If you’ve overheard your friends talking about their Medicare Advantage plan, and would like to know more, you’re not alone. Medicare Advantage also called “Part C”, is a popular choice because it provides seniors with coverage beyond Original Medicare. Medicare Advantage plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans. Cost, coverage, and rules for how you receive services vary from plan to plan, and comparing each type is a smart way to secure coverage that fits your needs.
Different Types of Medicare Advantage Plans
Health Maintenance Organizations (HMOs)
An HMO plan typically requires that you select a primary care doctor from the plan’s network of providers. In most cases, you’re required to use doctors, health care providers and hospitals within the plan’s network, except in an emergency. You may need a referral to see a specialist. Compared to other plans, an HMO can be a cost-effective option, but you may pay the full cost of care if you do not follow the plan’s rules. Prescription drug coverage is usually covered but individual plans vary.
Preferred Provider Organizations (PPOs)
PPOs tend to be less restrictive than HMOs, but increased flexibility can cost you more. You do have the option to use any doctor, specialist, or hospital you choose, but you will pay less if you stay within the plan’s network. A referral is generally not required to see a specialist. Prescription drug coverage is often covered, but individual plans vary.
Private Fee for Service Plans (PFFSs)
With a PFFS plan, the plan decides how much it will pay doctors and hospitals, and how much you will pay. If the plan has a network of providers, you don’t need to go to doctors or hospitals on the list. However, not all Medicare providers accept the PFFS plan—an important fact to know. Typically, with a PFFS plan, you do not need to get a referral to see a specialist. Prescription drug coverage may be covered, but individual plans vary.
Special Needs Plans (SNPs)
Membership in an SNP is limited to people with specific diseases or who have specialized health needs. If you have a severe chronic condition, live in a nursing home, or receive both Medicare and Medicaid, you may be eligible. Benefits are tailored to meet the needs of the groups they serve and care is often limited to doctors and hospitals in the plan’s network. You may need a referral to see a specialist. All SNPs must provide Medicare prescription drug coverage.
Making Sense of Different Plans
Understanding the differences between the various types of Medicare Advantage plans will help you make an informed decision. Factors like cost, referrals and whether or not you can use doctors outside a plan’s network vary greatly—but can significantly impact your ability to receive affordable, timely care.
When comparing plans, be sure to think about the type of health care you need and how often you visit your doctor. While cost is a big consideration, it should not be the deciding factor.
Now that you’ve decided to join Medicare Advantage (Part C) as a way to receive your Medicare benefits, you may be wondering when you can enroll. Medicare only allows you to join, switch or make changes at very specific times—when you first get Medicare and during yearly enrollment periods. It’s important to know when these specific deadlines occur to avoid missing them and delaying your health care coverage.
Initial Enrollment Period
When you first become eligible to receive Medicare, you enter your Initial Enrollment Period. This is a 7-month period of time that begins 3 months before your 65th birthday, includes your birthday month and ends 3 months after. For 7 full months, you are in your unique initial enrollment period and can sign up for Medicare Part C. In most cases, this is the best time to join. However, if you didn’t join and you already have Original Medicare, you can still join a Medicare Advantage plan during other enrollment periods.
Other Enrollment Periods
Annual Enrollment extends between October 15 and December 7. During this time, anyone can join, switch or drop a Medicare Advantage plan. As long as the plan you are requesting receives your information by December 7, your new coverage will begin on January 1. During Annual Enrollment, you can:
Change from Original Medicare to a Medicare Advantage plan.
Change from a Medicare Advantage Plan back to Original Medicare.
Switch from one Medicare Advantage plan to another Medicare Advantage plan.
Open Enrollment is the opportunity to make a change after the Annual Enrollment Period. During this time, it is possible to change from a Medicare Advantage Plan to Original Medicare plus a Part D Plan or switch from one Medicare Advantage Plan to another. The Open Enrollment Period is from January 1st to March 31st. Any changes take effect the following month.
