Medicare Advantage plans

 

If you receive your Part A and Part B benefits directly from the government, you have Original Medicare. If you receive your benefits from a Medicare Advantage organization or other private company approved by Medicare, you have a Medicare Advantage plan. Many of these plans provide extra coverage and may lower your out-of-pocket costs. 

If you have Medicare Parts A and B, you can join a Medicare Advantage plan. With these plans, you can’t have a Medigap policy, because Medicare Advantage plans cover many of the same benefits a Medigap policy covers. This includes benefits like extra days in the hospital after you’ve used the days that Medicare covers. 

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Medicare Advantage plans include all of the following: 

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• Health Maintenance Organization (HMO) plans. You must get your care and services from doctors and other healthcare providers in the plan’s network except in the case of an emergency. These are usually managed care plans where your Primary Care Physician is at the center of your health plan.

• Preferred Provider Organization (PPO) plans.  These plans offer the same general benefits as an HMO (meaning there is still an “in network” panel of doctors and hospitals, but you will have more options to get care out of network and across state lines.

• Private Fee-for-Service (PFFS) plans.  This is a Medicare Advantage (MA) health plan, offered by a State licensed risk bearing entity, which has a yearly contract with the Centers for Medicare & Medicaid Services (CMS) to provide beneficiaries with all their Medicare benefits, plus any additional benefits the company decides

• Special Needs Plans (SNPs). Medicare SNPs are Medicare Advantage plans that include RX coverage and limit membership to people with specific diseases or characteristics or Medicaid eligibility. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.

 

If you decide to join a Medicare Advantage plan, you use the health card that you get from your Medicare Advantage plan provider for your health care. Also, you might have to pay a monthly premium for your Medicare Advantage plan because of the extra benefits it offers.

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You can enroll in a Medicare Advantage plan during your Initial Enrollment Period (IEP), as explained under the “Signing up for Medicare” section, the first time you’re eligible for Medicare. You can also enroll during the annual Medicare open enrollment period from October 15 to December 7 each year. The effective date for the enrollment is January 1 of the following year. For example, if you signed up on November 8, 2021, your coverage would become active on January 1, 2022. There are also special enrollment periods for some situations.