Medicare Advantage Plans
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There is a lot to think about when considering Medicare Advantage insurance and we are here to assist you. Our knowledgeable agents can help you find the plan that best fits your needs and budget – now and in the future.
Medicare Open Enrollment for the 2013 Annual Election Period begins on October 15th and runs through December 7th.
What Is Medicare Advantage Insurance Coverage?
Medicare Advantage plans are private health insurance policies offered from approved providers like Anthem Blue Cross and Blue Shield, Aetna, Humana, Coventry, United Healthcare and several others. Sometimes they are referred to as MA, MAPD or Part C policies and they are typically HMO or PPO type policies. That is to say these plans use their own networks of doctors and hospitals.
When you enroll in an Advantage plan, you still have Original Medicare A and B benefits, but these benefits are administered by the MA provider that you have chosen. You will still pay your Medicare Part B premiums to the government as before and in some cases you will also pay premiums to your chosen MA provider. (Some Advantage carriers do offer plans with no monthly premiums.)
By law, Ohio Medicare Advantage plans must cover all the benefits of Original Medicare Parts A and B except for hospice care. Hospice care is still administered by the the federal government under Original Medicare.
It is important to note that an Advantage plan is not the same as Medicare supplement coverage (like Plan F for instance.) These two insurance options are very different and, by rule, you cannot purchase both. You either enroll in one or the other depending on your insurance needs and budget.
What Are The Costs Associated With MA Coverage?
MA insurance plans do not cover everything. All plans will have some amount of out-of-pocket expenses in the way of doctor’s office copays, coinsurance, deductibles, etc. It is important to understand your out-of-pocket exposure before enrolling.
Almost all Advantage plans offer discounts for using the pre-approved network of health care providers and facilities for care. Should you be out of network for non-emergency care, then your out-of-pocket expenses will likely be greater than had you stayed in network.
Some plans will require a referral for you to see certain doctors and/or specialists. It is very important to make sure that your primary care physician (or other doctors you see regularly) accepts the Advantage plan that you are considering before purchasing the coverage.
Additional Benefits Offered By Some Part C Providers
MA plans will cover a variety of services above and beyond Original Medicare.
Most insurance plans include prescription drug coverage and some will offer dental, vision, hearing, wellness and gym membership benefits.
Added benefits are unique to MA coverage and make them different than a traditional Medicare supplement. By rule, Medicare supplements providers cannot offer Part D prescription drug coverage, dental, vision, hearing and other ancillary benefits unless they are sold on a stand-alone basis.
Some Medicare supplement providers offer gym memberships (like Silver Sneakers) but that will also be separate from the actual supplemental plan you have chosen. In this way, Advantage plans are allowed to include some ancillary benefits (Prescription Part D being the most common) that a Medicare supplement cannot.
Enroll In And Disenroll From Medicare Advantage
There are only certain times of the year that you can enroll and disenroll from Medicare Advantage coverage. Once you are eligible for Medicare Parts A and B (usually at age 65) then you can purchase coverage during your six month open enrollment window.
Once you are enrolled in a plan however, there are only certain times of the year when you can disenroll or change plans. This is referred to as the Annual Election Period – or AEP for short. The Annual Election Period typically runs from the middle of October thru the first week of December. If you leave your service area or your plan makes changes mid-year, you may also be able to disenroll.
Once you have enrolled in an Advantage plan, you can also disenroll during a special period of time that runs from January 1 thru February 15th directly after AEP. This would allow you to switch back to Original Medicare A and B with the federal government and purchase a Part D prescription plan. However, you may not be able to automatically purchase a Medicare supplement.
Medicare Advantage Insurance One Year Trial Period
Medicare rules allow for a one year grace period for consumers to try a Medicare Advantage plan in Ohio. After one year, you can move back to Original Medicare, re-enroll in your old Medicare supplement, or purchase a new one if you were new to Medicare Part B the year before.
After the one year grace period, Medicare supplement companies will require some amount of medical underwriting and can turn you down if you do not meet their health standards. It is important to be aware of this one year window once enrolled in a MA plan for the first time.
Pros And Cons Of Medicare Advantage Plans
Let’s start with the pros. Many seniors like MA plans because they are usually less expensive than a traditional supplement. Assuming the plan also includes Part D drug coverage, then the monthly premium savings can be significant when compared to a traditional supplement.
And it’s also a plus if your regular doctors and hospitals all participate in and accept your chosen MA coverage. You will not have to worry about where you receive care and will enjoy the savings they provide.
There is a downside to signing up for network driven coverage as well. The most common complaint MA members have is the network restrictions. If you are referred to a specialist or rehabilitation facility that does not accept your plan, then your out-of-pocket expenses can be much higher.
And once you have been in a MA plan for more than one year, it is difficult to leave the plan and purchase a non-network driven plan (like a Medicare supplement) if you are in poor health. Medical underwriting requirements may exclude some applicants from coverage with most if not all supplement providers.
Typically when consumers want to leave a Medicare Advantage plan and purchase a supplement it is because they are experiencing high out-of-pocket costs and/or running into network restrictions. At this point, it can be difficult to medically qualify for a supplement if the one year grace period has passed.
It is important to note that if your MA carrier drops coverage in your area or you leave their service area, then in most cases you will be provided a guaranteed issue period of time when you can purchase a new Advantage plan as well as some Medicare supplements without the need for medical underwriting.
Contact Us For Quotes, Coverage Options And Details
Hyers and Associates, Inc. is a full service, independent Medicare insurance agency based in Ohio. We offer both Advantage and Supplement plans to those who are eligible or soon to be eligible for Parts A & B in several states.
We represent all of our carriers direct – at no additional cost to you. Contact us for more information or to discuss your insurance options today.