2022-23 Medicare Advantage Insurance Plans

Our independent insurance agency offers Medicare Advantage plans across the country. You can compare prices, benefits, and coverage options using our services.

There is a lot to know when considering Medicare Advantage insurance and we are here to help. Our knowledgeable agents will help you find the plans that best fit your needs and budget.

We are now in the Medicare Advantage Open Enrollment Annual Election Period (AEP). Pre-AEP runs from October 1st through the 15th. You can only view plans at this time.

Traditional AEP runs from October 15th thru December 7th. This is when you can make changes to your existing coverage for a January 1, 2023 effective date.

Advantage plans are private health insurance policies that by rule must cover the benefits of Original Medicare Parts A & B.

They also help close the gaps associated with Parts A & B while limiting your overall out of pocket exposure. Most Advantage plans also include prescription drug coverage and some will also offer dental, vision, hearing and other benefits.

These policies have names like MA, MAPD or Part C plans. HMO and PPO options are most common. There are several others to choose from like PFFS, Medical Savings Accounts and Special Needs Plans.

Our agency works with all carriers direct and can help you compare benefits, plan design and prices. We are appointed with Aetna, Anthem Blue Cross & Blue Shield, Bright Health, Centene, Cigna, Humana, Medical Mutual of Ohio, MediGold, Lasso, WellCare, United Healthcare AARP and several others.

When enrolled in an Advantage plan, you keep and continue to pay  for Original Medicare A and B. These benefits are administered privately by the MA provider you choose, however. You always pay your monthly Medicare Part B premiums to the government. You also must pay premiums for your chosen MA provider if there are any. (Many Advantage carriers offer plans with no monthly premiums.)

By rule, Medicare Advantage plans must cover all the benefits of Original Medicare Parts A and B except for hospice care. (Hospice care is administered by the the federal government under Original Medicare.) However, MA plans help reduce your out-of-pocket costs not covered by Medicare A & B.

It is important to note that an Advantage plan is not the same as Medicare supplement coverage – like Plans G or F for instance. These two insurance options are very different and by rule, you cannot have both. It’s one or the other. We work with both types.

Medicare Facts & Figures:

• Nearly 68 million Americans are on Medicare
• Of those 68 million, approximately 36% choose Medicare Advantage plans
• The average monthly premium is $30 across the country (many plans cost $0)
• The maximum in-network out of pocket cost is $7,550, but many plans are much less
• The maximum out of pocket costs is $11,300 for PPO type plans
• Enrollment in MA plans has been growing steadily for the last several years
• If you are under age 65, Medicare supplements may not be available in some states

MAPD insurance plans do not cover everything. All plans will have some amount of out of pocket costs – like copays, coinsurance, deductibles, etc. It’s important to understand your out-of-pocket exposure before enrolling in a plan. All plans have a maximum yearly out of pocket for the insured, but these amounts will differ for in and out of network services.

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 you are considering before you enroll.

MA plans cover a variety of services above and beyond Original Medicare. Most policies include prescription drug coverage and some also offer dental, vision and hearing benefits. And many include a free Silver Sneakers gym membership and/or similar fitness program. Others provide rides to doctor’s appointments, free meal delivery during recovery periods and Telehealth benefits.

Medicare Part B Giveback Benefit

One feature our clients are very interested in is the Medicare Part B Giveback benefit. Certain Advantage plans will reimburse a portion of the Medicare Part B premiums you owe the government each month. You can only enroll in one of these plans if it’s offered in your service area or county. Some counties have several policies with the Medicare giveback benefit while others will have none at all.

The amount of your rebate will vary based on the plan you choose. And you want to make sure the plan is a good overall fit for your needs. It should include your most important doctors & hospitals while also covering your prescriptions. The maximum giveback amount ranges from $0.10 up to the full standard premium.

Value-added benefits such as the ones listed above are unique to Medicare Advantage coverage. Medicare supplements, on the other hand, cannot bundle benefits like dental, vision, hearing into their coverage. By rule, Medicare supplements providers cannot offer Part D prescription either. Ancillary items must be purchased separately.

However, some Medicare supplement providers offer gym memberships like Silver Sneakers. In summary Advantage plans are allowed to include ancillary benefits – like Prescription Drug, dental & vision, hearing, Giveback Benefit – that a Medicare supplement cannot.

There are only certain times of the year you can enroll and disenroll from Medicare Advantage coverage once you are a member. However, those who are new to Medicare (or losing group coverage) can enroll using their open enrollment or guarantee issue window.

Once you are enrolled in an Advantage plan, 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 runs from October 15th through December 7th each year. (If you leave your service area or your plan makes changes mid-year, you may also be able to enroll in a new plan outside of AEP.)

Once you have enrolled in an Advantage plan, you can also disenroll during a special period of time known as the Medicare Advantage Disenrollment Period that runs from January 1 through February 15th. This window allows you to switch back to Original Medicare A and B (provided by the government) and purchase a Part D prescription plan. You may also purchase a Medicare supplement, but medical underwriting might be needed.

Medicare rules allow for a one year grace period for consumers to try a Medicare Advantage plan. 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.

If you stay with your MAPD plan beyond the one year window and wish to switch back to Original Medicare and purchase a supplement (like Plan F, G, N, etc.), medical underwriting will be required.

This means your must have reasonable good health in order to enroll with most Medicare supplement providers. It is important to be aware of this one year window once enrolled in a MAPD plan for the first time.

Let’s start with the pros. Many consumers like MA plans because they are usually less expensive than a traditional supplement. Assuming the plan also includes Part D drug coverage, the monthly premium savings can be significant when compared to a traditional supplement and stand-alone Part D insurance combination.

And it’s also a plus if your regular doctors and hospitals all participate in and accept your chosen coverage. You will not need to worry about where you receive care nor out of network issues.

But there can be a downside to network driven MA plans. The most common complaint members have is 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 higher.

And once you have been in a MA plan for more than one year, it can be difficult to leave the plan and purchase a Medicare supplement if you’re 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’s because they are experiencing high out-of-pocket costs and/or running in to 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 or you leave their service area, you will be provided a guaranteed issue window to enroll in a new Advantage or Medicare supplement plan. Medical underwriting will not be required for most policies during these Special Enrollment Periods.

Hyers and Associates, Inc. is a full-service, independent insurance agency based in Columbus, Ohio. We offer 2023 Medicare Advantage plans, Supplements, and Part D policies across the country. Our licensed agents help those who are new to Medicare, losing other coverage, moving to a new service area, and also during the AEP and OEP enrollment windows.

We represent all insurance companies direct – at no additional cost to you. Contact us for more information or to discuss your insurance options today.