Medicare Advantage Information

What are Medicare Advantage Plans?

Additional Benefits for Medicare

Medicare Advantage (MA) plans are health plans offered by private insurance companies that combine Medicare Part A (Hospital) and Medicare Part B (Medical). Many MA plans also include Part D (Prescription Drug) and additional benefits not provided by Original Medicare, such as dental, vision, hearing, and wellness programs.

When can I enroll into a Medicare Advantage Plan?

Enrollment Periods

Keep in mind that there are enrollment periods. Enrollment periods are certain seasons or months of the year where you are allowed to join or switch a Medicare Advantage Health Plan.

Initial Enrollment Period (IEP): Begins three months before your 65th birthday and ends three months after.
Annual Enrollment Period (AEP): October 15 to December 7 each year, when you can switch to a different MAPD plan or join one if you are not already enrolled.
Open Enrollment Period: Occurs between January 1st to March 31st, allowing current MA plan beneficiaries to switch plans or return to Original Medicare.

How do I know if this Medicare Advantage Plan is good for me?

Choosing the Right Health Insurance Plan

Selecting the right Medicare Advantage plan can seem overwhelming, but breaking down the decision-making process can help you find a plan that is more suitable to you. Here are some factors you can consider:

Chronic Conditions and Special Needs: If you have ongoing health concerns such as diabetes, heart disease, or to her chronic conditions, consider an MA plan tailored to specific health needs, like a C-Special Needs Plan (CSNP).
Understanding the Formulary: Each MAPD plan has a formulary, or a list of covered drugs, which categorizes medications into different tiers. Lower-tier drugs typically have lower copayments, while higher-tier or specialty drugs may have higher costs.
Checking Your Medications: Ensure your prescriptions are included and covered in the health plan’s formulary and identify which tier they fall under.
Evaluate Network Restrictions and Flexibility:
- Preferred Providers: Some plans, like Health Maintenance Organization (HMO) plans, restrict you to a network of approved doctors and hospitals. Make sure that your preferred providers are in-network to avoid unexpected costs.
- Out-of-Network Options: If flexibility is important, a Preferred Provider Organization (PPO) plan may be a better fit, as it allows you to visit out-of-network providers at a higher cost. However, be mindful of the potential for higher premiums and out-of-pocket expenses.
- Specialists and Referrals: Consider if the plan requires referrals to see specialists, as this can impact your convenience and access to specialized care.

For detailed information about Medicare plans, including benefits, coverage, and plan options, please refer to the plan’s Summary of Benefits or call 1-800-MEDICARE (TTY users call 1-877-486-2048) or visit www.medicare.gov.