Medicare Advantage Insurance Plan (Part C) Basics

Medicare Advantage Plans are offered by private insurance companies and provide all of your Part A and Part B benefits (some also include prescription coverage)

About Medicare Advantage Plans (Part C)

Medicare Advantage Insurance Plans are offered by private insurance companies and are approved by the Federal Government. They cover the same benefits as Part A (hospital insurance) and Part B (doctor visits). Some also offer other benefits that Original Medicare doesn’t cover like vision, dental and prescription drugs, even gym memberships and may also offer additional benefits like transportation to and from your doctor’s office. These plans typically use HMO, PPO or PFFS networks. These networks change every year, and can impact which doctors accept your plan. Your SmartMatch licensed insurance agent will make sure you understand a plan’s network and coverage rules before you enroll.

Medicare Advantage Networks

Medicare Advantage Plans typically use HMO, PPO or PFFS networks. Below is the list of the Medicare Advantage Networks, and how they work.
  • HMO — Health Maintenance Organizations have a specific network of select physicians and might require a referral from a primary care physician before a patient can see a specialist. HMOs also provide additional benefits like coverage for deductibles and more.
  • PPO — A preferred provider organization allows customers to save money when they use a physician inside the plan's network. Customers are still able to see doctors outside the network, but might have to pay a higher cost.
  • PFFS — Private Fee-For-Service plans work similarly to that of Original Medicare, but the plan determines how much it will pay the physician or facility and how much the patient will pay out-of-pocket.
  • HMOPOS— A HMO “Point-of-Service" plan operates like a HMO but allows for some services to be covered by an out-of-network physician often for a higher copayment or coinsurance.
  • MSA— A Medical Savings Account plan combines a high-deductible plan with a bank account where money is deposited by the plan to be used for health care services.

Medicare Advantage Enrollment periods

Initial Coverage Election Period (ICEP)
The Initial Coverage Election Period (ICEP) is the seven-month window starting three months before you're first eligible for Medicare Part A and B. For most adults, the ICEP starts three months before the month they turn 65. During this time you can sign up for any Medicare Advantage plan that suits your needs.

Medicare Advantage Annual Election Period (AEP)
The Medicare Advantage Annual Election Period (AEP) is when Medicare beneficiaries can add, change or drop their Medicare Part D or Medicare Advantage Part C plan coverage for the next year. The AEP starts on October 15th and continues through December 7th of each year with coverage or plan changes taking effect on January 1st of the new year. Outside of this time, most people will only have a limited opportunity to change their Medicare Advantage plan coverage throughout the year.

The Medicare Advantage Open Enrollment Period (OEP)
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 annually and allows those who are enrolled in a Medicare Advantage Plan to make a one-time change. You can either move to another Medicare Advantage Plan or disenroll from your Medicare Advantage plan and return to Original Medicare and purchase a Medicare Supplement Plan. Note, if you leave a Medicare Advantage Plan and return to Original Medicare, you may be required to answer health questions in order to qualify and obtain a Medicare Supplement Insurance Plan.

Your SmartMatch licensed insurance agent will make sure you understand a plan’s network and coverage rules before you enroll.



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