Medicare Advantage PlanThe Medicare Advantage plan (which is also known as Medicare Part C), is a plan provided through insurance companies to give you the basic coverage of Medicare Part A and B, but with added benefits! The Medicare Advantage plan is often part of a PPO (Preferred Provider Organization) or HMO (Health Maintenance Organization).
It is possible that the additional benefits provided by Medicare Advantage may come at no additional cost to you. This means that it is typical for a Medicare Advantage plan to carry a $0 monthly premium and copayment. It is important to note, however, that the benefit of these Medicare Advantage plans can differ from state to state, as well as from county to county within any given state. Given the fact that you are required to seek care within a certain network of providers under the plan, the area in which you live may affect whether the Medicare Advantage plan is the right fit for you. Our team can help you determine whether having a Medicare Advantage plan for your health insurance in Grand Junction, CO would be a benefit to you, based on your healthcare needs and the availability of providers in the area. |
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Medicare Advantage Plan Specifics
You are required to already be enrolled in Medicare Part A and B before you are eligible to enroll in a Medicare Advantage plan.
The Medicare Advantage plan is an alternative to having a Medicare supplement (or Medigap) plan and Part D plan paired with your traditional Medicare Part A and B. Under a Medicare Advantage plan, you will still have your Part A and Part B coverage in place but will also be responsible for paying your Medicare Part B monthly premium.
There is very little underwriting required with a Medicare Advantage plan and therefore it is much easier to qualify for the Medicare Advantage plan when a health condition has prevented you from obtaining a Medicare Supplement plan outside of the open enrollment period.
When you choose a Medicare Advantage plan, your benefits no longer come directly from Medicare, but from your Medicare Advantage insurance company. This is important for you to remember when you are at the doctor, as you will need to present your specific Medicare Advantage plan information instead of your Medicare card in order to avoid disruptions with your claims.
The Medicare Advantage plan is an alternative to having a Medicare supplement (or Medigap) plan and Part D plan paired with your traditional Medicare Part A and B. Under a Medicare Advantage plan, you will still have your Part A and Part B coverage in place but will also be responsible for paying your Medicare Part B monthly premium.
There is very little underwriting required with a Medicare Advantage plan and therefore it is much easier to qualify for the Medicare Advantage plan when a health condition has prevented you from obtaining a Medicare Supplement plan outside of the open enrollment period.
When you choose a Medicare Advantage plan, your benefits no longer come directly from Medicare, but from your Medicare Advantage insurance company. This is important for you to remember when you are at the doctor, as you will need to present your specific Medicare Advantage plan information instead of your Medicare card in order to avoid disruptions with your claims.
Medicare Advantage BenefitsTypically, the Medicare Advantage plan will come with lower premiums than a Medicare Supplement plan.
The Medicare Advantage plan also provides additional benefits that a traditional Medicare Part A and B plan do not offer. These benefits can include dental, hearing, vision, fitness memberships, over the counter and prescription drug coverage, and nutrition programs, to name only a few. Again, it is important to remember that not all possible benefits will be available in your area, but our team can help you determine what benefits are available locally in order to give you the most accurate information in deciding if the Medicare Advantage plan is right for you. You will have a specific copayment to make when you are at the doctor or the hospital under the Medicare Advantage plan that you choose. This means that your costs will be more predictable and should help you in preparing for medical events as they occur. |
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Health Maintenance Organization (HMO) Specifics
In most Medicare Advantage plans with an HMO, your care will come from doctors and hospitals within the designated network of providers. You are able to receive care outside of the network in emergencies or urgent care situations. With an HMO, you are required to choose a primary care physician. This physician will need to provide a referral if you need to see a specialist. Typically, prescription drugs will also be covered with a Medicare Advantage plan in an HMO.
Preferred Provider Organization (PPO) Specifics
Similarly to HMO’s, a PPO will have a specific network of providers to choose from to receive care – however, with a PPO, it is allowable to receive care from a physician outside the network, but the out-of-pocket costs when doing so will be much higher than if the provider were in network. Essentially, you have the flexibility and option to choose an out-of-network provider, but it comes at a higher cost than staying in-network. You are not required to choose a primary care physician with a PPO plan and will not need a referral to a specialist in most cases. Not all PPO plans offer prescription drug coverage, and if you are enrolled in a Medicare Advantage plan, you are NOT eligible for a Medicare Part D plan – this is something very specific to keep in mind if you know you are going to enroll in a plan with prescription drug coverage.
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970-236-7770!
Enrollment Period
The initial enrollment period for a Medicare Advantage plan begins just before you turn 65 and ends a few months later. After that, during the annual open enrollment which occurs from October 15th – December 7th each year, you are able to switch to the Medicare Advantage plan from the traditional Medicare Part A and B, make changes to your existing Advantage plan, or drop the Advantage plan and go back to the traditional Medicare Part A and B.
Medicare Supplement Plan vs. Medicare Advantage Plan
There are a few key items to keep in mind in the differences between a Medical Supplement plan and a Medicare Advantage plan. One, Advantage plans provide a much smaller network of providers. Additionally, Medicare Supplement plans do not have coverage changes year-to-year, whereas you will need to review Advantage changes carefully on an annual basis to ensure the plan is still meeting your needs. Additionally, Medicare Supplement plans have less upfront costs, but can offer far fewer benefits than a Medicare Advantage plan.
Our team is available to help you determine which plan is right for you – what matters is that you are happy with the coverage and that it is meeting your needs on a long-term basis.
Our team is available to help you determine which plan is right for you – what matters is that you are happy with the coverage and that it is meeting your needs on a long-term basis.
New To Medicare?
Call our office Today at
970-236-7770!
970-236-7770!
