Medicare Advantage Plans

Considering to get a Medicare Advantage Plan? SimpleChoice makes it easy to compare costs and coverage so you can choose your plan with confidence. Learn more about what Medicare Advantage can offer and how can we help. 

What is Medicare Advantage Plans?

Medicare Advantage Plans, often known as “Part C” or “MA Plans,” are an additional option for Part A and Part B coverage under Medicare.

Medicare Advantage Plans may cover fitness programs, and some vision, hearing, and dental services (like routine check ups or cleanings). Plans can cover additional benefits.

Difference between Original Medicare and Medicare Advantage Plan

Types of Medicare Advantage Plans

Medicare Advantage Plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).

Here are the most common types of Medicare Advantage Plans:

1. Health Maintenance Organization (HMO)

In HMO plans, you often have to use the doctors, other healthcare professionals, and hospitals in the network, with the following exceptions:

  • emergency services;
  • urgent care outside the area; and
  • temporary dialysis away from home. 

Prescription medications are typically covered under HMO plans.

You must join an HMO Plan that offers prescription drug coverage if you want Medicare drug coverage (Part D). You cannot join a separate Medicare drug plan if you join an HMO plan without drug coverage.

2. Preferred Provider Organization (PPO)

A private insurance company offers a Medicare PPO Plan (Part C). PPOs have network doctors, hospitals, and other providers. Using network doctors, hospitals, and other providers saves money. You can also use out-of-network doctors for covered services if they agree to treat you and have not opted out of Medicare (for Medicare Part A and Part B products and services). Emergency care is always covered.

If you want Medicare drug coverage, you must enroll in a PPO Plan that covers prescription drugs. Remember that if you join a PPO Plan that does not include prescription drug coverage, you will be unable to join a Medicare Drug Plan (Part D).

3. Private Fee-for-Service (PFFS) Plans

A commercial insurance business may provide a Medicare PFFS Plan, a form of Medicare Advantage Plan (Part C). PFFS plans are not the same as Medigap or Original Medicare. The plan establishes how much it will pay hospitals, doctors, and other healthcare organizations as well as how much you will have to pay for any services you receive.

If your Private Fee-for-Service Plan does not provide drug coverage, you can enroll in a separate Medicare Drug Plan (Part D).

4. Special Needs Plans (SNP)

Medicare Special Needs Plans only let people who have certain diseases or traits join. Medicare Special Needs Plans (SNPs) customize their benefits, provider choices, and drug formularies to meet the needs of the groups they serve.

Medicare Special Needs Plans are usually experts in the diseases or conditions that affect their patients. A Special Needs Plans offers benefits tailored to its members’ specific needs, such as care coordination services.

Enrolling in Medicare Advantage Plans

You can sign up for a Medicare Advantage Plan only during certain times:

Initial Coverage Enrollment Period: This is a seven-month period that begins three months before the month you turn 65 and ends three months after the month you turn 65. 

Annual Enrollment Period:You can enroll in, change, or terminate a plan from October 15 through December 7 every year. Your protection will start on January 1st (as long as the plan gets your request by December 7).

Open Enrollment Period for Medicare Advantage: If you are enrolled in a Medicare Advantage Plan from January 1 through March 31 of every year, you can change to a different Medicare Advantage Plan or move to Original Medicare (and sign up for a new Medicare prescription plan) once during this time.

Special Enrollment Period — A special enrollment period can be caused by a number of reasons. Check out this blog to check if you qualify for an Special Enrollment Period.

Different Medicare Advantage Plans function in various ways. Find and compare Medicare health plans in your area before enrolling with the help our agents from Simple Choice Insurance Brokerage.

Still undecided on what Medicare Advantage Plans suit your needs? Check out this video to help you learn more.