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The Added Benefits of Medicare Advantage Plansmedicare and stethoscope

Advantage Plan Enrollment: The When, Where and How of Getting an Medicare Advantage Plan

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Senior citizens who have paid into the Medicare system are eligible to receive health insurance through the Original Medicare program. However, many seniors also have the option to choose an alternative to Original coverage, called Medicare Advantage insurance.

Medicare Advantage, sometimes called Medicare Part C, is very similar to Original coverage. However, it offers quite a few unique benefits. It also presents different personal costs, eligibility requirements and enrollment rules.

What is Medicare Advantage?

A Medicare Advantage plan is a private health plan approved by the government-run Medicare program. Major insurers offer these plans. When you join an Medicare Advantage plan, you remain in the Medicare program. However, the Advantage plan will replace the standard Original Medicare plan.

Your Medicare Advantage plan must cover all benefits provided under Original Medicare Parts A & B, except for hospice care. Most plans will also provide added benefits not covered by Original Medicare such as:

  • Prescription coverage
  • Dental care
  • Hearing services
  • Vision exams

What are the Costs?

Advantage plans come in many shapes and sizes. They include:

  • HMOs
  • HMO Point-of-Service Plans (HMOPOS)
  • PPOs
  • Private Fee-for-Service (PFFS) Coverage
  • MSAs (Medical Savings Accounts)
  • Special Needs Plans (SNPs)

Under each plan, your out-of-pocket costs might vary.

  • You will usually have to pay a premium for the Part C coverage itself. Different plans will come with different premiums.
  • You will still pay your Original Medicare Part B premium even if you have a Medicare Advantage plan.
  • Deductibles and other personal costs, like co-payments or coinsurance, will vary from plan to plan.

Only certain doctors will accept certain Medicare Advantage plans. Furthermore, most plans include provider networks of physicians who accept coverage at the best cost benefits.  You will likely have to seek services within your plan’s network to receive the lowest costs for covered care. Call your care provider to learn whether they accept your plan.

Or contact a Licensed Agents at Senior Market Agents Network at 877-209-4949 who can check which plans your providers accept. 

How do I Qualify for Medicare Advantage Plans?

You usually qualify for a Medicare Advantage plan if:

  • You are over 65 years old
  • You have Original Medicare Parts A & B. You must already have Original Parts A & B to qualify for an Advantage plan.
  • You do not have end-stage renal disease (ESRD)
  • Not all Advantage plans are available in all locations. You will have to enroll in a plan offered in your county and state.

Please note: If you want a Special Needs Plan (SNP), you must meet all enrollment requirements for that plan. You must also continue to meet those requirements every time you renew your plan.

When Can I Get an Medicare Advantage Plan?

As you approach age 65, you will reach the period when you become eligible for Original Medicare. At the same time, you can start exploring your Medicare Advantage options.

Most people can enroll in an Medicare Advantage plan during an Initial Coverage Election Period (ICEP). The ICEP most-often occurs at the same time as the Original Medicare Enrollment Period. This is a 7-month period when you first become eligible for Medicare. Most people can begin enrollment:

  • 3 months before their 65th birthday
  • The month of their 65th birthday
  • 3 months after their birthday

Other opportunities exist to help you get a Medicare Advantage coverage as well.

  • You can apply for coverage during the annual Medicare Advantage election period, also called Open Enrollment. This time lasts from January 1 to December 31 starting in 2019.
  • Individuals who wish to switch plans can also do so during the Open Enrollment period.
  • Various individuals can qualify for special election periods (SEPs) outside of the annual enrollment period. Individual circumstances will determine your eligibility.
  • A dis-enrollment period exists every year during the time period of January 1 through March 31 At this time, you can drop your Medicare Advantage plan and return to Original Medicare or make changes to your plans.

What are the rules for Medicare Advantage Plans?

Please remember, your insurance company might terminate your Medicare Advantage plan in certain cases.

Most commonly, this occurs if:

  • You fail to pay your premiums.
  • You move outside your plan’s service area.
  • Medicare terminates its Medicare Contract with your Medicare Advantage plan.
    Your Medicare Advantage plan Company will no longer offer your plan next year.
  • You no longer meet the conditions to qualify for a Special Needs Medicare Advantage Plan.

Still, if you face these circumstances, you will qualify for a Special Enrollment Period (SEP). and can enroll during this time which you can:

  • Get a new Medicare Advantage plan.
  • Opt to return to Original Medicare coverage during a special election period.
  • You can also enroll in a Part D Prescription drug coverage plan if your enrolling in a MediGap (Medicare Supplement Plan) 

Speak to your agent. Use their expertise to help guide you in making the right choices for your Medicare Coverage. Senior Market Agents Network can help you get the Medicare Advantage plan you need. We’re ready and able to help. Call us at 877-209-4949 now. 

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Senior Market Agents Network is not connected with or endorsed by the United States government or the federal Medicare program. Senior Market Agents Network is an Independent Insurance Agency Licensed in New Jersey, New York, Pennsylvania, Maryland, Virginia, West Virginia, South Carolina, North Carolina, Georgia, Florida, Ohio, Texas, Arizona and Michigan.