MEDICARE ADVANTAGE (PART C)

A Medicare Advantage Plan is a Medicare health insurance plan option. Medicare Advantage Plans, sometimes called “Part C”, are offered by private insurance companies that are approved by Medicare.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan (associated with HMO or PPO networks) are a Medicare health plan choice you can make instead of Medicare Supplement.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies and offer Medicare approved plans.

If you join a Medicare Advantage Plan, the plan will provide coverage for Part A (Hospital Insurance) and Part B (Medical Insurance) and often include Part D prescription coverage. Medicare Advantage Plans may offer extra coverage.

The Center for Medicare Services pays a monthly fixed dollar amount to the insurance companies that offer Medicare Advantage Plans. The insurance companies must follow minimum benefit coverage requirements set by Medicare. However, each Medicare Advantage Plan (as set by the insurance company), is able to charge different copay, coinsurance, and out-of-pocket maximum amounts for each service offered. For example,some plans require referrals to see specialists, each plan has a network of physicians to choose from. These requirements update in January of each year.

Different Types of Medicare Advantage Plans

  • (HMO) Health Maintenance Organization - provides in- network coverage only, unless urgent or emergent
  • (PPO) Preferred Provider Organization - providens in and out-of-network coverage at different costs
  • (SNP) Special Needs Plan- *requires specific conditions
  •   (D-SNP) Dual Special Needs Plan. * Medicaid eligibility is required
  •  

How Much Does a Medicare Advantage Plan Cost?

In addition to your Medicare Part B premium, you usually pay a monthly premium to the insurance company for the plan itself. In addition to the plan premium and Part B premium, each Medicare Advantage Plan can charge different copay, coinsurance, and out-of-pocket maximum amounts for each service offered. The combination of factors changes your true overall cost for a Medicare Advantage plan.

Costs to consider before purchasing a plan:  

  • Monthly plan premium, if any.
  • Monthly Medicare Part B premium reimbursement, if any.
  • Plan deductible, if any for medical and/or prescription.
  • Copayment or coinsurance for each visit or service obtained.
  • The type of health care services you need and how often you use them.
  • Are you using in-network or out-of-network providers.
  • Do you need or want additional benefits offered by the plan that may add premium.
  • The plans annual out-of-pocket maximum.

Different Types of Medicare Advantage Plans

Not all Medicare Advantage Plans work the same way. Before you enroll into a plan, please take the time to find and compare all available Medicare plans in your county. Our agency is here to provide the information to you at your request, or you may use our enrollment tools located on each carrier page and quote page.

A Few Extra Things You Should Know about Medicare Advantage Plans

  • There are specific Enrollment Periods that determine when enrollment into a plan can occur.
  • As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
  • Check with each plan you are considering for coverage on any specific service or prescription you want covered.
  • You must follow plan requirements for care, such as getting a referral to see a specialist, or getting prior approval for certain procedures to avoid higher costs.
  • You can join a Medicare Advantage Plan even if you have a pre-existing condition.
  • If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher depending on the type of Medicare Advantage Plan.
  • If the Medicare Advantage plan you are enrolled with decides to stop participating in your county; you‘ll have a Special Enrollment Period to select another plan or return to Original Medicare.

Annual Enrollment Period

This year, the Annual Enrollment Period (AEP) starts October 15th and ends on December 7th for a January 1st effective date.

Medicare Advantage (MA) plan options are limited by the county you reside in. They are available with prescription drugs (MAPD), and without prescription (MA) benefits. 

Annual Enrollment Period (AEP) is a specific time each year when you can change plans. During the AEP you can switch from one you switch from one plan to any other plan that is available in your county. 

NOTE: If you do not select a plan with prescription benefits (MA) at your enrollment, you will not be able to make a change until the next AEP to a plan which cover prescription drugs (MAPD).

During the AEP you can also switch from a Medicare Supplement (Medigap) plan with or without a Prescription drug plan (PDP) to an MA or MAPD plan. This is also the time where you can move from an MA or MAPD plan to a Medicare Supplement. To do this you will need to complete an application with a health questionnaire. AEP starts October 15th and ends on December 7th for a January 1st effective date. Other than this time, you would need to have a Special Enrollment Period (SEP) available to you. 

Acronyms Index

Important Information about Your Coverage

If you’re happy with your current Medicare Prescription Drug Plan and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.

If you have Original Medicare and you want Medicare prescription drug coverage, you can:

  1. Join a Medicare Prescription Drug Plan
  2. Join a Medicare Advantage Plan (like an HMO, PPO, or Private-Fee-for-Service Plan) or other Medicare Health Plan that offers both health coverage and prescription drug coverage

Note: If you didn’t join a Medicare drug plan when you were first eligible, you may have to pay a penalty to join later.

If you’re happy with your current Medicare Advantage Plan with drug coverage and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.

If you’re happy with your current Medicare Advantage Plan that DOESN’T cover prescription drugs and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue. If you want to add Medicare drug coverage to this plan, call your current plan to speak to a representative. Note that if you didn’t add Medicare drug coverage when you were first eligible, you may have to pay a penalty to add it later.

Call your employer or union benefits administrator to find out how their coverage works with Medicare. You may not be able to have both Medicare drug coverage and your employer/retiree drug coverage at the same time. Joining a Medicare drug plan may limit or end your employer or union coverage for you and/or any family members covered by your plan.

You can apply for Extra Help paying for Medicare prescription drug coverage anytime by filling out and mailing an application to Social Security. There’s no cost or obligation to apply.

Call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778). You can also apply online at www.socialsecurity.gov.

You qualify for Extra Help paying for Medicare prescription drug coverage for one of these reasons:

  • You have Medicare and full Medicaid coverage
  • You get help from your state to pay your Medicare premiums
  • You get SSI
  • You applied and qualified for Extra Help

Additional Medigap Information

  • Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,200 in 2017) before your Medigap policy pays anything.
  • 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
  • You must also pay a separate $250 deductible for foreign travel emergency and there is a $50,000 lifetime maximum benefit.
  • After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($183 in 2017) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L) - [Excess charges do to apply to maximum out of pocket].
  • Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states).
  • 2017 Out of Pocket Limit for Plan K is $5,120.
  • 2017 Out of Pocket Limit for Plan L is $2,560.

Initial Enrollment

  • You must be enrolled in both Medicare Part A and Medicare Part B and live in the plan's service area to be eligible for these plans.
  • You are first eligible during the 7-month Initial Coverage Enrollment Period (ICEP), the 3 months before your 65th birthday, the month of, and 3 months after. CAUTION: You only have one choice so take your time, ask for help and choose wisely.
  • You must continue to pay your Medicare Part B premium in addition to any plan premium shown below.

About the Information Presented

  • This is a web site from CDA Insurance LLC. CDA Insurance LLC is not an insurance carrier, we are an agency that represents many companies offering products to the general public and also to medicare recipients. We do our best to assure that all information presented on our web site is current and accurate.
  • CDA Insurance LLC is not associated with Medicare or the Center for Medicare and Medicaid Services. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov.
  • A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the “gaps” in original Medicare coverage. CDA Insurance LLC is an agency that sells Medicare Supplement plans to medicare beneficiaries. Submitting our online quote request form does NOT affect your current enrollment, nor will it enroll you in a Medicare Supplement plan or other Medicare plans. To apply for coverage you must submit an application for the company and plan that you want.