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Medicare Advantage Plans

Medicare Advantage Plans

Medicare Advantage Plans are a type of Medicare plan that is offered by a private company. This private company contracts with Medicare, and they provide Part A and Part B benefits. When you enroll in a Medicare Advantage plan, most Medicare services are still covered by the plan.

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What does Medicare Advantage Include?

Medicare Advantage plans coverage can include prescription drug coverage and very often dental, vision, hearing, and additional benefits. 

What does Medicare Advantage Include?

Medicare Advantage plans coverage can include prescription drug coverage and very often dental, vision, hearing, and additional benefits. 

What does Medicare Advantage Include?

Medicare Advantage plans coverage can include prescription drug coverage and very often dental, vision, hearing, and additional benefits. 

Is there a maximum out of pocket with Medicare Advantage?

Absolutely! Each plan is required to have a yearly out-of-pocket maximum. Once you reach that amount for covered services, you won't owe a dime for additional care!

Is there a maximum out of pocket with Medicare Advantage?

Absolutely! Each plan is required to have a yearly out-of-pocket maximum. Once you reach that amount for covered services, you won't owe a dime for additional care!

Is there a maximum out of pocket with Medicare Advantage?

Absolutely! Each plan is required to have a yearly out-of-pocket maximum. Once you reach that amount for covered services, you won't owe a dime for additional care!

Can I go to any doctor or facility with a Medicare Advantage plan?

Medicare Advantage plans have networks of doctors, hospitals, and other facilities. If you utilize the plan's network, it will save you money.

Can I go to any doctor or facility with a Medicare Advantage plan?

Medicare Advantage plans have networks of doctors, hospitals, and other facilities. If you utilize the plan's network, it will save you money.

Can I go to any doctor or facility with a Medicare Advantage plan?

Medicare Advantage plans have networks of doctors, hospitals, and other facilities. If you utilize the plan's network, it will save you money.

What happens if my doctor leaves the Medicare Advantage network?

Providers can join or leave networks at any time. If that happens, you might need to choose a new doctor within the plan's network. 

What happens if my doctor leaves the Medicare Advantage network?

Providers can join or leave networks at any time. If that happens, you might need to choose a new doctor within the plan's network. 

What happens if my doctor leaves the Medicare Advantage network?

Providers can join or leave networks at any time. If that happens, you might need to choose a new doctor within the plan's network. 

Is Original Medicare the same as Medicare Advantage?

Yes and no! Everything that is in Original Medicare is required to be included in Medicare Advantage. Medicare Advantage plans may include extras like prescription drug coverage, dental, vision, and hearing.

Is Original Medicare the same as Medicare Advantage?

Yes and no! Everything that is in Original Medicare is required to be included in Medicare Advantage. Medicare Advantage plans may include extras like prescription drug coverage, dental, vision, and hearing.

Is Original Medicare the same as Medicare Advantage?

Yes and no! Everything that is in Original Medicare is required to be included in Medicare Advantage. Medicare Advantage plans may include extras like prescription drug coverage, dental, vision, and hearing.

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What Are The Types Of Medicare Advantage Plans?

There are several different types of Medicare Advantage Plans including:

  • Health Maintenance Organization - HMO

    With a HMO, you will need to choose your primary care physician at enrollment. 


    Additionally, you very likely will be required to get a referral from your primary physician when / if you want to see a specialist. Other than an emergency there is no coverage outside of the plan’s network. 


    The benefit is that you have lower out of pocket expenses as long as you stay within the plan’s coverage network.

  • Preferred Provider Organization – PPO

    You do not need to pick a primary care physician or get referrals if you need to see a specialist as you do with an HMO. If your provider accepts Medicare and agrees to bill your plan, you are not limited to your network. 


    It is important to note that a provider might accept Medicare however not agree to bill your provider, so it’s important to confirm prior to any treatment.

  • Private Fee-for-Service (PFFS) Plans

    A Medicare PFFS Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. PFFS plans aren’t the same as Original Medicare or Medigap. 


