Our independent insurance agency offers Medicare Advantage plans in Ohio (and several other states) direct. You can compare prices, benefits and coverage options online using our services.
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.
The 2017 Medicare Open Enrollment for the Annual Election Period begins on October 15th and runs through December 7th. New coverage will be effective January 1, 2017.
Advantage plans are private health insurance policies that, by rule, must cover the benefits of Original Medicare Parts A & B.
They also help to fill in some of the gaps associated with Parts A & B while limiting the overall out of pocket for the insured. Most Advantage plans also include prescription drug coverage and some will also offer dental, vision and hearing benefits.
These policies are often referred to as MA, MAPD, Medigap or Part C policies. HMO and PPO plans are most common, but 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 for 2016. We are appointed with Aetna, Anthem Blue Cross & Blue Shield, Coventry, HealthSpan, Humana, Medical Mutual of Ohio, United Healthcare Secure Horizons (AARP) and several others.
When you enroll in an Advantage plan, you still have Original Medicare A and B benefits, but these benefits are administered privately by the MA provider that you have chosen. You will still pay your Medicare Part B premiums to the government 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 rule, 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.) MA plans help to reduce the 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 Plan 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.
Medigap Facts & Figures:
- There are approximately 45 million Americans on Medicare
- Of those 45 million, approximately 30% are enrolled in Medicare Advantage plans
- The average monthly premium is $35 across the country (some plans cost $0)
- The maximum in-network out of pocket is $6,700, but some plans are much less
- 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 expenses – 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 can 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 will cover a variety of services above and beyond Original Medicare. Most policies include prescription drug coverage and some will also offer dental, vision, hearing, wellness and gym membership benefits.
Added benefits are unique to MA coverage as traditional Medicare supplements cannot bundle coverage. By rule, Medicare supplements providers cannot offer Part D prescription drug coverage, dental, vision, hearing or other ancillary benefits of these types.
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.
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 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 Ohio. We offer Medicare Advantage plans, supplements, and Part D policies to those who are eligible for Parts A & B. losing other coverage or shopping during the Open Enrollment AEP window. We work in several states across the country.
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.
