MEDICARE ADVANTAGE PLANS Flashcards
Medicare Advantage Plans (MA)
An MA plan (also known as Medicare Part C) can be an excellent option for individuals who want to join a private health plan and receive coverage for their Medicare benefits. It combines the traditional programs of parts A and B with coverage of additional services such as drugs, vision, hearing, or even fitness activities. Some plans even provide food benefits or reimbursement towards your Part B premium amounts (paid directly to Social Security). To be eligible for this type of plan, you must have both parts A and B of Medicare and live in an area where there are plans available.
The federal government contracts with private insurance companies and managed care organizations such as HMOs to offer these health plans. The amount approved each month by the federal government will then cover the cost of these services given to members enrolled in Medicare Advantage plans. According to a study done by the Kaiser Foundation, the national average amount that the insurance company receives was almost $1000 per month in 2019. (https://www.kff.org/medicare/press-release/payments-to-medicare-advantage-plans-boosted-medicare-spending-by-7-billion-in-2019/)
The member will have to pay co-payments, deductibles, and coinsurance based on the policies set by their chosen Medicare Advantage provider.
MA Open Enrollment vs. Annual Enrollment
The Annual Enrollment Period (Annual Election Period or AEP) for Medicare Advantage and Medicare Drug plans is October 15th through December 7th of every year. This period does not apply to Medicare Supplement (Medigap) plans. During this AEP, you can change from one Medicare Advantage Plan to another, enroll in a Medicare Advantage Plan or Drug Plan, or drop your plan all together.
Anyone with Medicare Parts A or B can enroll in a Drug plan during this period.
Anyone with Medicare Parts A AND B can enroll in a Medicare Advantage Plan during this period.
If you want to switch to a Medicare Supplement Plan during this time, the company still reviews your medical history. It can decline you unless you are in your Medigap open enrollment period or have a Guaranteed Issue period.
The Medicare Advantage Annual Enrollment Period (OEP) only applies to people who have a Medicare Advantage Plan. During the OEP, someone can drop their plan or change to another plan ONE time. The OEP is from January 1st to March 31st of every year.
Medicare Select
Select plans are technically a type of Medigap policy aimed at providing more customized healthcare coverage. This writer considers it a hybrid between Medicare Supplement and Medicare Advantage.
The reason? It typically requires users to use doctors and hospitals in the plan’s network for routine care. This means that non-network options like out-of-network hospitals incur a greater cost for the user, except in cases of emergency.
Moves out of the plan’s service area are still possible. However, the user can purchase a different Medicare supplement policy with fewer benefits if it comes from the same company offering them their current Select coverage. As an added benefit, if you’ve had the policy for over six months, you will not need to answer medical questions when switching plans.