    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.

  • Medicare Special Needs Plans

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When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan.


Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.


When can I enroll?


Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.

 

  • For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31

  • If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability

  • You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year


What You Need to Know

The main thing to know is that for most people, out-of-pocket costs will likely be lower with a Medicare Advantage Plan.


With an Advantage plan, you still get Part A and Part B coverage, and some Advantage plans offer additional benefits that Part A and B don’t cover —things like dental, hearing and vision.


When choosing a plan, you can see if the service or services you are interested in are covered BEFORE enrolling in the plan. If you need help doing this, we are Marquette, MI Medicare Advantage agents and are always happy to provide our input after you tell us what you are looking for.

Folks with pre-existing conditions don’t have to worry. You can still join a Medicare Advantage plan if you have a pre-existing condition. An exception to this rule is if you have End-State Renal Disease.


A Quick Recap 

 

  ✔  You must be enrolled in Medicare Part A and Part B in order to enroll in a Medicare Advantage Plan

  ✔  You must live in the Medicare Advantage plan's service area 


  ✔  You must pay the Part B premium which is $164.90 in 2023

  ✔  Your Part B premium might be higher, depending on your income

Frequently Asked

Questions

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  • Do I have to pay my Medicare Part B premium if I have an Advantage plan?

    To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. 



    In 2023, the standard Part B premium amount is $164.90 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount.

  • If I'm disabled and receive Social Security Disability Insurance, when can I enroll in a Medicare Advantage plan?

    If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.

  • When can I switch or drop my Medicare Advantage plan?

    You can switch or drop your Medicare Advantage during an enrollment period between October 15 and December 7 of each year.

  • What is the difference between a PPO and a HMO?

    PPO: Wider network, no referrals needed for specialists, but potentially higher costs for out-of-network care. Like having a big phonebook, with some charges for extra calls.


    HMO: Smaller network, referrals usually needed, but often lower costs and easier access to in-network care. Think of it as a close-knit group of friends - introductions are easy!


    Which one is right for you? Depends on your needs! Consider flexibility vs. cost, and check if your current doctors are in-network for either option. 

  • Why it's important to know if your health provider accepts Medicare?

    Knowing if your doctor or hospital accepts Medicare is crucial for several reasons:


    1. Avoiding Unexpected Bills: Imagine seeing your usual specialist, only to realize they're not "in-network" with your Medicare plan. You could face surprise charges for the entire visit! Knowing upfront who accepts Medicare helps you ** avoid financial surprises and plan your budget effectively.**


    2. Smoother Claims Processing: When your provider participates in Medicare, they handle billing directly with the program, minimizing paperwork and hassle for you. No need to worry about submitting claims or fighting for reimbursements!


    3. Guaranteed Coverage: When a provider opts out of Medicare, they can charge any amount they see fit for services, potentially exceeding what Medicare usually covers. Choosing in-network providers ensures you receive coverage and predictable costs as defined by your Medicare plan.


    4. Network Benefits: Many Medicare plans offer additional benefits like preventive screenings or discounts on certain services specifically with in-network providers. Choosing out-of-network might mean missing out on these valuable perks.


    5. Peace of Mind: Knowing your healthcare team accepts Medicare brings peace of mind. You can focus on getting the care you need without worrying about unexpected costs or claims headaches.

  • Why it's important to know if your provider will bill your health provider

    Knowing if your provider "bills Medicare directly" is key! Here's why:


    1. Avoid surprise bills: Some providers bill you separately, meaning you could face unexpected charges even with Medicare. Check upfront to avoid financial surprises!


    2. Easier claims: When they bill directly, Medicare handles most paperwork, saving you time and hassle.


    3. Predictable costs: In-network providers typically follow set charges covered by your plan, minimizing out-of-pocket expenses.


    4. Peace of mind: Knowing upfront eases worries about billing complexities and lets you focus on your health.

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