How Medicare Advantage Plans Work
Medicare Advantage plans often include extra benefits, such as prescription drug coverage and routine dental services.
Medicare Advantage plans have contracts with Medicare; the government program pays each plan a fixed amount each month. The insurance company pays a portion of your costs according to Medicare rules and coordinates your care.
There are costs associated with Medicare Advantage plans. Many Medicare services require copayments or coinsurance, and plans might have deductibles and premiums. Some plans have premiums as low as $0 per month, but you may want to look at other plan costs when you’re looking for a plan. No matter what Medicare Advantage plan you may enroll in, you still need to pay your monthly Medicare Part B Premium.
Depending on the type of plan, there may be different rules. For example, some plans may restrict you to network doctors in the plan’s network and/or require you to get a referral to see a specialist.
Every Medicare Advantage plan has a maximum out-of-pocket amount; this amount is the most that you will spend on health costs each year. After you spend up to that amount, your Medicare Advantage plan will pay all costs for Medicare-covered services. Each Medicare Advantage plan could have a different limit, and that amount may change each year.
Do You Understand How Medicare Supplement Works?
Types of Medicare Advantage Plans
There are many kinds of Medicare Advantage plans, although not every type of plan may be available in the area where you live. Some types of plans include:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
- HMO Point-Of-Service (HMO-POS)
- Medical Savings Account (MSA)
Switching to Medicare Advantage – Things to Consider
If you’re trying to decide whether to change to a Medicare Advantage plan, you might want to ask yourself the following questions:
Do I want all my Medicare coverage in one plan?
Some beneficiaries enjoy the convenience of getting all their Medicare Part A, Part B, and prescription drug coverage (Medicare Part D) benefits in a single Medicare Advantage Prescription Drug plan. Not every Medicare Advantage plan includes prescription drug coverage.
What prescription drugs do I take?
Original Medicare (Part A and Part B) includes limited prescription drug coverage and doesn’t normally cover medications you take at home. Most Medicare Advantage plans offer prescription drug coverage.
But you may want to look carefully at plans you’re considering, making sure they cover prescription drugs and that they cover your medications specifically. Each Medicare Advantage Prescription Drug plan has a formulary (a list of covered medications). You can compare the formulary with your own list of prescriptions. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
Is my doctor in the plan’s network?
If you want to stay with your current doctor, you can ask the doctor if s/he is in the plan’s network, or check the plan’s website to view its list of providers. Not every type of Medicare Advantage plan has a provider network, and some plans may give you more flexibility to use out-of-network providers.
Do I need to see specialists for my health conditions?
Keep in mind that some plan types, such as HMOs, may require you to get a referral to see a specialist. Others, such as PPOs, typically don’t require a referral to see a specialist.
Do I typically have a lot of doctor visits?
If you tend to visit health-care providers frequently, you might want to weigh the costs of Medicare Advantage plans against Medicare Supplement (Medigap) plans. Medicare Advantage plans generally charge a copayment or coinsurance for most doctor visits, and you might have to pay a deductible before the plan starts covering these visits. Medigap plans help pay for Original Medicare’s out-of-pocket costs. Read more about Medigap plans.
You can easily compare plan options by entering your zip code where indicated on this page.
When you can switch to a Medicare Advantage plan
If you’re thinking about switching to a Medicare Advantage plan, be aware that you can generally make this change only during certain time periods.
You can enroll during your Initial Coverage Election Period (ICEP), which is generally the same seven-month time period as your Medicare Initial Enrollment Period – when you’re first eligible for Medicare. However, your Initial Coverage Election Period will be different if you chose to delay enrollment in Medicare Part B. In this case, your Initial Coverage Election Period (ICEP) would start three months before you enroll in Part B, and end the last day of the month before your Part B coverage starts.
Another opportunity to enroll in a Medicare Advantage plan is during Fall Open Enrollment (also known as the Annual Election Period), which runs from October 15 to December 7 every year. If you already have a Medicare Advantage plan, you can also use this period to change plans or disenroll from your plan and go back to Original Medicare.
In some situations you may qualify for a Special Election Period – for example, if you had health coverage through an employer and the coverage ended.
If you’d like to start looking at Medicare Advantage plans in your vicinity, just enter your zip code where indicated on this page to get started. You can also use the contact in-formation below to talk to a licensed insurance agent at eHealth.