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FAQs: What Are Medicare Advantage Plans?

Many Arizonans are looking to Medicare Advantage Plans to replace Medicare Parts A & B. What are these plans, and are they right for your retirement y...
Monday, 23 May 2022

Many Arizonans are looking to Medicare Advantage Plans to replace Medicare Parts A & B. What are these plans, and are they right for your retirement years?

Learn the Advantages of Expanding Your Medicare Coverage

Seniors approaching their 64th birthday are about to enter a whole new world - the world of Medicare. Learning what original Medicare covers and does not cover can be confusing in the extreme. This is one of the many reasons Medicare Advantage Plans have gained popularity in recent years. Finding the right plan for you is essential, as they all come with their own set of pros and cons. 

What Is A Medicare Advantage Plan?

Medicare Advantage Plans are an alternative way to receive the benefits of traditional Medicare Part A and Part B coverage. 

Medicare Advantage Plans (also known as Medicare Part C) are health insurance policies from privately operated Medicare-accredited companies. These private insurers must follow Medicare regulations. Drug coverage (Part D) is frequently included in Medicare Advantage Plans, as are other supplemental benefits that may differ based on the plan you purchase. 

To illustrate the difference between original Medicare and Medicare Advantage Plans, imagine you are going to bake two loaves of bread. The ingredients of the first loaf are very basic, and you likely have them on hand already - flour and water. The loaf from these ingredients may taste rather bland, but the bread does have nutritional value.

The second loaf of bread has the basic ingredients from the first loaf and includes yeast, salt, oil, and spices, which you can personalize according to your palate. 

Whether the first or the second loaf is the right option for you will depend on your dietary needs, budget, and personal tastes.

Original Medicare is like the first loaf of bread. The benefits are more basic, and you have access to these benefits as soon as you turn 65.

Related: When I’m 64: How Should I Be Preparing For Medicare?

A Medicare Advantage Plan can be likened to the second loaf of bread. You have the same benefits as Original Medicare, but you also can add to those primary benefits with additional perks. Depending on the plan you purchase, some of these are prescription drug coverage, dental and vision insurance, gym memberships, wellness classes, and so on. 

Which choice is right for you (or if another, supplemental plan, is right for you) will depend on your personal needs and budget. 

How Do Medicare Advantage Plans Work?

If you decide to enroll in a Medicare Advantage Plan, you will continue to receive all the benefits of traditional Medicare Parts A and B (e.g., coverage for physician visits and hospitalizations) plus additional benefits from your specific plan.

If your plan is a fee-for-service plan, you will have access to a network of providers and services, plus you can go out-of-network and pay for services without any restrictions. 

If your plan is a coordinated care plan, you will be limited to a network of providers who provide medical services that your insurance company approves. 

Finally, if your plan is an HMO, you will have to choose a primary care doctor who coordinates your care and referrals to other providers. You will also have to choose a medical facility as your medical home, with a limited network of providers. The specific providers in your network will be listed in your insurance company’s plan booklet or on their website.

When Can You Sign Up For A Medicare Advantage Plan?

You are eligible to enroll in a Medicare Advantage Plan during the same period you would normally sign up for Medicare, during the three months prior to the month of your 65th birthday month. So, fi you birthday is in May, you can enroll as early as February.  This is for enrollment only, the Medicare benefits don't start until May 1st.

You can also switch from original Medicare to a Medicare Advantage Plan or change your current Advantage Plan during the annual open enrollment period from October 15th through December 7th. 

Essential Things To Know About MA Plans

Since Medicare Advantage Plans are managed care plans, you will have a primary care provider who coordinates all of your care. This provider may be a physician, nurse practitioner, or other licensed healthcare professional. Still, they must be in-network for the insurance company. If you have a medical condition that requires you to see an out-of-network provider, your insurance company may require you to get a referral from your primary care provider. 

MA Plans work similarly to health insurance you may have had before becoming eligible for Medicare. On the one hand, you will likely have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. On the other hand, certain services may be subject to a yearly deductible, which you must pay before the policy kicks in. And depending on how robust your policy coverage is, you may have a monthly premium payment to keep coverage.

Help Deciding Which Medicare Plan is Right For You

In addition to original Medicare and Medicare Advantage Plans, seniors also have options with Medigap Plans. The differences between these plan options can be so minor that they are easy to miss if you try to research them all independently. Rather than floating in a sea of confusion, contact an independent Medicare supplements broker for a lifeline. At Anderson Insurance Services, we help seniors select the best option for their unique needs.

Contact us today to schedule a free Medicare Insurance consultation with one of our experienced brokers.

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