Medicare Advantage

Medicare Advantage plans are also known as Part C plans. They are offered by private insurance companies that contract with Medicare to provide you with Part A and Part B benefits. Most Medicare services are covered through the plan but are not paid for under Original Medicare. Most Medicare Advantage plans offer prescription drug coverage.

A consumer has a 7 month enrollment period for guarantee issue. This period includes 3 month prior to turning age 65, the month you do turn age 65 and 3 months after you turn age 65.

Types of Medicare Advantage Plans:

  • HMO (Health Maintenance Organization) – a health plan where you choose a Primary Care Physician that manages and coordinates your healthcare within the plan’s network. Your PCP must give you a referral prior to seeing any type of specialist.
  • PPO (Preferred Provider Organization) – a health plan that allows you to choose from a network of preferred providers. You do not need to select a PCP and you do not need referrals to see other providers or specialists within your chosen network.
  • PFFS (Private-Fee-for-Service) – a health plan that determines how much it will pay for doctors, other health care providers, hospitals and services. You do not need a PCP and you do not need a referral to see a specialist. Always confirm with the medical facility first to confirm they accept your plan.
  • SNP (Special Needs Plans) – these plans limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
  • MMSA (Medicare Medical Savings Account) – this type of plan combines a high-deductible insurance plan with a medical savings account that you can use only to pay for health care costs.
    If a member enrolls in a Medicare Advantage plan and decides they do not want this plan, they may disenroll during the Medicare Disenroll Period which is from January 1st – February 14th. Once a consumer disenrolls from a Medicare Advantage plan they return to Original Medicare and are allowed to enroll in Part D (prescription plan).