Medicare Advantage Plans


Retirement comes with increasing medical bills, and while it's a stage of life to look forward to, it's also important to consider how you'll cover these bills. Medicare is one of the most common and widely used programs, but it doesn't always cover the total cost of your bills. So consider other options, like Part C, a Medicare Advantage plan, which may be helpful.


What is a Medicare Advantage Plan?

A Medicare Advantage plan is like a medicare supplement: an alternative method of receiving Medicare Part A and Part B coverage. This type of medicare supplement plan is sometimes referred to as Part C because they are separate plans approved by the Medicare program but offered through private insurance companies.


Who is Eligible for Medicare Advantage Plans?

If you meet the following requirements, you should be eligible for a Medicare Advantage plan:

Medicare Advantage enrollees can learn more about eligibility requirements with each Advantage plan. Determining if you need to sign up for Medicare is one of the first steps in choosing the right plan for your needs.


Types of Medicare Advantage Plans

Each enrollee is different; thus, there are many different types of Medicare Advantage plans to choose from, with the following being the most common:


Health Maintenance Organization (HMO) Plans

An HMO plan is a type that requires you to receive medical services from providers who are in-network. However, you don't typically have to go in-network if you need emergency care or out-of-area urgent care. HMO plans also cover prescription drugs, which can be beneficial in offsetting the cost of medications.

Here are a few things to know about HMO plans:

In return, HMO plans often have lower premiums and out-of-pocket costs. While they may also have a smaller network of medical providers, this type of policy tends to be cheaper.


Preferred Provider Organization (PPO) Plans

A Preferred Provider Organization Plan (PPO plan) refers to a type of Medicare health plan that includes a network of healthcare providers. In this plan, you pay less if you use this network of providers. However, if you choose to receive services outside of the network, you may pay more. This gives you more flexibility to choose your medical providers, but knowing how much more they will charge is essential.

Here are a few things to know about PPO plans:

A PPO includes a network of medical professionals that are cheaper to use. However, it also allows you to use certain medical providers that you want at a higher cost.


Private Fee-for-Service (PFFS) Plans

Private fee-for-service (PFFS) plans are a type of insurance coverage available through a private provider. Because it's a private insurance provider, they decide how much you pay each year and how much the medical providers make within the program. This can affect which medical providers choose to work with the program.

A PFFS works similar to a PPO in that you can typically visit any medical providers within the available network. However, while you may be allowed to choose medical providers out of network, it will cost more. You can also typically go to any Medicare-approved doctor or healthcare provider that agrees to treat you with your insurance in this program.

Here are a few things to know about PFFS plans:

Always check with your medical provider before receiving medical care with a PFFS plan to cover it. Doctors out of network don't have to provide you with medical care.


Special Needs Plans (SNPs)

Special Needs Plans (SNPs) are a type of Medicare Advantage plan that limits its membership to policyholders who have specific healthcare needs. This plan varies depending on your medical conditions and treatments and is usually customized to meet your needs.

Under this plan, you must receive all medical care from approved healthcare providers unless you need urgent or emergency care. Additionally, if you have certain conditions, like end-stage renal disease (ESRD), you are exempt from receiving services in the SNP network.

Here are a few things to know about SNPs:

This type of plan limits membership to certain groups with specific healthcare needs. This includes either:

This is not a complete list of available plans. There may be other ones available, depending on your healthcare needs. It's always a good idea to shop around and find the best plan for you.

Other, less common, plans may include:


What is a Medicare Medical Savings Account Plan?

A Medicare Medical Savings Account (MSA) Plan is a high-deductible Advantage plan with a bank account. In this plan, Medicare deposits money into your specified account. Policyholders can then use the deposited funds to pay for their healthcare needs.

However, only certain expenses are eligible to count towards the deductible. The amount deposited into the account is usually less than this amount, meaning you will have to pay out-of-pocket before coverage begins. The program works by cooperating with private insurance companies. The companies offer care coverage for specific healthcare providers and needs.

Most MSA Plans have two parts, including:

MSA plans cover most medical services, including hospital, ongoing medical care, needs, and costs. Many MSA plans also cover other expenses, like dental, vision, hearing, and long-term care that are not traditionally covered by Medicare programs. It is important to note that most MSA plans do not cover prescription drug coverage, meaning you will usually need to enroll in part D.


What is the Difference Between Medicare and Medicare Advantage?

It can be helpful to consider the differences between Medicare and Medicare Advantage when deciding which one is right for you. Here are a few important distinctions:

Both plans don't typically offer coverage outside the U.S. Evaluate the pros and cons when deciding which plan is right for you.


What Does a Medicare Advantage Plan Cover?

A Medicare Advantage plan covers the same services as Original Medicare. However, it doesn't cover any services that aren't considered necessary under Medicare.

Medicare Advantage plans typically cover services like:

Some may also cover things like dental, vision, hearing, and in some cases, access to the SilverSneakers program. SilverSneakers is a fitness membership that provides seniors with a network of fitness classes.


What are the Advantages of a Medicare Advantage Plan?

There are many reasons to consider a Medicare Advantage Plan. Here are a few of the top benefits:

Perhaps one of the best parts of a Medicare Advantage plan is that you may have more control over what's included or not with so many options available. For example, if you have a medical provider that you prefer to stay with, you may be able to find an affordable plan that allows you to continue visiting them.

Your out-of-pocket costs are also limited with a Medicare Advantage plan. Once you reach the plan's limit, you will no longer be charged for medical services.


