Understanding The Benefits Of Medicare Advantage

Reviewed and Updated by Anastasia Iliou,

Medicare Advantage is a coverage option that provides more benefits than basic plans. It includes Original Medicare, which is made of Medicare Part A (hospital care) and Part B (medical/doctor care), plus additional services such as prescription drug coverage, dental, and vision coverage.

Medicare Advantage plans are sometimes confused with Medicare Supplement (Med Supp) plans, but they are completely different. While Medicare Advantage (MA) includes extra service coverage, Medicare Supplement plans provide more financial coverage (but not more services).

 Medicare Advantage Benefits

  • Hospital stays, skilled nursing care, home health care, etc. (essentially Part A)
  • Doctor visits, outpatient care, preventative services, etc. (essentially Part B)
  • Hearing care, vision care, fitness programs, wellness services, nurse help lines, prescription drug coverage, etc. (Part C)
  • Prescription drug coverage (essentially Part D)

Types of Medicare Advantage Plans

  • HMO Plans (Health Maintenance Organization) You’ll select one primary physician and only see that doctor, unless your doctor recommends another specialist (such as a cardiologist or dentist). 
  • HMO-POS Plans (Point-Of-Service) You’ll select one primary physician but can also visit other specialists in your network for a fee (like a cardiologist or dentist) even without a doctor recommendation. 
  • PPO Plans (Preferred Provider Organization) You can see any doctor, but in-network doctors will be much cheaper for you. 
  • PFFS Plans (Private Fee-For-Service) You will not need referrals or a primary physician, but not all doctors will accept this plan. 
  • SNP (Special Needs Plans) You are only eligible if you have a chronic illness or disability, live in a nursing home, or are dual-eligible for Medicare and Medicaid. 
  • MSA (Medical Savings Account) Medicare will deposit money into a separate bank account for you to use for Medical expenses.

Enrollment Periods

There is a seven-month window during which you can enroll in Medicare. It lasts from three months before your 65th birthday through three months after. During this period, you can purchase a Medicare Advantage plan for the first time or add any additional coverage. Additionally, you can always add or change your plan during the annual enrollment period, or AEP (October 15th through December 7th every year).

You may qualify for a SEP (Special Election Period), during which you can enroll even though it is not during AEP or your initial enrollment period. You can qualify if you:

  • Move residences to an area where different plan options are available
  • Move to an area where the nearest hospital or doctor’s office is out-of-network
  • Are released from incarceration
  • Lose Medicaid eligibility
  • Leave a job or start a new job that offers different plans
  • Were in a plan that is now discontinued

Do you still have questions about Medicare Advantage or are you hoping to purchase a plan? Set up an appointment with one of our licensed agents today. Call us now at 1-844-431-1832.

 

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