In the United States, a citizen’s 65th birthday means Medicare eligibility. For most seniors, this will be their first time receiving government healthcare benefits. As with most government programs, Medicare and Medicare Advantage can be difficult to understand at first.
The knowledge you gain here will be useful for understanding your Medicare benefits.
This article is for those interested in learning more about Medicare Advantage plans and how they differ from Medicare. To learn more about what a Medicare Advantage plan can do for you click here.
What is Medicare Advantage?
You may be familiar with Medicare Advantage Plans, Medicare Part C, or Medicare Advantage (MA). What it is important to know is that Medicare Advantage is a supplemental program and adds coverage in addition to standard Medicare benefits and coverage.
Medicare Advantage Plans are typically associated with managed care plans such as Health Management Organizations(HMOs) and Preferred Provider Organizations(PPOs).
While these Health Management organizations (HMOs) and Preferred Provider Organizations
(PPOs) have limited provider networks, they are required by law to have increased coverage requirements compared to standard Medicare.
How does Medicare Advantage Differ From Standard Medicare?
Medicare is federal health insurance for seniors age 65 and older, and individuals under 65 with disabilities or conditions. A Standard Medicare Plan includes Part A and Part B coverage. Parts A and B cover visits to any doctor or hospital visits anywhere in the United States that takes Advantage. Medicare Advantage combines Medicare part A and B benefits and additional coverage into one healthcare plan.
Medicare Alone Has No Limit on Out-of-Pocket Expenses
With no limits on out-of-pocket responsibility, you may be forced to pay a large amount in the event of a serious health emergency. Medicare Advantage Plans Have defined limits on Out-of-Pocket Costs. With a Medicare Advantage plan, you can better budget for the future knowing the maximum total deductibles are capped annually.
Standard Medicare Does Not Include Prescription Drug Coverage
Standard Advantage members can join a separate Medicare drug plan to cover prescription drugs (Part D). To help pay the out-of-pocket costs associated with Original Medicare, individuals can also buy supplemental coverage.
Most Medicare Advantage Plans have Prescription Drug Coverage.
Medicare Advantage plans typically include prescription drug coverage. It is important to note that If you join an HMO or PPO that doesn’t cover drugs, you can’t join a separate Medicare drug plan.
Who Can Enroll in a Medicare Advantage Plan?
Nearly half of all eligible Medicare beneficiaries are enrolled in Medicare Advantage plans.
To join a Medicare Advantage Plan, you must:
- Have existing Part A and Part B benefits.
- Live in the plan’s service area.
- Be a U.S. citizen or lawfully present in the U.S.
When Can someone sign-up for Medicare Advantage?
The time around seniors turning 65 is called the Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. During this time individuals can sign up for Medicare Advantage.
Each year individuals can make changes to their Medicare Advantage Plan for the following year. There are 2 enrollment periods each year.
Open Enrollment Period (October 15-December 7)
During this period seniors are able to change from Original Medicare (with or without a Medicare drug plan) to a Medicare Advantage Plan.
Medicare Advantage Open Enrollment Period (January 1 – March 31)
This period does not allow an individual to sign up for Medicare Advantage. It does however allow a senior to make changes to their existing Medicare Advantage plan including returning to Medicare.
Special Needs Plans
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP). These plans are designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be someone living in an institution such as a long-term nursing facility. An individual with a severe or disabling chronic condition.
Special Enrollment Periods
Certain life events may allow a person to make changes to their Medicare benefits. A good example of this would be a move. When someone changes residence, they may become eligible for different plans. Another example would be if a person now qualifies for extra help with prescription drug costs.
Medicare beneficiaries requiring long-term nursing care are eligible to make changes. If an individual moves into an institution such as a nursing facility they are eligible to make changes to their Medicare benefits.
Care at Meadowcrest Family Physicians is Covered under Medicare and Medicare Advantage.
Meadowcrest Family Physicians have been serving Advantage patients for many years. We have found that our patients are getting better care more affordably with Medicare Advantage Plans. By exploring your Medicare Advantage options, you can make a better-informed decision about your healthcare.
Last year more than ever, seniors just like you exercised their right to Medicare benefit alternatives. Medicare Advantage gives seniors access to high-quality healthcare at an affordable price. Nearly half of all current Medicare members are enrolled in a Medicare Advantage Plan.
At Meadowcrest Family Physicians, we want to make sure our patients receive the best possible care in and out of our offices. If you need additional information regarding Medicare Advantage plans we have resources to help. Please make an appointment with our in-office rep to learn your options.