Medicare Advantage Plans

Medicare Advantage PlansMedicare Advantage plans offer additional benefits that medicare part A and B do not, and plans start out at $0 premium, these plans offer a Maximum out of pocket limit for Doctor and Hospital bills, And Many offer Prescription drug coverage and other Benefits like Dental, Vision and Gym Membership. Let one of out trained Specialist help you navigate the different options to find the plan that gives you the coverage you need.

Understanding Medicare Advantage Plans

Do I qualify for a Medicare Advantage Plan?

If you have Medicare Part A and Part B coverage. You live in an area serviced by the Medicare Advantage plan. You don’t have end-stage renal disease (ESRD – permanent kidney failure requiring dialysis or a kidney transplant), then you do qualify for an Advantage plan.

There are the different types of Medicare Advantage Plans:

  • Health Maintenance Organization (HMO) plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
  • Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.
  • Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
  • Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
  • HMO Point-of-Service (HMOPOS) plans—These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

How and When Can I enroll in an Advantage Plan?

  1. During the Initial Coverage Election Period (ICEP)
  • The ICEP, or the Initial Coverage Election Period, refers to the period during which people who are newly eligible for Medicare can enroll in a Medicare Advantage plan. During the ICEP, your clients can enroll in a Medicare Advantage health plan with or without prescription drug coverage
    • The ICEP begins 3 months before the month of entitlement to Medicare (e.g., the person’s 65th birthday). However, unlike the IEP for Parts B and D, the ICEP ends either the last day of the month before your client enrolls in both Parts A and B or the last day of your client’s IEP for Part B – whichever is later. Here are two examples to help better illustrate:
      • Example #1: Mary turns 65 on June 15. She enrolls in both Parts A and B, with coverage taking effect June 1. Her ICEP to enroll in a Medicare Advantage plan is the 7-month period surrounding her birthday month (June). Therefore, her ICEP begins March 1 and ends September 1. If she chooses to enroll in a Medicare Advantage plan, her coverage in this plan cannot take effect before June 1 (i.e., the effective dates of both Parts A and B).
      • Example #2: Jim celebrated his 65th birthday on April 10, 2016. Since he was still working and had insurance through his employer, he enrolled in Part A but delayed Part B. Upon retiring, he gets an 8-month Special Enrollment Period (SEP) to enroll in Part B. He retires and enrolls in Part B with coverage taking effect May 1, 2017. His ICEP to enroll in an MA plan, therefore, is from February 1-April 30, 2017. If he enrolls in a Medicare Advantage plan his coverage cannot take effect before May 1 (i.e., the date in which he has both Parts A and B.)
  • Medicare Annual Open Enrollment (AEP)
    • Open Enrollment Period, which runs October 15 to December 7. Once you select a new plan to enroll in, you’ll be disenrolled automatically from your old plan when your new plan’s coverage begins. If you enroll in multiple plans you will be enrolled in the last plan that you selected.
  • A Special Enrollment Period
    • Special circumstances (Special Enrollment Periods) You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs).