Medicare Advantage

Medicare Advantage plans, also known as Part C, are insurance plans offered by private companies as an alternative to Original Medicare.  If you have Medicare Part A and Part B you can choose to assign your Medicare benefits to a private company who will coordinate your healthcare with Medicare Advantage plan. Medicare Advantage plans must meet or exceed the benefits offered under Original Medicare.  There are additional benefits that aren’t covered under Original Medicare that are covered under Part C plans. Medicare Advantage plans are overseen by CMS, the Centers for Medicare and Medicaid Services.

Why choose a Medicare Advantage Plan?

Here are some of the features of a Medicare Advantage Plan:

  • Low (or sometime no) monthly premium
  • Predictable costs for most healthcare services
  • Annual Out of pocket maximum for cost containment
  • Extra benefits, such as vision, hearing, dental and/or fitness memberships (depending upon plan/location)
  • Access to healthcare network
  • One plan, one card
  • Can include Prescription coverage
  • Some plans will cover a portion of your Part B premium

Medicare advantage plans have grown in popularity since they first became available in 1997.  They provide a cost-effective way to receive your Medicare benefits and get some additional perks.

Types of plans:

Just like employer plans, Medicare Advantage Plans have many different plan designs depending on geographic area you live. Its important to pick a plan that fits your needs and your budget.

HMO also known as a Health Maintenance Organization, where you pick a primary care physician to manage your healthcare.  HMO plans typically require a referral to see a specialist and you access care within their contracted network. If you physician is In Network, an HMO plan can have the lowest premiums available and save you money plus additional benefits. May or may not include prescription coverage.

PPO >also known as a Preferred Provider Organization, which offers access to medical professionals both In and Out of network. There is greater savings in if you access care with In Network Providers, but freedom to go Out of Network. May or may not include prescription coverage.

PFFS which as known as Private Fee for Service plans. These plans are typically in rural areas with no medical groups. These plans were designed to give seniors access to Medicare Advantage plans without having networks of doctors in the area. With a PFFS plan, the physician needs to agree to the plan’s terms and accept payment from the plan before they treat you, this process is called deeming. With a PFFS plan, your physician will know how much they will be paid by the plan and you will have predictable costs as well. May or may not include prescription coverage.

SNP – Special Needs Plans are plans for people on Medicare and Medicaid, or have a chronic illness (such as ESRD, dialysis, cardiac conditions, COPD etc.) or reside in institution.  You must meet criteria to join a SNP. Typically, SNP plans have coordinated care and offer extra benefits for things such as transportation and over the counter products. All SNP plans include prescription coverage.

HMO-POS are HMO plans with both in and out of network benefits, you pay more for out of network services and less for in network benefits.

Medicare Savings Account (MSA) has a high deductible and a bank account to assist with the deductible. The amount of money that the plan deposits into the bank account varies by plan. Just like an HSA account, the money is tax free if you use it for medical services that are approved by the IRS.

Costs associated with a Medicare Advantage Plans:

What can I expect to pay with a Medicare Advantage Plan?

Like most Medicare beneficiaries living on a fixed income, cost is important.  One of the selling features of a Medicare Advantage plan is the fixed, predictable costs. Medicare advantage plans have an out of pocket maximum that Original Medicare doesn’t have.

Here are some of the costs you could incur with a MA plan:

  • If the plan has a monthly premium (some do not)
  • Some plans pay a portion of  your Part B premium
  • Deductible – some MA plans have a medical and/or prescription deductible
  • Copays or coinsurance for each service, such as doctor visit, ambulance, outpatient procedure or inpatient hospital stay etc.
  • Out of pocket maximum for medical services –  the most you will pay in a calendar year


To join a Medicare Advantage, plan you need to live in the plans service area, have Medicare Part and Part B, continue to pay your Part B premium, and do not have End Stage Renal disease. You cannot be turned down for a preexisting condition. You may enroll into a plan during an enrollment period.


There are enrollment periods that you may join, change or leave a Medicare Advantage (MA) Plan.

Initial Coverage Election Period- (ICEP) You may elect to join a MA plan when you are first enrolling into Original Medicare. Your ICEP window is 7 months long around your 65th birthday You may join 3 months before your 65th birthday, the month of your birthday and 3 months after your birthday. If you are disabled and receiving Social Secuity benefits, you have a 7-month ICEP window around the 25th month that you have been collecting SSDI benefits.

Annual Election Period (AEP) – AEP runs every year from October 15th – December 7th.  This is time to add, drop or change your Medicare Advantage plan for the next year.  Every October 1st Medicare Advantage Plans release the next year plan benefits.  It pays to compare your current plan with the new plans to make sure you are maximizing your Medicare benefits.

Open Enrollment Period (OEP) –  OEP, starting in 2019, will run from January 1st – March 31st. It gives you one chance to make a like to lie plan switch.

Special Election Period (SEP) – once you have enrolled into a Medicare Advantage plan, you are typically in that plan until the next AEP. However certain circumstances can open a special enrollment period, such as moving outside the plan’s service area, being Dual Eligible for Medicare and Medicaid, receiving prescription assistance from the federal government, and several others. You may have a SEP and not realize it. Our trained agents can assist to see if you qualify for an SEP.

Its pays to compare your Medicare Advantage plan every year to make sure you are maximizing your Medicare benefits – for your free no obligation Medicare review click here.

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