HOW DO I ENROLL IN MEDICARE ADVANTAGE?
You can enroll in a Medicare Advantage plan during your Initial Enrollment Period (IEP) or Special Enrollment Period (SEP), but only after you have signed up for both Parts A and B. Medicare Advantage members can change plans each year during the Annual Enrollment Period (AEP) from October 15 to December 7.
You can enroll in a Medicare Advantage plan directly with the insurance company, usually over the phone, in-person, or by going online. An agent or broker can also help you sign up for a plan.
Is there a penalty for enrolling late?
There may be penalties for enrolling late in Parts B and D. However, there is no penalty for enrolling late in a Part C, Medicare Advantage plan. If you did not sign up for a Medicare Advantage plan during your Initial Enrollment Period, you can do so each year during the Annual Enrollment Period from October 15 to December 7.
CHOOSING YOUR MEDICARE ADVANTAGE COVERAGE
There are different levels of Medicare Advantage coverage that vary in price and coverage. Each provider has its own range of plan options for you to choose from, and some include unique offerings like fitness memberships, over-the-counter benefits, and more. You should compare plan benefits, costs, and networks to determine the right plan for you.
WILL A MEDICARE ADVANTAGE PLAN COVER THIS BENEFIT?
This chart provides a high-level overview of the coverage that is included in most Medicare Advantage plans.
Benefits vary by insurance provider and plan.
Will my doctor be covered?
It depends on the doctor and what type of Medicare plan that you have. Over 90% of doctors accept some form of Medicare, whether Original Medicare (Parts A and B) or Medicare Advantage (Part C). If your doctor isn’t part of a Medicare participating provider, the doctor can choose on an individual basis to accept or treat a person on Medicare. If you enroll in a Medicare Advantage plan, your doctor may or may not be in your insurance provider’s network. We recommend checking your private insurance provider’s directory to make sure your doctor is in network. If you have a Medicare supplement plan, you can see any doctor that accepts Medicare.
Do I have a choice in my Medicare Advantage insurance provider?
Yes, you can choose from any private Medicare insurance companies in your state that offer coverage in your area. Each private insurance company offers a variety of plans to match different needs.
What is preventive care?
Preventive services help you identify and treat health problems early so you can stay healthy. These include exams, shots, lab tests, and screenings, among others. Medicare Part B covers some preventive care services, although you may have a 20% coinsurance on services after you have met your deductible. If you have a Medicare Advantage (Part C) plan, your private insurance provider will have a list of preventive services they cover.
WHAT TYPE OF MEDICARE ADVANTAGE NETWORK SHOULD I HAVE?
If you sign up for a Medicare Advantage plan, you will also be able to choose the type of network you want. The main types are Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) plans and Preferred Provider Organization (PPO) plans. Your options will vary depending on your eligibility and what private insurance companies offer in your area. Some factors to consider when choosing a network include if your preferred doctors and hospitals are in your network, your travel habits, and costs.
HMO & HMO-POS PLANS
With an HMO plan, you must get your care and services from providers in your plan’s network. You may have lower costs, such as your monthly premium, with an HMO plan. HMO-POS plans are fairly similar, but in some cases, you can also get routine care out of state.
With a PPO plan, you have a wider network of doctors and hospitals to choose from. However, you will pay less if you choose to get in-network care.
What are PFFS and SNP plans?
You may also be able to enroll in a Private Fee-for-Service (PFFS) plan or Special Needs Plan (SNP). PFFS plans determine how much the company will pay doctors, other health care providers, and hospitals, and then how much you must pay. SNPs limit their memberships to people with special circumstances such as an illness or income.
HOW MUCH WILL MY MEDICARE ADVANTAGE PLAN COST?
Because all plans are different, your costs will vary based on the provider and the coverage included in your chosen plan. You’ll want to compare plans to understand how much premiums are in relation to out-of-pocket costs like copays and coinsurance. While some Medicare Advantage plans may have lower premiums, they may have higher out-of-pocket expenses.
What’s the difference between a copay, deductible, and coinsurance?
While your insurance plan will pay for part of your coverage, you will likely also have to pay additional out-of-pocket costs through one of these methods:
- Copay: A preset amount you pay at the time you receive care. Copays vary from plan to plan. For example, you may have a $25 copay when you visit your primary care doctor.
- Deductible: This is the total amount of money you pay for qualifying services before your benefits kick in. For example, you pay $500 per year before your insurance provider starts covering costs.
- Coinsurance: Coinsurance is when you pay a percentage of your medical bill and your insurance covers the rest. For Medicare Part B, after you meet your deductible you will pay 20% of each medical bill and Medicare will pay the remaining 80%.
Each insurance plan has different types of payments and amounts you’ll owe, so we recommended reviewing these costs before you choose your coverage.