Medicare Advantage is a type of Medicare health plan. Offered by private insurance companies approved by Medicare, these plans are an “all in one” alternative to Original Medicare. Plan participants still have Medicare and must be eligible for Original Medicare to join. These plans can provide benefits above and beyond Original Medicare, such as Dental, Vision, Hearing, Transportation, Meals, and much more. 22 million people were enrolled in MA plans in 2019, continuing an ongoing and upward trend. That’s 34% of Medicare beneficiaries!
Medicare Advantage plans are considered Part C of Medicare and provide coverage for Part A and Part B benefits. Often a Medicare Part C plan will include Part D prescription drug coverage, and be considered a Medicare Advantage Prescription Drug Plan (MAPD). Part C plans that do not include drug coverage are typically called MA-Only Plans. These MA-Only plans are often an appropriate choice for someone who receives their prescription coverage through the Veteran’s Administration or as a retiree group benefit.
Medicare Advantage health plans are similar to private individual or group health insurance. Most services, such as office visits, lab work, surgery, and many others, are covered after a small co-pay. Plans might offer designated provider network and all plans place a yearly limit on total out-of-pocket expenses. Each plan has different benefits and rules… Some require a referral to see a specialist while others won’t. Some will cover a portion of out-of-network care, while others may cover only network doctors and facilities.
Selecting a plan with a low or no annual premium can be important. To best estimate possible annual expenses, it is also essential to check co-pay and Maximum Out of Pocket (MOOP) costs, especially for expensive hospital stays and procedures. The quality and size of a particular plan’s network and drug formulary can be an important factor. Plan benefits change only once per year, but network and covered medications can be added or removed throughout the year. Benefit changes are summarized in the Annual Notice of Change (ANOC) packet mailed by every company to its plan members each fall.
Medicare Advantage plan types are typically described by the type of network they operate on, or by the special circumstances of the people they serve. Both plan type and geography are important factors in plan selection.
Medicare Advantage Plan types include:
- Medicare Health Maintenance Organization (HMO)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service (PFFS)
- Point of Service (HMO-POS)
- Medicare Medical Savings Account Plans (MSA)
- Medicare Special Needs Plans (SNP)
- Medicare-Medicaid Special Needs Plans (DSNP)
- Chronic Disease Special Needs Plans (CSNP)
Geography plays a big role in Medicare Advantage plan eligibility- these products are available on a county-by-county basis, using the plan member’s home address to determine coverage offerings. A permanent move to a new area will generally trigger a special enrollment period (SEP) for people who already had coverage prior to their move. To ensure compensation eligibility, it’s important to maintain the proper state licensing and appointments. UAR works hard to ensure proper Ready-to-Sell status for all our Medicare agents.
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