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Medicare Advantage (Part C) is an all-in-one Original Medicare alternative that coordinates your healthcare benefits to lower costs. Part C plans are offered by Medicare-approved private companies that must follow rules set by Medicare and most of them include prescription drug coverage (Part D).
In certain types of MA plans that can’t offer drug coverage (like Medical Savings Account plans) or choose not to offer drug coverage (like certain Private Fee-for-Service plans), you can join a separate Medicare drug plan.
You can enroll in an Advantage plan as long as you’re enrolled in Medicare Parts A and B first—you cannot be turned down based on your health or finances (with the exception of Special Needs Plans). The choice between Part C and Original Medicare, then, is completely up to you.
Each of these plans functions in the same way, but with a few key variations in the price and specific structure. Within the category of Medicare Advantage, there are five different types of plans:
To enroll in a Special Needs Plan (SNP), you must either be in great financial need or have a serious health condition. If you are enrolled in both Medicare and Medicaid, you are eligible for a D-SNP.
If you have a qualifying illness/condition, you are eligible for a C-SNP. If you live in an institution, such as a nursing home, you qualify for an I-SNP. All SNPs must provide Medicare drug coverage and the plans’ benefits are targeted to its beneficiaries’ special needs.
Of the Advantage plans, Health Maintenance Organization (HMO) plans rely the most on their network. Out-of-network emergency care is covered, but any other care outside of its specified limits will not be covered.
And, you are required to have a primary care physician and specialist referrals. In most cases drugs are covered in HMO plans but you should check that with your plan’s provider.
Preferred Provider Organization (PPO) plans, on the other hand, do not require a primary care physician or referrals. Their networks cover a large area, with opportunities to seek healthcare from a variety of providers.
You pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network but you can also use out‑of‑network providers for covered services.
Keep in mind that if you decide to use out-of-network providers, the services will usually cost more, and it is important that the provider agrees to treat you and hasn’t opted out of Medicare. Nevertheless, you will always be covered in urgent or emergency situations.
Dual Special Needs Plans provide affordable healthcare coverage to those who qualify for both Medicare and Medicaid which offers all the usual benefits of Original Medicare, as well as the coordinated healthcare services of Advantage plans to lower your out-of-pocket costs.
The main task of Chronic Special Needs Plans is to help people with disabling chronic conditions get the care they need with ease and comfort. C-SNPs cover a variety of life-threatening illnesses and if you qualify for one, you will receive individualized benefits at a very low cost.
With Private-Fee-for-Service (PFFS) plans, the network of coverage is negotiable. Your insurance provider has a healthcare network of people who have agreed to accept its plan.
However, you have the opportunity to negotiate and receive coverage from any other providers that agree to the terms. These plans will determine how much they will pay for your medical services and how much you will pay.
Medicare Medical Savings Account (MSA) Plans combine a medical savings account and a high deductible insurance plan which you can use to pay for your health care expenses.
The high deductible must first be met in order for the plan to provide coverage. The plan will also deposit money into the bank account, which you can use to pay toward your deductible.
Medicare Advantage is an upgraded version of Original Medicare. No matter the insurance provider or Advantage plan you choose, it is required by law to cover all of the same benefits as Original Medicare.
Your out-of-pocket costs compared to an Original Medicare plan, then, will always be lower with an Advantage plan. Most providers offer little to no monthly premiums.
This means that you won’t be paying much for this additional cost coverage either which will make your part of the financial responsibility more tolerable.
Because it is inexpensive and provides a better alternative, Part C will likely be a better option for you than Original Medicare on its own.
You can join any of the Medicare Advantage plans if you in the service area of the plan and its provider you wish to join, you already have Original Medicare (Part A and Part B), and you are a U.S. citizen or lawfully present in the U.S.
Typically, you can enroll in Medicare Advanage Plans during these periods:
Initial Enrollment Period (IEP)
This is a seven-month period, including the three months before, the month of, and the three months after the month you first become eligible for Medicare which is during the month of your 65th birthday or your 25th birthday if you have collected disability benefits.
Fall Open Enrollment Period
This Open Enrollment Period is open from October 15th through December 7th each year. During this time you can change your Medicare coverage, pick a new Medicare Advantage Plan, or switch between Original Medicare and Medicare Advantage. You can also change your Part D coverage during this time.
Medicare Advantage Open Enrollment Period
The MA Open Enrollment Period lasts from January 1st to March 31st every year, and if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. It is important to mention that you can make changes only once during this time period.
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Choosing an Advantage plan is one of the most important decisions you will make as a Medicare beneficiary. But how do you compare your options? How do you know if it’s the best option for you?
Texas Medicare Advisors has the skills and experience to get you the coverage you need. We will make sure that you’re getting the best coverage in your area. If you want to get started, give us a call at 512-900-3008.
Medicare Advantage (Part C) is an all-in-one Original Medicare alternative that coordinates your healthcare benefits to lower costs.
You can enroll in an Advantage plan as long as you’re enrolled in Medicare Parts A and B first—you cannot be turned down based on your health or finances (with the exception of Special Needs Plans). The choice between Part C and Original Medicare, then, is completely up to you.
Within the category of Medicare Advantage, there are five different types of plans:
Each of these plans functions in the same way, but with a few key variations in the price and specific structure.
To enroll in a Special Needs Plan (SNP), you must either be in great financial need or have a serious health condition. If you are enrolled in both Medicare and Medicaid, you are eligible for a D-SNP. If you have a qualifying illness/condition, you are eligible for a C-SNP. If you live in an institution, such as a nursing home, you qualify for an I-SNP.
Of the Advantage plans, Health Maintenance Organization (HMO) plans rely the most on its network. Out-of-network emergency care is covered, but any other care outside of its specified limits will not be covered. And, you are required to have a primary care physician and specialist referrals.
Preferred Provider Organization (PPO) plans, on the other hand, do not require a primary care physician or referrals. Their networks cover a large area, with opportunities to seek healthcare from a variety of providers.
With Private-Fee-for-Service (PFFS) plans, the network of coverage is negotiable. Your insurance provider has a healthcare network of people who have agreed to accept its plan. However, you have the opportunity to negotiate and receive coverage from any other providers that agree to the terms. These plans will determine how much they will pay for your medical services and how much you will pay.
Medicare Medical Savings Account (MSA) Plans combine a bank account and high deductible. The high deductible must first be met in order for the plan to provide coverage. The plan will also deposit money into the bank account, which you can use to pay toward your deductible.
Medicare Advantage is an upgraded version of Original Medicare. No matter the insurance provider or Advantage plan you choose, it is required by law to cover all of the same benefits as Original Medicare.
Your out-of-pocket costs compared to an Original Medicare plan, then, will always be lower with an Advantage plan. Most providers offer little to no monthly premiums, meaning that you won’t be paying much for this additional cost coverage, either.
Because it is inexpensive and provides a better alternative, Part C will likely be a better option for you than Original Medicare on its own.
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Texas Medicare Advisors 512-265-0252
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