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MEDICARE ADVANTAGE PLANS
These are plans offered by Insurance companies that include Part A and Part B of Medicare along with the option of Drug Coverage.
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EXPLORE YOUR MEDICARE OPTIONS...
What Are Medicare Advantage Plans?
These plans allow Medicare beneficiaries to receive Medicare-covered benefits through private health plans which may also include extra benefits such as prescription drug coverage. In exchange for the benefits, coverage may be limited to network of providers. 
STEP 1 - MEDICARE ADVANTAGE PLAN OPTIONS
Plans are offered by the county that you live... |
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WE ARE HERE TO HELP YOU!We are here to help you understand and select the plan that works best for you. Call our office at (360) 722-7889
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Part B Premium
The standard Part B premium amount is $148.50 (or higher depending on Income). Part B deductible and coinsurance $203; 20% copay thereafter |
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Part C (Medicare Advantage Plans)
Medicare Part C are not a separate benefit; Part C refers to Medicare Advantage plans, which combine your benefits from Parts A, B, and sometimes D (prescription drugs) in a single plan.
Medicare Advantage plans are offered through private companies and must be approved by the Centers for Medicare & Medicaid Services (CMS). These plans can offer additional benefits such as vision, hearing, and dental benefits, and health and wellness programs.
To ensure your care is covered, you may need to receive your care within the plan's specific provider networks and at preferred hospitals.
Medicare Advantage plans usually feature:
Medicare Part C must cover all of the services that Parts A and B
cover except hospice care (still provided by Original Medicare).
Eligibility
To enroll in a Medicare Advantage plan, you must:
Note: You are eligible to enroll in Original Medicare (Medicare Part A and Part B) if you have been diagnosed with end stage renal disease (ESRD). However, you are not eligible to enroll in Medicare Advantage plans if you have that diagnosis.
Types of Medicare Advantage Plans
HMO
HMO (Health Maintenance Organization) plan members generally see doctors, specialists, or hospitals that are part of the plan's network, except for an emergency, out-of-area urgent care, or out-of-area dialysis.
PPO
A PPO (Preferred Provider Organization) plan has a network of providers, but members can also use out-of-network providers for covered services. Typically in-network services cost the member less out of pocket than out-of-network services. Providers must accept Medicare to ensure care is covered.
SNP
A SNP (Special Needs Plan) is a type of Medicare Advantage plan that is limited to certain Medicare beneficiaries, such as those in certain care facilities (like nursing homes), those eligible for both Medicare and Medicaid, or those with certain chronic or disabling conditions. Members generally see doctors, specialists, or hospitals that are part of the plan's network, except for an emergency, out-of-area urgent care, or out-of-area dialysis.
MSA
An MSA (Medical Savings Account) plan combines a high-deductible health plan with a Medical Savings Account that members can use to manage their health care costs. Once the deductible is met, the plan covers 100% of Part A and Part B costs. Also:
PFFS
A PFFS (Private Fee-For-Service) plan is a type of Medicare Advantage plan in which a beneficiary is not limited to a specific network of providers. An enrollee may receive covered services from any provider in the United States who accepts Medicare and agrees to the PFFS plan's terms and conditions for payment. Providers are not required to accept PFFS plan enrollees, and may or may not decide to provide care to beneficiaries. It is the responsibility of the enrollee to notify a provider of their PFFS coverage prior to the visit.
Medicare Part C are not a separate benefit; Part C refers to Medicare Advantage plans, which combine your benefits from Parts A, B, and sometimes D (prescription drugs) in a single plan.
Medicare Advantage plans are offered through private companies and must be approved by the Centers for Medicare & Medicaid Services (CMS). These plans can offer additional benefits such as vision, hearing, and dental benefits, and health and wellness programs.
To ensure your care is covered, you may need to receive your care within the plan's specific provider networks and at preferred hospitals.
Medicare Advantage plans usually feature:
- No or minimal medical deductibles
- Simple co-pays for most covered services
- Limits on your out-of-pocket expenses
- Coverage for urgent or emergency care when traveling outside the United States.
- Coverage for chiropractic care
- Fitness benefits
Medicare Part C must cover all of the services that Parts A and B
cover except hospice care (still provided by Original Medicare).
Eligibility
To enroll in a Medicare Advantage plan, you must:
- Be entitled to Part A and enrolled in Part B.
- Maintain a permanent residence for at least 6 months out of the year in your chosen plan's service area.
- After you enroll, continue to pay your Part B premium as well as any Medicare Advantage plan premium.
Note: You are eligible to enroll in Original Medicare (Medicare Part A and Part B) if you have been diagnosed with end stage renal disease (ESRD). However, you are not eligible to enroll in Medicare Advantage plans if you have that diagnosis.
Types of Medicare Advantage Plans
HMO
HMO (Health Maintenance Organization) plan members generally see doctors, specialists, or hospitals that are part of the plan's network, except for an emergency, out-of-area urgent care, or out-of-area dialysis.
