Medicare Advantage Plans are offered by private insurance companies
and provide all of your Part A and Part B benefits (some also include
prescription coverage)
About Medicare Advantage Plans (Part C)
Medicare Advantage Insurance Plans are offered by private
insurance companies and are approved by the Federal Government.
They cover the same benefits as Part A (hospital insurance) and
Part B (doctor visits). Some also offer other benefits that
Original Medicare doesn’t cover like vision, dental and
prescription drugs, even gym memberships and may also offer
additional benefits like transportation to and from your
doctor’s office. These plans typically use HMO, PPO or PFFS
networks. These networks change every year, and can impact which
doctors accept your plan. Your SmartMatch licensed insurance
agent will make sure you understand a plan’s network and
coverage rules before you enroll.
Medicare Advantage Networks
Medicare Advantage Plans typically use HMO, PPO or PFFS
networks. Below is the list of the Medicare Advantage Networks,
and how they work.
HMO — Health Maintenance Organizations have a
specific network of select physicians and might require a
referral from a primary care physician before a patient can
see a specialist. HMOs also provide additional benefits like
coverage for deductibles and more.
PPO — A preferred provider organization
allows customers to save money when they use a physician
inside the plan's network. Customers are still able to see
doctors outside the network, but might have to pay a higher
cost.
PFFS — Private Fee-For-Service plans work
similarly to that of Original Medicare, but the plan
determines how much it will pay the physician or facility and
how much the patient will pay out-of-pocket.
HMOPOS— A HMO “Point-of-Service" plan
operates like a HMO but allows for some services to be covered
by an out-of-network physician often for a higher copayment or
coinsurance.
MSA— A Medical Savings Account plan combines
a high-deductible plan with a bank account where money is
deposited by the plan to be used for health care services.
Medicare Advantage Enrollment periods
Initial Coverage Election Period (ICEP) The Initial Coverage Election Period (ICEP) is the
seven-month window starting three months before you're first
eligible for Medicare Part A and B. For most adults, the ICEP
starts three months before the month they turn 65. During this
time you can sign up for any Medicare Advantage plan that suits
your needs.
Medicare Advantage Annual Election Period (AEP)
The Medicare Advantage Annual Election Period (AEP) is when
Medicare beneficiaries can add, change or drop their Medicare
Part D or Medicare Advantage Part C plan coverage for the next
year. The AEP starts on October 15th and continues through
December 7th of each year with coverage or plan changes taking
effect on January 1st of the new year. Outside of this time,
most people will only have a limited opportunity to change their
Medicare Advantage plan coverage throughout the year.
The Medicare Advantage Open Enrollment Period (OEP)
The Medicare Advantage Open Enrollment Period runs from January
1 through March 31 annually and allows those who are enrolled in
a Medicare Advantage Plan to make a one-time change. You can
either move to another Medicare Advantage Plan or disenroll from
your Medicare Advantage plan and return to Original Medicare and
purchase a Medicare Supplement Plan. Note, if you leave a
Medicare Advantage Plan and return to Original Medicare, you may
be required to answer health questions in order to qualify and
obtain a Medicare Supplement Insurance Plan. Your
SmartMatch licensed insurance agent will make sure you
understand a plan’s network and coverage rules before you
enroll.