Medicare Advantage Plans
Another way to get your Medicare coverage is through Part C, also known as Medicare Advantage plans (MA plans). MA plans are approved by Medicare but offered by private insurance companies.
Before enrolling in a Part C plan, you must first be enrolled in Original Medicare. You can then choose the MA plan you want and sign up directly with the private insurer. When you join a Medicare Advantage plan, you are still considered a Medicare beneficiary and you still have Medicare rights and protections, such as the right to appeal.
Medicare Advantage plans provide all of your Part A and Part B coverage, except hospice care, which is still covered under Original Medicare. These plans often provide additional benefits, including vision, hearing, and dental care, or other benefits that go beyond Original Medicare, such as lower cost- sharing. Many MA plans also include optional Medicare prescription drug coverage at no extra charge. Some MA plans charge a monthly premium on top of your monthly premium for Part B coverage.
The average monthly Medicare Advantage premium is $32.60 in 2013.
MA plans often have provider networks, which means that you may have to see certain doctors and go to certain hospitals in the plan’s network to get care. If you use a provider that is not in the network, you may have to pay a higher copyament or up to the full cost of the service.
Types of Medicare Advantage Plans
The two most popular types of Medicare Advantage plans are Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. Other options include Private Fee- for-Service Plans, HMO Point-of-Service plans, Medical Savings Accounts, and Special Needs plans. Different types of plans offer different benefits, so it is important to compare each type of plan to make an informed decision based on your needs.
Health Maintenance Organization (HMO)
With an HMO, you must receive services from providers in the plan’s network, except for emergency room, urgent care visits, and renal dialysis services.
You must also select a primary care doctor, who provides referrals to any specialists you may need.
Out-of-pocket costs are usually lower than with Original Medicare or PPO plans.
Preferred Provider Organization (PPO)
PPOs are similar to HMO plans, but you can also receive covered services outside the provider network and you typically do not need a referral for care by a specialist.
Out-of-pocket costs are typically higher than with HMO plans. Your costs are also generally higher if you use providers outside the network.
For additional information about your MA plan options, see the article The Different Types of Medicare Advantage Plans on Medicare.com.
Out-of-pocket costs and yearly deductibles can vary depending on the plan you choose. It’s important to review all your options to find a plan that is best suited for you.
Joining and Switching Medicare Advantage Plans
When you first become eligible for Medicare, you can join during your 7-month Initial Enrollment Period.
If you get Medicare due to a disability, you can join during the 7-month period surrounding your 25th month of disability benefits.
Anyone can join, switch, or drop a Medicare Advantage plan from October 15 through December 7 each year. This is called the Annual Election Period or Annual Open Enrollment Period.
If you want to disenroll from your MA plan and switch to Original Medicare, you can make this switch during the Disenrollment Period for Medicare Advantage, which takes place each year from January 1 through February 14.
You may also be able to join, switch, or drop a Medicare Advantage plan during a Special Enrollment Period if you:
- Move out of your plan’s service area
- Have a low income and limited resources and qualify for Extra Help from Medicare
- Receive Medicaid coverage
- Receive Supplemental Security Income (SSI) benefits
- Live in a nursing home, skilled nursing facility, or rehabilitation hospital