5 Most Important Things You Should Know About Medicare Advantage

Many policyholders are familiar with Medicare, but what about its alternative, Medicare Advantage? Originally known as Medicare+Choice, Medicare Advantage (MA) provides services through a private-sector health insurer. This is also known as “Part C” because it combines Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).

When it comes to health coverage, it’s easy to get confused by the jargon used in policies. That’s why we want to offer a simplified explanation about Medicare Advantage. While it’s still relatively new, this new policy provides a bundle of services, all for a lower price.

Here are five things you should know about Medicare Advantage today.

1. Types Of Medicare Advantage Plans


Medicare Advantage plans are offered by private companies that contract Medicare to provide Part A and Part B benefits. Below are the types of MA plans you should know.

  • Health Maintenance Organization (HMO) Plan

The MA HMO offers all in-network services except for emergencies, out-of-network urgent care, and out-of-area dialysis. If you want these added options, you can pay a little more and opt for the Private Fee-for-Service (PFFS) Plan.

  • Preferred Provider Organization (PPO) Plan

PPO plans have a network of health care providers you can see for less. It grants you flexibility but incentivizes in-network service. Usually, it includes drug coverage, but if it doesn’t, you can’t join a Medicare Prescription Drug Plan (Part D). Keep that in mind when looking for a PPO plan with prescription drug coverage.

  • Private Fee-for-Service (PFFS) Plan

A PFFS plan allows you to get healthcare services from anywhere. The policy determines how much it pays for services, and how much you pay when you receive care. If the PFFS has a network, you can still see whoever you want, but it’s cheaper to stay within the preferred group.

  • Special Needs Plan (SNP)

Medicare SNP is similar to HMO and PPO, but it’s designed for policyholders that require special care. This plan applies to those who require institutional or in-home care or have a disability or chronic illness.

  • HMO Point of Service (HMO-POS) Plan

Similar to the Medical Advantage HMO plan, except it allows you to receive out-of-network service at a higher cost.

  • Medicare Medical Savings Account (MSA) Plan

The MSA serves as medical savings account outside of Medicare. This plan combines high-deductibles with a savings account you can use to cover your medical costs before you meet the expense.

2. Where Can I Enroll In Medicare Advantage?

Source: Forbes

There are a few ways you can begin shopping and comparing MA plans. First, you need to check to see if your area offers a Medicare Advantage plan on this link or other health marketplaces using the Medicare Plan Finder. All you need to do is enter your zip code and scan through the results.

You can also visit their official website and join online and fill out an online enrollment application. Shortly after, you’ll be issued a Medicare number, and the date your coverage will be active.

3. Medicare Advantage Enrollment Dates

Source: Alcatel-Lucent Enterprise

Healthcare plans usually have special enrollment periods you have to abide by every year, and Medicare Advantage is no exception. The first time you may be eligible to sign up for a MA plan is during your Initial Enrollment Period. For changes effective the following year, you must enroll between Oct. 15 and Dec. 7.

4. Know Your Prescription Drug Plan


Usually, MA plans have prescription drug coverage (Part D), with the exception of Medicare Medical Savings Account. Other ones, such as private fee-for-service health insurance, may choose not to offer this option.

Be careful when signing up for additional drug coverage. You may be disenrolled from a MA plan and returned to the original Medicare if you’re currently in a MA HMO or PPO, and you join a Medicare prescription drug plan.

Making sure the medications you take are covered on your plan can help you save thousands of dollars a year. You also need to consider what discounts are offered for things like mail-in prescriptions. In some cases, you can get a better deal on your medication if you order it in bulk. By reviewing the details of the prescription coverage a MA policy offers, you can make an educated decision regarding if the policy is right for you.

5. The Pros And Cons Of Medicare Advantage

Source: El Foro Económico Mundial

Is the MA plan right for you? Weigh the advantages and disadvantages of this type of insurance to determine if it fits your needs.

The Pros

  • More Affordable

While MA premium rates and cost-sharing may vary, they generally cost less compared to other plans. Also, it limits your maximum out-of-pocket expense, so you don’t pay for covered medical costs after you surpass the higher amount.

With the traditional Medicare plan, there was no limit on your potential out-of-pocket expenses.

  • Reliable Network

MA plans, such as the HMO, require you to select a primary care physician (PCP). From there, your care is coordinated by a trusted network of healthcare providers that’ll work together to deliver the best possible service for your case.

  • May Include Drug Coverage, Vision, Dental, and Hearing

This form of insurance aims to be a one-stop-shop for all of your health-related needs. That’s why it coordinates coverage benefits from Plan A and Plan B, and Plan D (prescription drug coverage). It also may include services Medicare won’t cover, such as vision, hearing, and dental.

Source: HITInfrastructure

The Cons

  • Doesn’t Cover Out-of-Network Services

Instead of going to any facility that accepts Medicare, you’re restricted to a network. Any care or services outside of it will not be included in your out-of-pocket maximum, and it won’t be covered by your plan.

  • Requires Referral and Plan Authorization

To prevent the incorrect or unnecessary use of healthcare services, you’ll need prior authorization before receiving medical assistance. In this plan, your primary care physician will also refer you to see specialists beforehand.

  • Limited To A Regional Network

Unlike traditional plans that are nationwide, MA plans require you to live in the participating region for a minimum of six months before enrollment.

Choosing the right Medicare Advantage (MA) plan is a significant decision, and it’s essential to carefully assess whether it’s the best fit for your healthcare needs. To make an informed choice, it’s advisable to start by researching and comparing available MA plans.

Begin your search by exploring the various MA plans offered in your area. You can do this by visiting the official Medicare website or consulting with a licensed insurance agent who specializes in Medicare. When evaluating these plans, consider factors such as your current health condition, prescription drug needs, preferred doctors and hospitals, and your budget.

Finding plans that meet your specific requirements is crucial. Some MA plans may offer additional benefits like dental, vision, or fitness programs, which could be beneficial depending on your needs. On the downside, MA plans often have network restrictions, meaning you may need referrals to see specialists or be limited to specific healthcare providers.

By carefully weighing the advantages and disadvantages of Medicare Advantage plans and conducting thorough research, you can make a well-informed decision about whether this type of insurance aligns with your healthcare needs and financial situation. Taking the time to find the right plan can provide you with the peace of mind and coverage you require for your health and well-being.


MA plans may be more affordable and offer more coverage compared to other insurance plans. If you’re eligible and can benefit more from Medicare Advantage, speak to a licensed insurance agent about finding MA plans in your area. You can also visit a health marketplace online and enter your zip code for a free quote.

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