What are the Disadvantages of a Medicare Advantage Plan?

Of course, it's important to be aware of the considerations of a Medicare Advantage Plan before choosing it as your healthcare coverage.


In-Network Requirement

One important consideration is that with a Medicare Advantage Plan, you may be required to choose medical providers within a network. Additionally, most plans require that you use your Medicare Advantage plan when receiving medical services to be eligible. Once you enroll in a Medicare Advantage plan, they will provide you with an approved card. The red, white, and blue card is small enough to fit in your wallet and should be carried around with you at all times.


Referral Requirement

Most Medicare Advantage plans require a referral. You may also have to choose a primary provider. If you have a medical professional who leaves the program, you'll need to select a new medical provider. However, the good thing is that you can usually find out what providers and services are covered with a policy before choosing that policy. Fortunately, most preventative services don't require a referral.


Provider Can Leave the Plan

It's also important to note that medical providers can enter and exit different Medicare Advantage programs at any time. Even after they have left the program, continuing to work with your healthcare provider can lead to more out-of-pocket costs for you. If your current provider chooses to leave the program and stay with the same Medicare Advantage program, you will usually have to choose a new provider.

Additionally, just as medical providers can come and go, so can specific Medicare Advantage plans. Because private insurance companies offer Medicare Advantage plans, they can choose not to participate in the program at any time. If this occurs, you'll also need to select a new plan.


Limited Coverage Between States

Medicare Advantage plans may be limited to your state. The specific coverage that you receive may vary from state to state. This is unlike the Original Medicare program, which is offered the same across the country. If you move to a new state or area, you may have to change your plan.

Other potential considerations include limited-service providers or plans that can be confusing to figure out. Fortunately, there are many tools available online that can help you choose the right plan for you.


How Much Do Medicare Advantage Plans Cost?

When you choose to join a Medicare Advantage plan, the Original Medicare program will pay a fixed monthly fee on your behalf. However, depending on the plan and the provider you choose, you may still be subject to other out-of-pocket costs or rules. These rules may change from year to year.

The specific cost of your Medicare Advantage plan may also change from year to year. For example, you are required to pay a Part B premium. In 2020, this amount was $144.60. However, this amount may be different based on your income level, as some may pay lower or higher. You may also be subject to other costs, including:

When choosing a Medicare Advantage plan, ensure that you find out all costs involved with the plan. Otherwise, you could be subject to unexpected bills.


How to Enroll in Medicare Advantage

If you're interested in enrolling in a Medicare Advantage plan, you can do so with the following steps:

1. Choose a Medicare plan: It's important first to choose a plan that meets your healthcare needs. Medicare.gov has a helpful tool that can help you compare plans.

2. Check your plan eligibility: Once you have chosen a healthcare plan that meets your needs, you want to check your eligibility. Different plans have different requirements, so it's important to know the specific regulations for the one you want to enroll in. In addition, you will need your personal information, as well as information about your Original Medicare plan.

3. Fill out your application: Next, you will fill out your enrollment application within the application timeline. You'll have to include your personal information.

4. Collect your paperwork: If approved, you'll receive a Medicare card, number, and information about the program.


Frequently Asked Questions About Medicare Advantage

If you have a lot of questions regarding Medicare Advantage plans, you're not alone. Here are some of the most frequently asked questions we get:


What if I Have a Pre-Existing Condition?

Even if you have a pre-existing condition, you can join a Medicare Advantage plan. Some Medicare Advantage plans, including special needs plans, are specifically designed for those with chronic medical conditions. A pre-existing condition does not make you ineligible for a Medicare Advantage plan.


What if I Have End-Stage Renal Disease (ESRD)?

Even certain medical conditions, like ESRD, allow you to receive coverage with a Medicare Advantage plan. As of Jan. 2021, people with ESRD can choose between Original Medicare or a Medicare Advantage Plan to meet their healthcare needs.


What Other Types of Medicare Advantage Plans are Available?

There are many Medicare Advantage Plans available. The most common are HMO, PPO, PFFS, and SNPs. Another available type, although less common, is MSAs.


How Do I Join or Switch a Medicare Advantage Plan?

You can usually make changes to your existing Medicare Advantage Plan, as long as you do so during the enrollment period. If you want to switch plans, join the new plan during the open enrollment period. This will automatically un-enroll you in the plan that you're currently enrolled in.

If you want to switch to Original Medicare, you will need to call the Medicare program instead.


What Happens if My Provider Opts Out of the Program?

If you're currently enrolled in a Medicare Advantage plan and stop participating in the Medicare program, you will need to reconsider your healthcare needs. If they opt-out of the Medicare program, your coverage will end on December 31 of that year. If this happens, you have a few

options available:


What If I Already Have Insurance?

If you already have insurance, like through an employer, it's important to consider how joining a Medicare Advantage plan may affect this. Always talk to your employer or human resource department before making changes. You may lose your work-sponsored healthcare coverage by joining a Medicare Advantage plan.


I Lost My Medicare Advantage Card. Do I Need It?

It's important that you keep your Medicare Advantage card in a safe location, as you will frequently need it to access medical services. In addition to needing the card for medical services, you'll also need the information on it if you want to switch back to the Original Medicare program.


Fast Facts to Know About the Medicare Advantage Program

Here are a few fast facts to know about the Medicare Advantage Program:

One plan isn't better for all seniors. Instead, it's important to compare the advantages and disadvantages of each one based on your healthcare needs.


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