The 8 things you need to know about Advantage Plans, (aka Medicare Part C).
The main reason people choose to take out an Advantage plan is the potential cost savings of medical care. Like any other Insurance policy Medicare Parts A and B have deductibles and co-pays, they also have coverage limits. Once the limits of the policy have been reached, you will be responsible for any additional costs you may incur for your care. Please refer to our Medicare Part A 2021 Premium and Benefits table and our Medicare Part B 2021 Premium and Benefits table for a full breakdown of the costs associated with medical care you receive. Part C Medicare Advantage Plans have a cap or maximum on your medical expenses per year. Once you have reached that level, there are no further costs incurred, no matter how much care you receive.
Other people choose the plans for the additional benefits they provide. Benefits are dependent on the plan but commonly include things like Dental and Vision coverage. A popular benefit is the Silver Sneakers Fitness Program which provides free access to gyms, fitness centers and exercise classes.
Typically, these have a low premium or no premium. You are required to have a primary care physician (PCP). Your PCP must refer you to a specialist. You must stay in the network to have full coverage. It may offer drug coverage and more additional benefits than other types of Advantage Plans.
These plans typically do not require you to have a PCP (Primary Care Physician). It has a network, however, you can go out-of-network at a higher cost. It does not require a referral to see a specialist and may offer drug coverage. You may have a premium and you pay coinsurance or copays for doctors and medical services.
Most of these plans structure the amount they will pay, and you will pay for medical care. The plan may allow you to go out-of-network to a Medicare provider that will accept the payment of the plan, but you may pay a higher cost. It may also offer drug coverage.
Typically these are plans that are for special medical needs such as diabetes, chronic heart condition, or COPD (Chronic Obstructive Pulmonary Disease). These plans require a PCP (Primary Care Physician) and your PCP must refer you to a specialist. They do allow enrollment anytime after you are diagnosed, rather than during a specific enrollment period.
Once you have your Advantage plan, when you receive any medical care you will present your Advantage plan insurance card.
Before you can apply for an Advantage Plan you must first apply for the original Medicare Part A and B because your membership number will be required for the application. There is an Open Enrollment Period each year from October 15 to December 7th. You must live in the service area of the Advantage Plan you have chosen. Enrollments can also be made due to changes in personal circumstances, such as moving out of the service area of your current plan.
If you want to know if your doctor and preferred hospital accepts the plan you are interested in we can help. We can also determine if your medications will be covered at a reasonable rate by the Advantage Plan at your preferred pharmacy. We can also advise you of additional benefits offered by different plans.
We are licensed, certified, and appointed by many major insurance companies that offer Medicare Advantage Plans. This allows us to give you options to consider for the benefits you want. We have over 15 years of experience with Medicare Advantage Plans and have helped countless people find the plan that is right for them. We know what questions to ask to help you find the plan that best fits your needs now and in the future.
We build relationships with our clients. As changes occur in your health, Medicare, or Medicare Advantage Plans, we keep our clients up to date to make sure that they still have the best plan for their needs. Most importantly, there is NEVER any cost or obligation for our services.
READY TO TAKE THE NEXT STEP Complete the form below to get the information you need!
Yes, you need both Part A and Part B to apply and live in the service area of the plan.
When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:
No, they do not. Advantage Plans can have different maximum out of pocket, different additional benefits and much more.
You can apply online by copying and pasting:
Or call Social Security at: 800-772-1213
NO: If you receive COBRA benefits you are no longer working for this employer. If you wait until these benefits have expired before enrolling in Part B, you won’t qualify for a special enrollment period for Part B. Instead, you’ll likely pay late penalties, and you would be able to enroll only during the General Enrollment Period that runs from Jan. 1 to March 31 each year, with coverage not beginning until the following July 1.