Medicare is a national health insurance program that provides health insurance to Americans aged 65 and older. Medicare also provides healthcare insurance services to people with disabilities like end-stage renal disease and amyotrophic lateral sclerosis. Still, they need to get qualified by the SSA. By enrolling in Medicare, you can cover about half of your healthcare expenses by choosing different types of insurance like Parts: A, B, C, and D.
From covering hospital services to outpatient services to self-administered prescription drugs; Medicare comes with many other advantages. Providing a Medicare supplement plan, this program has also brought a Medicare Advantage plan.
Today in this article, we will understand Medicare Advantage plans, their types, how to get one, and the best time to enroll. Without wasting any of our time, let us get started!
Contents
What Is The Medicare Advantage Plan?
Medicare Advantage Plans, which is also known as Medicare Part C, come with additional benefits. It allows you to choose your own plan just like Medicare (Parts A and B) but offers you some wellness programs and other benefits. Here extra benefits may include benefits (some services of Part D) prescribe drug coverage, with additional services like vision and dental insurance.
All these services are provided by private insurance companies. Medicare Advantage Plans cover out-of-pocket expense limits, which Part A and B lack. The best part of this plan is that it works with different healthcare providers and facilities to offer the beneficiary a network of doctors, hospitals, and other healthcare providers.
In some cases, Medicare Advantage Plans require members to use the providers within their network to give its beneficiaries the full range of benefits.
What Are The Different Types Of Medicare Advantage Plans?
Medicare Advantage plans have 4 different types that offer lower co-payments for doctor visits. However, it is important to know that not all Medicare Advantage Plans are the same, and the benefits, costs, and rules can vary depending on the plan and the insurance company offering it.
Medicare might also bring Medicare Advantage plans 2024, but before that, let us get to know about the types of Medicare Advantage plans like Health Maintenance Organization Plans, Preferred Provider Organization Plans, Private Fee-for-Service Plans, and Special Needs Plans (SNPs)
1. Health Maintenance Organization (HMO)
Plans allow you to get services and care from qualified doctors, healthcare providers, and hospitals who are available within the network. But if you are choosing services from out of the network, it might cost you higher co-payment or coinsurance.
If you want to cover Medicare drug coverage (Part D), you must join HMO Plan that offers prescription drug coverage. You need to note that if you take HMO without prescription drug coverage, you cannot join a separate prescription drug plan, i.e., Part D.
2. Preferred Provider Organization (PPO)
Plans benefit you by paying less if you take the services from doctors, hospitals, and other healthcare providers within the network. It also allows you to choose doctors or hospitals outside the networks, but you need to pay high from your pocket. It also offers perceived drug coverage, and you get one by enrolling in PPO Plan that offers Medicare Part D.
3. Private Fee-for-Service Plans (PFFS)
This plan is different from the Health Maintenance Organization plan and Preferred Provider Organization plan it will pay decides what amount it will pay to doctors, other healthcare providers, and hospitals and what amount you must pay for the services you take.
When you take this plan, it creates a contract with the doctors who will treat you, but you need to note that the doctor needs to agree to the terms and conditions provided by the plan. In case of emergency or urgency, if you seek a doctor or hospital outside the network, this plan might not cover these services, or you might need to pay higher.
4. Special Needs Plans (SNPs)
This is specifically designed for people who are facing specific diseases or conditions like HIV, AIDS, or ESRD or for people who are dependent on alcohol. This plan provides you with the best doctors and services within or outside the networks that meet the need of people from a specific group.
How Can You Join Medicare Advantage Plan?
Before joining any of these plans, you need to find and compare the offered medical advantage plans. For that, you need to have Part A and B in place and find out if the Medicare Advantage plan provides coverage in your area. You also need to understand if the plan fulfills all your needs and is accepted by your doctor. After understanding the plan’s rules and costs, you can enroll in the Medicare plan by using Medicare’s Plan Finder, where you will need to add the Zip code of your area.
Later it will redirect you to the website where you will find all the plan details. After that, you must fill the form with all your details like name, contact no. The next step is to call your insurance company from where you choose the plan. Once you sign up for a Medicare Advantage Plan, you must give your Medicare number and Part A or B starting coverage date that is available on your Medicare card.
Note that you do not provide any personal information over the phone, such as credit card numbers or bank account numbers. Medicare does not call you without your permission or come to your home without an invitation to sell Medicare products. If such incidents happen, report a plan to 1-800-Medicare.
What Is The Best Time To Enroll Medicare Advantage Plan?
You must sign up for the Medicare Advantage plan three months before turning 65 years old and three months after your 65th birthday. When you sign up during your initial enrollment period, your insurance coverage will begin on the first of the following month.
Suppose you have already signed up for Medicare and wish to enroll in the Medicare Advantage plan. In that case, you can change and sign up during the Medicare Annual Enrollment period between the 15th of October and the 7th of December of every year. After signing up during this period, your coverage will start from the 1st of January next year.
Conclusion
Medicare gives ample benefits by providing insurance to people who are 65 and above and also to people who are facing critical disorders. This Medicare Advantage plan offers several benefits, such as the best doctor and hospital services. To get services from this plan, you must first enroll in Medicare Parts A and B before signing up for Part C.
Before you choose and enroll in any of the advantage plans, ensure that you understand and read all the plans carefully. By staying informed about the plans and their terms and conditions, you can make the right decision when choosing your insurance.