Special Enrollment periods were created for people to join and make changes to Medicare Part C when circumstances make it difficult for them to meet regular enrollment periods. For instance, if you move, lose your current coverage, have the opportunity to get other coverage, or meet one of several other special situations, you can usually join, switch or drop a Medicare Advantage plan.
For example, if you are enrolled in Medicare Part C, but move to a new address with better coverage available, you have 2 months to switch plans. If you were living abroad, but are now back in the United States, you have 2 months to join a Medicare Advantage plan. Or, if you lose coverage through an employer (COBRA included) you typically have 2 months to join a Medicare Advantage plan. While there are many special circumstances that may qualify for Special Enrollment, here is a quick summary of the main conditions that meet Special Enrollment criteria:
Move to a new address, move back into the country or move into or out of a nursing home or assisted living facility.
No longer being eligible for Medicaid or extra help, or losing employer coverage.
Have your current Part C plan terminated by Medicare or not renewed.
Reviewing Coverage and Switching Medicare Advantage Plans
When the goal is to spend the least amount of money for the most amount of coverage, you owe it to yourself to get the best deal you can with Medicare Part C. Initial Enrollment is usually the best time to sign up, but once you have coverage, Annual Enrollment (Oct 15 – Dec 7) is a great time to make changes to an existing plan or switch between plans. If you miss the December 7 deadline, you can still drop your current Medicare Advantage plan and return to Original Medicare during Medicare Advantage Dis enrollment (Jan 1 – Feb 14).
If you leave your plan and return to Original Medicare, you have until February 14 to join a prescription drug plan. However, you may not switch from Original Medicare to a Medicare Advantage plan or switch between Medicare Advantage plans during this time.
Even if you think your current Medicare Advantage plan meets your needs, it makes sense to look over new coverage options. Shopping around for better rates and benefits for the upcoming year is a smart way to make sure you’re getting a plan that fits your health care needs and your budget.
Are you new to Medicare? If you’re not quite 65, but you’re anxious to explore your options with Medicare Supplement insurance, here’s some information that can help. Even if you’re already a recipient of Medicare, taking a few minutes to understand what to look for when choosing a Medicare Supplement Insurance plan is smart.
Medicare Supplement can help you pay for many of the out-of-pocket expenses associated with Medicare, like deductibles, coinsurance and copayments. But, there’s more to each supplement plan than meets the eye. Knowing what to look for—and what to ask yourself—can help you choose the right plan to fit your needs and budget. Ready to go browsing? Here are the top three questions to ask yourself when shopping for Medicare Supplement insurance.
What are my current and future healthcare needs?
While it’s not always possible to predict the type of health care that you will need in the future, there are some things that you will know ahead of time to help you narrow your choices. For instance, all but two supplement plans include coverage for foreign travel. If you are sure you will not be traveling out of the country, consider looking at plans that do not offer this coverage to potentially reduce your premium.
In addition to thinking about the coverage you don’t need, take some time to identify the coverage you will need. For instance, if a current medical condition requires you to visit your doctor on a regular basis, look for plans that pay the entire Part B coinsurance or copayment amount.
Which plans best meet my financial needs?
Remember, with all Medicare Supplement insurance, you will be responsible for paying a monthly premium for your supplement plan, as well as your Medicare Part B Premium. And, if you take prescription drugs, you will likely need to purchase Part D, prescription drug coverage. Beyond these three initial costs, any other out-of-pocket expenses will vary, based on which supplement plan you choose. For instance, Plan C and F are the most comprehensive, with coverage for almost all out-of-pocket expenses you are likely to face. While you won’t need to pay each time you visit the doctor, your monthly premium for these plans may be higher than those offering less coverage.
Each plan offers slightly different benefits, with monthly premiums that vary. Think about how much money you can budget for medical care, and compare plans side-by-side to identify the coverage that fits those needs. Find the right combination of benefits that work for your budget, and then shop around to find the best price.
Have I compared the costs of the plans I like at a few different companies?