PPO
A PPO (Preferred Provider Organization) plan has a network of providers, but members can also use out-of-network providers for covered services. Typically in-network services cost the member less out of pocket than out-of-network services. Providers must accept Medicare to ensure care is covered.
SNP
A SNP (Special Needs Plan) is a type of Medicare Advantage plan that is limited to certain Medicare beneficiaries, such as those in certain care facilities (like nursing homes), those eligible for both Medicare and Medicaid, or those with certain chronic or disabling conditions. Members generally see doctors, specialists, or hospitals that are part of the plan's network, except for an emergency, out-of-area urgent care, or out-of-area dialysis.
MSA
An MSA (Medical Savings Account) plan combines a high-deductible health plan with a Medical Savings Account that members can use to manage their health care costs. Once the deductible is met, the plan covers 100% of Part A and Part B costs. Also:
- There are no premiums for MSAs.
- Beneficiaries must still pay a Part B premium.
- Prescription drugs are not covered in an MSA plan, although enrollment in a prescription drug plan is permitted.
PFFS
A PFFS (Private Fee-For-Service) plan is a type of Medicare Advantage plan in which a beneficiary is not limited to a specific network of providers. An enrollee may receive covered services from any provider in the United States who accepts Medicare and agrees to the PFFS plan's terms and conditions for payment. Providers are not required to accept PFFS plan enrollees, and may or may not decide to provide care to beneficiaries. It is the responsibility of the enrollee to notify a provider of their PFFS coverage prior to the visit.
Frequently Asked Questions
What is a Medicare Advantage Plan?
Medicare Advantage Plans are offered by private insurance companies. Medicare Advantage plans offer the same rights and protections and, at a minimum, the same benefits as original Medicare offers. Often they include prescription drug coverage in their benefits package.
There are a variety of types of coverage.
Why Choose a Medicare Advantage Plan?
There are a variety of benefits to enrolling in Medicare Advantage. For example, Medicare Advantage plans often:
Who Can Join a Medicare Advantage Plan?
If you are enrolled in original Medicare, you can join a Medicare Advantage plan offered in your service area, even if you have a pre-existing condition, except for end-stage renal disease (ESRD). If you are turning 65, you have a seven-month window to join, starting three months before your birth month.
What Happens to My Supplemental or Medigap Coverage if I Choose Medicare Advantage?
If you have a supplemental policy and join a Medicare Advantage Plan you may want to contact your insurer to see if you should drop your supplemental policy. Supplemental policies can’t be used to pay Medicare Advantage plan copayments, deductibles or premiums. If you already have a Medicare Advantage plan, you do not need a supplemental policy, and no one should sell you one.
When Can I Join or Change My Medicare Advantage Plan?
Medicare Advantage plans are governed by the same enrollment regulations as original Medicare. In most cases, people join a plan during open enrollment in the fall and are enrolled in a plan for the calendar year. If you are turning 65, you have a seven-month window that starts three months before your birth month.
What is a Medicare Advantage Plan?
Medicare Advantage Plans are offered by private insurance companies. Medicare Advantage plans offer the same rights and protections and, at a minimum, the same benefits as original Medicare offers. Often they include prescription drug coverage in their benefits package.
There are a variety of types of coverage.
- Part A: Original Medicare – Hospital, skilled nursing, hospice and some home health (inpatient)
- Part B: Original Medicare – Clinical services (outpatient)
- Part C: Medicare Advantage plans (includes at least the same services as Parts A and B)
- Part D: Prescription drug coverage
Why Choose a Medicare Advantage Plan?
There are a variety of benefits to enrolling in Medicare Advantage. For example, Medicare Advantage plans often:
- Offer additional services, such as prescription drug coverage, vision, dental, hearing, memberships to health and wellness programs, and other benefits not provided by traditional Medicare
- Focus on wellness and improved health outcomes
- Have defined annual out-of-pocket limits for medical care
- In all cases, eliminate the need for Medicare supplemental (or Medigap) plans, which typically cover “gaps” in original Medicare, such as co-payments and deductibles
Who Can Join a Medicare Advantage Plan?
If you are enrolled in original Medicare, you can join a Medicare Advantage plan offered in your service area, even if you have a pre-existing condition, except for end-stage renal disease (ESRD). If you are turning 65, you have a seven-month window to join, starting three months before your birth month.
What Happens to My Supplemental or Medigap Coverage if I Choose Medicare Advantage?
If you have a supplemental policy and join a Medicare Advantage Plan you may want to contact your insurer to see if you should drop your supplemental policy. Supplemental policies can’t be used to pay Medicare Advantage plan copayments, deductibles or premiums. If you already have a Medicare Advantage plan, you do not need a supplemental policy, and no one should sell you one.
When Can I Join or Change My Medicare Advantage Plan?
Medicare Advantage plans are governed by the same enrollment regulations as original Medicare. In most cases, people join a plan during open enrollment in the fall and are enrolled in a plan for the calendar year. If you are turning 65, you have a seven-month window that starts three months before your birth month.
