benefits
Medicare Advantage plans may offer additional benefits such as:
Limited dental, vision or hearing coverage
A gym membership
A yearly physical exam
Remember that Medicare Advantage plans are created by carriers and CAN add extra benefits to the plans as they see fit.
You are not in the Original Medicare program at the point of enrollment into a Medicare Advantage plan.
Medicare Advantage Drug Coverage
Medicare Advantage plans that have a built-in drug plan are referred to as MAPD’s (Medicare Advantage Prescription Drug).
Are they better than a stand-alone prescription drug plan? Not necessarily but perhaps.
Sometimes people will tell you that it’s better because you only need to “use one card”. That just means that it’s convenient. It doesn’t mean it’s better nor less expensive than the Part D plan option.
MAPD plans also come with the prescription coverage included in the plans monthly premium (this includes plans that are $0/month)
When Can I Change Medicare Advantage Plans?
Medicare Advantage plans can be changed annually during the Annual Election Period from October 15 until December 7.
The only health status that would disallow you from signing up for a new plan or changing plans is your having ESRD (end stage renal disease). Outside of that one condition, you are free to change plans.
In addition to the Annual Election Period, you can also change your MA plan once per year during the Medicare Advantage Open Enrollment period which runs from January 1st - March 31st of every year (this is a new enrollment period that started in 2019 and replaced the older Medicare Advantage Disenrollment Period).
How Changing Medicare Advantage ACTUALLY Works
Changing Medicare Advantage plans is rather simple.
In the Fall, during the Annual Election Period or the Medicare Advantage Open Enrollment Period, you may change plans.
This requires a new application to be filled out for the new plan with a new carrier. Or, you may simply be changing from an HMO to a PPO with the same carrier, for example.
That will also require a new application and revised premium payments. There is no health underwriting required with this change.
Note that if you have end-stage renal disease, you do not qualify to change Medicare Advantage Plans.
Actual MA Plan Examples
We want to use this section to show you what Medicare Advantage plans on the market actually look like.
Too often, people will tell you to "just get company x" or "I love company y" but that doesn't actually describe what those companies plan actually look like.
This video highlights the details of some of the most popular Medicare Advantage plans on the market.
Changing Your Residence and Medicare Advantage
There are two situations when you are changing your permanent residence and have a Medicare Advantage plan.
The first is that you are moving outside of your current plan's service area.
The second is that you're moving within your current plans service area, but you will have new plan options available to you in your new zip code.
Review this video to see what to do in those two scenarios.
Also, the two links below will cover what happens if you move from your permanent residence with a Medicare Advantage plan.