MEDICARE ADVANTAGE (PART C)

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.

If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

Different Types of Medicare Advantage Plans

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Special Needs Plans (SNP)

There are other less common types of Medicare Advantage Plans that may be available:

  • HMO Point of Service (HMOPOS) Plans - An HMO plan that may allow you to get some services out-of-network for a higher cost.

How Much Does a Medicare Advantage Plan Cost?

In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:

  • Whether the plan charges a monthly premium.
  • Whether the plan pays any of your monthly Part B premium.
  • Whether the plan has a yearly deductible or any additional deductibles.
  • How much you pay for each visit or service (copayments or coinsurance).
  • The type of health care services you need and how often you get them.
  • Whether you follow the plan’s rules, like using network providers.
  • Whether you need extra benefits and if the plan charges for them.
  • The plan’s yearly limit on your out-of-pocket costs for all medical services.

Different Types of Medicare Advantage Plans

Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area. Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plan's Web site. Medicare also has information on quality to help you compare plans.

A Few Extra Things You Should Know about Medicare Advantage Plans

  • You can only join a plan at certain times during the year. In most cases, you're enrolled in a plan for a year.
  • As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
  • Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
  • You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
  • You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
  • If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
  • If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.

Annual Enrollment Period

This year, the Annual Enrollment Period (AEP) starts October 15th and ends on December 7th for a January 1st effective date.

Medicare Advantage (MA) plan options are limited by the county you reside in. These plans come as HMO, PPO and PFFS options. They are available with prescription drugs (MAPD), and without prescription (MA) benefits.

Annual Enrollment Period (AEP) is a specific time each year when you can change plans. During the AEP you can switch from one you switch from one plan to any other plan that is available in your county (as long as you do not have "final stage renal failure"). You can move from MAPD to MAPD, MA to MA, MAPD to MA and MA to MAPD.

If you do not select a plan with prescription benefits (MA) at your enrollment, you will not be able to make a change until the next AEP to a plan which cover prescription drugs (MAPD).

During the AEP you can also switch from a Medicare Supplement (Medi-Gap) plan with or without a Prescription drug plan (PDP) to an MA or MAPD plan. This is also the time where you can move from an MA or MAPD plan to a Medicare Supplement. To do this you will need to complete an application with a health questionnaire. AEP starts October 15th and ends on December 7th for a January 1st effective date. Other than this time, you would need to have a Special Enrollment Period (SEP) available to you.

Acronyms Index

Important Information about Your Coverage

If you’re happy with your current Medicare Prescription Drug Plan and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.

If you have Original Medicare and you want Medicare prescription drug coverage, you can:

  1. Join a Medicare Prescription Drug Plan
  2. Join a Medicare Advantage Plan (like an HMO, PPO, or Private-Fee-for-Service Plan) or other Medicare Health Plan that offers both health coverage and prescription drug coverage

Note: If you didn’t join a Medicare drug plan when you were first eligible, you may have to pay a penalty to join later.

If you’re happy with your current Medicare Advantage Plan with drug coverage and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.

If you’re happy with your current Medicare Advantage Plan that DOESN’T cover prescription drugs and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue. If you want to add Medicare drug coverage to this plan, call your current plan to speak to a representative. Note that if you didn’t add Medicare drug coverage when you were first eligible, you may have to pay a penalty to add it later.

Call your employer or union benefits administrator to find out how their coverage works with Medicare. You may not be able to have both Medicare drug coverage and your employer/retiree drug coverage at the same time. Joining a Medicare drug plan may limit or end your employer or union coverage for you and/or any family members covered by your plan.

You can apply for Extra Help paying for Medicare prescription drug coverage anytime by filling out and mailing an application to Social Security. There’s no cost or obligation to apply.

Call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778). You can also apply online at www.socialsecurity.gov.

You qualify for Extra Help paying for Medicare prescription drug coverage for one of these reasons:

  • You have Medicare and full Medicaid coverage
  • You get help from your state to pay your Medicare premiums
  • You get SSI
  • You applied and qualified for Extra Help

Medicare Disclaimers

  • If you need help, please call (800) 884-2343 Mon - Fri, 9am - 4pm PT and licensed insurance agents can assist with finding information on available Medicare Advantage Plans.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
  • You must be entitled to Medicare Part A and enrolled in Medicare Part B and live in the plan's service area to be eligible for these plans.
  • You must continue to pay your Medicare Part B premium in addition to any plan premium shown below.
  • Estimated annual savings is determined by subtracting a plan's annual cost estimate of the medications entered from the medications' average retail prices. The annual cost estimate for a plan includes covered annual monthly premiums and any annual cost sharing expenses that you must pay out-of-pocket for the medications entered. This number can only be calculated if the consumer enters medication information.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Important details and dates

  • When you first become eligible for Medicare, you can join during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65. CAUTION: You only have one choice so take your time, ask for help and choose wisely.
  • f you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of entitlement to disability payments, includes your 25th month, and ends 3 months after your 25th month of entitlement to disability payments. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.
  • You are also eligible during the Annual Election Period (AEP) which is from Oct.15 to Dec.7. You can change as many times as you want. The last change received by CMS prevails.
  • You have an opportunity to disenroll from your plan and return to Original Medicare and purchase a Part D Prescription Drug Plan during the new Medicare Advantage Disenrollment Period from Jan 1 to Feb 14.
  • You may be eligible for a Special Enrollment Period (SEP) if you reside in a nursing home, join a Special Needs Plan (SNP), move outside the plan's service area, the plan leaves your area, or other special situations.
  • This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-633-4227 (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-633-4227. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m EST., Monday through Friday. TTY users should call, 1-800-325-0778; or your Medicaid Office.

About the Information Presented

  • This is a web site from CDA Insurance LLC and is not associated with Medicare or the Center for Medicare and Medicaid Services. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (1-800-633-4227) (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • A Medicare Advantage plan is a health plan provided through a private insurer and delivering Medicare Part A and Part B benefits. A Part D Drug plan is a prescription drug plan provided through a private insurer and delivering Medicare Part D benefits. To apply for coverage you must submit an application for the company and plan that you want.
  • Disclaimer: Carriers may have made rate or underwriting adjustments that have not yet been reflected in our database. All data obtained from public sources.
  • CDA Insurance LLC is an agency that represents many companies offering products to Medicare recipients. We market plans using our consumer facing website. We have licensed insurance agents available to assist our clients in understanding the plans that are available and helping them decide which plan will most closely meet their needs. We do our best to assure that all information presented on our web site is compliant, current and accurate.
  • Submitting our online quote request form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage plan or other Medicare plans. To apply for coverage you must submit an application for the company and plan that you want.