The federal government standardizes all Medicare Supplement plans. That means that all Plans F or K, or C for example, must include the same benefits, regardless of the company that sells them. This makes it easy for you to compare premium amounts for different plans without having to keep track of benefits. Remember, there are major differences between companies in price. It’s critical that you compare the plans you are interested in at a few different companies in your area.
Like many seniors, if you’re struggling to pay for your health care costs, you may be wondering how Medicare Supplement insurance can help. With benefits for out-of-pocket expenses like deductibles, coinsurance, and copays, the right supplement plan can help you keep more money in your pocket where it belongs.
Plans are named after letters of the alphabet, with each letter representing a different combination of benefits. While all plans must offer a basic level of coverage, there are major differences between them, and it makes sense to compare plans to find one that meets your needs.
Seniors looking for comprehensive coverage often turn to Medicare Supplement Plan F, G or N. With the most benefits, these are the plans seniors look to when customizing a health plan with low out-of-pocket costs. Here’s some information on Medicare Supplement Plans N, F, and G—a quick resource for you to compare plan benefits to make the right choice.
Medicare Supplement Insurance Plans are Standardized
You may have heard the term standardized when talking about Medicare supplement plans. All that means is that policies with the same letter must include the same benefits. Insurance companies selling Medicare Supplement insurance are required by law to sell standardized policies. In other words, a Plan F from one company must include the same benefits as a Plan F offered through another company. However, companies are not required to charge the same for the same plans—and they don’t. It’s smart to compare plans for not only the right benefits but also, the right cost.
Comparing Medigap Plans F, G and N
While there are many different combinations of benefits offered through Medigap, Plans F, G and N are the most popular. With more coverage than any other supplement plan available, these are the three plans offering the most coverage for out-of-pocket expenses.
Plan F includes the following:
Part A & Part B coinsurance, copayment
Part A & Part B deductible
Part B excess charges
First 3 pints of blood
Hospice care &skilled nursing coinsurance
Foreign travel emergency coverage
Plan G includes the following:
All the benefits of Plan F except Part B deductible
Plan N includes the following:
All the benefits of Plan F except Part B excess charges AND Part B deductible
Plan F is a good choice if you visit the doctor frequently, and expect to face many out-of-pocket expenses. Plan G and Plan N offer almost everything Plan F offers. Remember, different Medigap plans are standardized, but prices vary significantly between companies. After choosing the plan that works best for your needs, take some time to review a few different companies to find the best price.
Each fall, if you are enrolled in a Medicare Advantage Plan or a Medicare Prescription Drug Plan (Part D), you will receive a “Plan Annual Notice of Change” (ANOC) in the mail. If this is your first notice, or you’re unsure what you are supposed to do with this information, you may find this article helpful.
Understanding the Medicare Annual Notice of Change
In late September, members of Medicare Advantage and Part D will receive a “Plan Annual Notice of Change”. The ANOC is sent by your plan to inform you of any changes in coverage, costs, or service area that will take effect in January. All Medicare plans are required to send this document no later than September 30, or 15 days before the start of the Annual Enrollment Period. The ANOC is usually mailed with your plan’s Evidence of Coverage (EOC), or documentation that goes into more detail about all of your plan’s cost, coverage and benefits—beyond any new changes.
What You Should Do
In September, when you receive your ANOC in the mail, you should review any changes to make sure your plan will continue to meet your needs for the upcoming year. Plans often make annual changes to costs and benefits, which means that your copay could change, as well as which providers are in-network or out-of-network. When reviewing, be sure of the following:
Providers, services and drugs you use are still available and covered under your plan.
Any out-of-pocket cost for care and services is understood.
If you decide that upcoming changes to your plan will not fit your needs, you may want to change your Medicare coverage during Annual Enrollment (October 15 – December 7). This is your time to review available plans to find one that meets your individual needs best. Of course, if your plan isn’t changing, or new changes will not affect you, you don’t need to do anything at all and you will continue to receive the covered services and care you have now.
Note: If for some reason you do not receive this document by September 30, contact your plan immediately.