|  | Healthcare Industry | Health Insurance

Medicare Advantage Plan Advice

Medicare Advantage plans are private plans that administer the benefits of original Medicare, sometimes in combination with Medicare Part D drug benefits. There are many moving parts to a Medicare Advantage plan, including the premium, deductibles, co-pays and other benefits. There may also be a network, and there are only certain times when you can enroll or make changes. With a little homework though, you can make the best plan choice for you, your health care needs and your budget.

  1. Types of Medicare Advantage Plans

    • There are a few types of Medicare Advantage Plans, and variations within those plans. There are Health Maintenance Organizations, or HMOs. HMOs have a network, and you choose a Primary Care Physician, or PCP. Any specialized care requires a referral from your PCP, with some exceptions. HMOs will, generally, only cover care received within the network unless in case of an emergency. Preferred Provider Organizations are similar to HMOs, but cover care, to a lesser extent, that's received out-of-network. Private fee-for-service plans require doctors to accept the plan's terms and conditions each time they render service. There is no network, but you do have to make sure your doctor will accept your plan, and they can change their minds at any time.

    How Plans Work

    • All Medicare Advantage Plans have a monthly premium, but this is just part of the overall cost of a Medicare Advantage Plan. You also need to continue to pay your Medicare Part B premiums. There are also co-pays, and there may be deductibles as well. Carefully examine plan materials to find these and the maximum you can be required to pay out-of-pocket.

    Part D

    • Most Medicare Advantage plans include Medicare Part D. You do not need to purchase a separate Medicare Part D plan. With Medicare Advantage plans, the premium for Part D is built into the overall plan premium. Each plan will have a formulary, which classifies prescription drugs into tiers. Each tier will have its own co-pay. You also may still experience the "doughnut hole," or coverage gap, depending on your drug costs. The gap is a part of all Part D plans, and it starts once you reach a certain amount of total prescription costs, and ends when you reach a certain amount of out-of-pocket costs, after which you start catastrophic coverage.

    Enrolling in a Plan

    • There are certain times that you can enroll into a Medicare Advantage plan. One is during your initial enrollment period, which is a seven month period that starts three months before the month you qualify for Medicare and ends three months after. You can also enroll, cancel or change plans from October 15 to December 7 each year. If you move to a new area that your current plan doesn't cover, you have a special enrollment period to choose a new plan. You can also unenroll from a Medicare Advantage plan from January 1-February 14 each year.

Health Insurance - Related Articles