A simplified guide to Medicare Advantage plans and enrollment

May 23, 2022

If you’ve been shopping for Medicare plans, you’ve probably heard about Medicare Advantage plans. You might have questions about what these plans are and how they’re different from other Medicare plans. This guide will help you understand what Medicare Advantage plans offer and how you can enroll. We’ll also answer questions about how to manage and update your Medicare Advantage plan.

What are Medicare Advantage plans?

When you have a Medicare Advantage plan, you get coverage for Parts A and B of Medicare, just like you would with Original Medicare. Medicare Advantage plans also provide coverage for some services that aren’t part of Original Medicare (hence the term “advantage”). You can’t combine Original Medicare with Medicare Advantage plans.

The extra services that are covered by Medicare Advantage varies widely between plans. Many plans offer dental care, vision coverage, and fitness benefits. Some plans may also pay for transportation to and from doctor’s appointments. Medicare Part D (prescription drug coverage) is included with certain types of Medicare Advantage plans too.

How are Medicare Advantage plans different from other Medicare options?

With Original Medicare, your Medicare Part A and Part B benefits are managed by the government. Medicare Advantage (Part C) plans are run by private insurance companies. The government pays the insurance companies to provide your Medicare services.

Medicare Advantage plans are available through many different types of insurance companies, and each state has different plans and providers. The best plan choice for someone else may not be ideal (or even available) for you. However, you’ll have plenty of choices to choose the best plan for your unique situation.

What are the most common types of Medicare Advantage plans?

Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Private Fee-for-Service (PFFS) plans are the most common types of Medicare Advantage plans.

If you get a Medicare Advantage plan that’s provided by an HMO, you’ll probably only be able to go to health care providers and hospitals that are part of the HMO’s network. Exceptions are made for emergencies. You might need a referral from your primary care doctor in order to see a specialist.

Medicare Advantage plans that are available through PPOs charge less if you use health care providers and hospitals that belong to the PPO’s network. If your providers aren’t in the PPO’s network, a higher fee will be charged.

When you have a Medicare Advantage plan that’s provided by a PFFS company, you can get care from any health care provider that accepts your plan’s payment terms. You’re also free to choose any hospital that accepts the plan’s terms. The PFFS company will determine how much your providers and hospitals will be paid for services. They’ll also let you know how much you have to pay for services you’ve received.

What other types of Medicare Advantage plans are available?

You could also consider using a Health Maintenance Organization Point-of-Service (HMO-POS) plan. These plans are run by HMOs, and they provide coverage for some out-of-network services that wouldn’t be covered by regular HMO plans. However, you’ll be responsible for higher copayments or coinsurance charges with out-of-network care.

A Medical Savings Account (MSA) plan has a high deductible, and it’s used in combination with your bank account. Medicare will put money into your account, and you can use it to pay for your health care throughout the year. The amount of money that Medicare deposits into your MSA is usually less than your annual deductible. MSA plans don’t include Medicare Part D, so you’ll need to buy a Medicare prescription drug plan separately.

If you have Medicare and Medicaid, you might be eligible for a Dual-Eligible Special Needs Plan (D-SNP). Special Needs Plans are open to people who live in nursing homes and to individuals with certain chronic conditions.

What is MAPD?

MAPD stands for Medicare Advantage – Prescription Drug Plan. It’s a bundle that gives you many Medicare parts, including Part D (prescription coverage), in one package. You’ll be covered for everything that would be provided with standard Medicare Advantage (Part C) plans, and you’ll have Part D as an added benefit.

MAPD plans are available from providers of standard Medicare Advantage plans, and your cost is determined by your location, income, and coverage needs.

How do I enroll in Medicare Advantage or MAPD plans?

To enroll in these plans, you must have Medicare Part A and Medicare Part B, and you’ll need to be living in the service area of your desired plan. You can enroll in your selected plan during your Initial Enrollment Period, which lasts 7 months and begins 3 months before your 65th birthday.

If you miss your Initial Enrollment Period, you will be able to sign up during Medicare’s Annual Enrollment Period, Oct. 15 – Dec. 7. Depending on the plan you choose, you might be allowed to make changes to your existing coverage from Jan. – Mar. Your SmartMatch licensed insurance agent will be able to provide you with more information about when you can change your coverage.

Where can I get assistance with choosing a Medicare Advantage or MAPD plan?

Medicare licensed insurance agents in your state can help you with sorting through your Medicare Advantage and MAPD plan options. Our SmartMatch licensed insurance agents are able to help you in one simple phone call. We’ll help you pick a suitable plan and offer guidance on how you can enroll. We’re happy to assist you with all of your Medicare needs, so contact us today or visit our Plan Comparison tool to get the process started.

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