Medicare Advantage Plans

Also known as Medicare Part C, Medicare Advantage plans are another way to get healthcare coverage for Medicare Part A and Part B. Medicare-approved private insurance companies offer Medicare Advantage plans under contract with the federal government. As a result, they’re required to follow specific guidelines set by Medicare.

In most Medicare Advantage plans you’ll need to use healthcare providers from a specific network. Also, you’ll be glad to know that most Medicare Advantage plans include Medicare Part D coverage for prescription drugs.

What Types of Medicare Advantage Plans Are There?

Currently, there are 5 types of Medicare Advantage plans: health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, private fee-for-service (PFFS) plans, special needs plans (SNP), and Medicare Advantage medical savings account (MSA) plans.

• HMO plans: Provide healthcare coverage from doctors, other health care providers, and/or hospitals in the plan’s network.
• PPO plans: Provide healthcare coverage from your preferred doctors, specialists, and healthcare facilities regardless whether they’re in your plan’s network or not.
• PFFS plans: Provide healthcare coverage from a contracted network of providers.
• SNPs: Provide healthcare coverage to people with specific diseases or conditions.
• Medicare Advantage medical savings account (MSA) plans: Provide original Medicare benefit coverage with additional benefits, but requires high deductibles along with a bank account for medical costs.

What Coverage Does Medicare Advantage Provide?

Medicare Advantage coverage includes:

• Inpatient healthcare: covered by Medicare Part A
• Outpatient healthcare: covered by Medicare Part B in general
• Inpatient hospital care and inpatient care in skilled nursing facilities as well as home healthcare: covered by Medicare Part C (same services as Medicare Part A)
• Hospice care: covered by original Medicare (Medicare Part A and Medicare Part B)
• Possible extra benefits: routine dental, hearing, and vision care, fitness benefits (e.g., SilverSneakers membership), healthcare product allowance, and emergency medical assistance while traveling outside the U.S.

How much Will Medicare Advantage Cost Me?

Medicare Advantage plan costs vary widely: from free or low-cost plans to several hundred dollars per month. Accordingly, higher-cost plans offer more benefits than lower-cost plans (e.g., a wider medical provider network, more specialized care coverage, and better cost-sharing benefits). Medicare Part C costs are determined by factors such as premiums, deductibles, copayments, and coinsurance. The plan you choose determines most of your Medicare Part C costs.

When Can I Enroll in Medicare Advantage?

If eligible for Medicare, you’ll be able to enroll in a Medicare Advantage plan during the following periods:

• Initial enrollment period: 7-month period starting three months before the month in which you turn 65 and ending three months after the month you turn 65.
  If under 65 and receiving Social Security disability benefits, you’ll qualify for Medicare in the 25th month after you begin receiving them; also, you can enroll in a Medicare Advantage plan 3 months before your month of eligibility until 3 months after you’ve become eligible.
• Open enrollment period: October 15 through December 7 every year.
  Once you’ve made your selection, Medicare Part C plan coverage will begin on January 1st of next year, and you’ll be able to also change, add, or drop current healthcare coverage.
• Medicare Advantage open enrollment period: you can change from one Medicare Advantage plan to another or drop Medicare Advantage to return to original Medicare.
• Special election period: you may qualify if you move outside your Medicare Advantage plan’s service area, qualify for extra help (e.g., program that helps pay for prescription drugs), or move into a nursing home, and you’ll be able to make changes to your Medicare Advantage plan or return to original Medicare.
• Specific times: Medicare Part C enrollment.

What Medicare Advantage Plans Are There for Special Needs?

SNPs are for people who live in institutions such as nursing homes, who live in the community but need at-home nursing care, those who are eligible for Medicare as well as Medicaid, and those who have certain chronic or disabling conditions. All Medicare Advantage Special Needs plans provide drug coverage (Medicare Part D), but require you to have a primary care doctor and, if you need to see a specialist, get a referral. You can enroll in SNP any time as long as you’re eligible for this type of plan.

How Does Medicare Advantage Work with TRICARE?

If you’re 65 and have TRICARE, you’re also eligible for Medicare and Medicare Advantage.

TRICARE offers comprehensive medical benefits for active and/or retired military personnel, spouses, and dependents. The TRICARE health insurance program is accepted worldwide.

If you enroll in TRICARE and Medicare Advantage, your Medicare Advantage plan will be your primary healthcare insurance plan and TRICARE will be your secondary health plan. Be careful, however, where you receive healthcare services because Medicare Advantage plans require that you use their provider network for healthcare services.

ALERT: When filing a claim, you may need to file a secondary claim with TRICARE after your Medicare Part C plan pays a claim because Medicare Advantage plans don’t automatically coordinate with TRICARE.

Also, please see our Frequently Asked Questions about Medicare page.

Need Help?

If you’d like to save time and money, please contact us at California Medicare Help, and we’ll help you choose the right Medicare Advantage plan for your specific situation.

Click on Get a Quote above and receive:
1. Medicare quotes for every major Medicare insurance plan in your zip code
2. Medicare Advantage and Supplement plan outlines
3. Your net prescription drug costs
4. Plus search for all plans your physicians accept
Self-enroll or text 1-707-478-0210 for fast help