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Medicare Advantage

Medicare Advantage plans are Medicare health plans offered by private companies who have contracts with Medicare, which allow them to provide you with Medicare Part A (hospital care) and Part B (medical care) benefits. If you enroll in a Medicare Advantage plan, your benefits typically only apply when you are visiting health care professionals that are within your program’s network.

If you are expecting to enroll in a Medicare Advantage Plan, you must do so during an enrollment period. These are the current Medicare Advantage enrollment periods:

  • Medicare Advantage Open Enrollment: This period falls between January 1 and March 31. Within this timeframe, you will be able to switch to a new Medicare Advantage Plan or return to Original Medicare coverage. 
  • Initial Enrollment Period: Your Initial Enrollment Period begins three months before your 65th birthday and ends three months after your birth month, granting you a total of seven months to enroll in Medicare. 
  • Annual Election Period: During The Annual Election Period, which falls between October 15 and December 7, you can make changes to your current Medicare Advantage plan.
  • Special Enrollment Period: The Special Election Period is any time outside of the initial or open enrollment period wherein certain individuals are eligible to enroll in a Medicare Advantage Plan. You must meet certain criteria to qualify for a Special Enrollment Period, including getting married, having a baby, or adopting a child.
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Medicare Advantage Benefits

Medicare Advantage plans offer the same benefits as Original Medicare plans, but plans that offer additional benefits can also be purchased. Some of the benefits you could have in your plan include:

  • Prescription drug coverage
  • Transportation to health care facilities
  • Wellness programs
  • Gym memberships
  • Meal delivery

Common Types of Medicare Advantage Plans

Medicare Advantage plans come in many different formats. The plan you choose will determine what healthcare expenses are covered. Therefore you should understand the different types of Medicare Advantage plans that are currently on the market.

Health Maintenance Organization (HMO) Plans

Health Maintenance Organization (HMO) Plans normally only cover services rendered by healthcare providers within your program’s network. Although emergency care, out-of-area urgent care, and out-of-area dialysis are also covered under HMO plans. If you use healthcare services outside of the plan’s network of providers, you may be liable for the entire cost of those services. Most HMO plans also provide prescription drug coverage.

Preferred Provider Organization (PPO) Plans

Preferred Provider Organization (PPO) plans prefer to cover the costs of healthcare services rendered within their network of providers, but they do allow beneficiaries to pursue out-of-network care if they choose. This means that a PPO will pay for your visits to any healthcare providers, but out-of-network services will usually cost more.

Private Fee-for-Service (PFFS) Plans

Private Fee-for-Service (PFFS) plans have set terms for how much you will pay healthcare providers for their services. Many PFFS plans form contracts with a network of providers who have agreed always to treat patients that are enrolled in that plan, regardless of if you’ve never seen them prior. It is possible to receive out-of-network care, but out-of-network healthcare providers must agree to your PFFS plan’s terms before your policy can cover those services.

Special Needs Plans (SNPs)

Special Needs Plans (SNP) limit enrollment to people who have specific ailments or characteristics. Their programs are often tailored to exactly fit the needs of their beneficiaries. When enrolled in an SNP plan, you will normally need to seek care from healthcare providers within your plan’s network.

Grutz Financial can help you get started with Medicare Advantage, contact us now to learn more.

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