Medicare Advantage
Medicare Advantage, or Medicare Part C, is an alternative to Original Medicare. In some states, it includes prescription drug coverage. It’s a good option to consider if you want lower premiums than Medigap.
Since there are many types of Advantage plans, you should go through them with an expert to make sure you get the right coverage for your situation. You can trust Simple Retirement Benefits. We work for you and we have your best interest in mind.
Medicare Advantage Benefits
Medicare requires Advantage plans to provide the same benefits of Part A and Part B — which is inpatient hospital care, hospice, skilled nursing facility, surgery, lab tests, home health care, medical equipment, outpatient care, and some preventative services.
Part C plans may also include additional benefits, like:
- Fitness memberships
- Adult day-care services
- Transportation to doctor visits
- Nutrition and wellness programs
- And more
The benefits available to you will depend on your state and plan providers.
Common Types of Medicare Advantage Plans
HMO Plans
Health maintenance organization (HMO) plans usually require you to visit in-network providers only and get referrals from a primary care physician.
PPO Plans
Preferred Provider Organization (PPO) plans don’t require referrals from a primary care doctor. In most cases, you pay less if you see doctors in the plan’s network.
MSA Plans
Medicare medical savings account (MSA) plans feature a high deductible health plan and a bank account to help cover your medical costs. Once you’ve used up the money in the account, you pay out-of-pocket until you hit the deductible.
PFFS Plans
Private-fee-for-service (PFFS) plans allow you to visit any Medicare-approved doctor, provider, and hospital that accepts the plan’s payment, terms, and conditions — and agrees to treat you. Not all providers will.
SNP
A special needs plan (SNP) has a benefits package meant for people with special medical needs. Examples include people who have both Medicare and Medicaid (dual-eligible SNP), reside in nursing homes (I-SNP), and have certain chronic conditions (C-SNP).
There is no “best” Medicare Advantage plan. There is only what is best FOR YOU.
Medicare Advantage Costs
The cost of your coverage can vary greatly. Some plans have a premium as low as $0. Each plan has a yearly out-of-pocket maximum (averaging $8,300 in 2023). Since premiums don’t count toward this maximum, you’ll continue paying the Medicare Part B premium — $164.90 in 2023.
Unlike Medicare Supplements, the Medicare Advantage rate is the same for anyone who’s enrolled, no matter your age, gender, etc.
In addition, each plan will tell you what your copays will be for various health care services. People often pay $50 to go to a specialist, but you might pay only $10 to see a primary care doctor. Surgeries and hospital stays will result in higher copays.
Is Medicare Advantage Optional?
Yes. Consider an Advantage plan if:
- You already have Medicare Part A, Part B, and Part D.
- You want to manage one plan for all your health insurance needs
- You want extra benefits such as dental, vision, and hearing
- You have an approved medical provider that you like, and you know they accept Medicare Advantage.
When to Enroll
There are certain times when you can enroll. The first time you may be able to sign up is during your Initial Enrollment Period, which begins three months before the month you turn 65.
If you’re enrolled in an Advantage plan but want to change, you can switch to a different program during the Medicare Advantage Open Enrollment Period — January 1 to March 31 every year.
You can also add, change, or drop your Advantage plan during the Annual Election Period (AEP) from October 15 to December 7.
Finally, some instances can trigger a special enrollment period, like if you move outside the Advantage plan’s service area. For questions about enrollment, contact Senior Retirement Benefits.
Need Help with Medicare Advantage?
If you have questions about Medicare Advantage, we want to help. Ask us about the benefits in your area. When you need a quote, we can provide that, too!
