Supplementing Medicare with peace of mind
Medicare Part C (Medicare Advantage)
Medicare Advantage Plans are private insurance plans, which are offered through an insurance company. A Medicare Advantage Plan works through a network of hospitals and physicians. Plans provide similar coverage to that found in Medicare Part A, for hospital care; Part B, for covered medical services, and in most cases, Part D, for prescription drug coverage. An Advantage plan combines Medicare services, Part A, Part B and Part D, into one package. And because it is not Original Medicare, an Advantage Plan can provide additional services, such as: vision, hearing, dental, gym memberships, transportation to a doctor office, and over the counter medications. These plans can even include adult daycare services, which is not covered by Original Medicare. At times, these additional services will require pre-authorization, to secure the coverage. Medicare Advantage Plans, cover any emergency or urgent care services, in and out of the service area, provided the service is deemed medically necessary.
If you are considering a Medicare Advantage plan, it is important to research and understand your options, verify physicians, medications and hospitals or other facility participation. Also, consider the associated plan's copays, coinsurance and out-of-pocket expenses, prior to choosing a plan. Some plans with no or low premiums, also have higher out-of-pocket costs. A qualified advisor can assist you with more information about Medicare Advantage Plans; to help you choose the coverage that is right for you.
Qualification and Requirements
As of 2021, Medicare Advantage Plans are available to anyone enrolled in Medicare Part A and Part B, provided: the beneficiary permanently resides within the coverage area. Enrollment in Advantage Plans is governed by certain enrollment restrictions. Medicare Advantage Plans do not have evidence of insurability requirements, but do have enrollment restrictions. During the initial enrollment period, annual enrollment period and special enrollment periods, a qualified beneficiary can add or delete coverage. Outside these stated enrollment periods, an Advantage Plan has no enrollment or disenrollment accessibility.
A Medicare Advantage election is offered during an initial enrollment period (IEP), which begins 3 months before the beneficiary's 65th birthday. The annual enrollment period (AEP), occurs between October 15th to December 7th each year. Open enrollment, OEP occurs January 1st through March 31st each year. A special enrollment period (SEP), which is determined by certain medical conditions, institutional stays or dual enrollment situations, can also provide a variable enrollment periods for certain beneficiaries. In some cases, Advantage Plans are available to beneficiaries under the age of 65, who qualify due to certain covered disabilities. You may be eligible to change an Advantage Plan due to qualifying events, under a special enrollment period. To determine your eligibility and to learn about the details applicable to your unique healthcare needs, speak with a licensed and certified advisor.
Types of Medicare Advantage Plans
Private insurance companies offer health maintenance organizations (HMOs) or preferred provider organizations (PPOs). An HMO plan works within a network of healthcare providers and requires you choose a primary care physician (PCP), who can then provide referrals to any specialists within the network. A PPO also works within a network of physicians and facilities. Physicians can be seen without a referral. Medicare Advantage plans offer low or no monthly premiums, but can potentially have higher out-of-pocket costs each year.
Regulations
Medicare Advantage Plans are regulated by the Federal Government through Centers of Medicare and Medicaid Services (CMS), and requires that these alternative plans cover everything Original Medicare covers. Plans can have significant out of pocket maximums, which vary by plan and provider. To understand which coverage options are available to you in your area, speak to a licensed and certified advisor.
