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Medicare Advantage Plans

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Medicare Advantage Plans

Medicare Advantage Plans will provide all of your Medicare Hospital Insurance (Part A), and Medical Insurance (Part B) coverage.  Medicare Advantage Plans are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D). In most cases, you’ll need to use health care providers who participate in the plan’s network. These plans set a limit on what you’ll have to pay out-of-pocket each year for covered services. (Source: Medicare.gov, 2022)

HMO Plans

Health Maintenance Organization Plans

You will use providers in the plan's network. The plan may require the selection of a PCP. Referrals may be necessary to see a specialist.

PPO Plans

Preferred Provider Organization Plans

In and out of network options for providers are available. In-network co-pays will be lower than out of network. PCP selection is not required. Referrals are typically not required to see a specialist.

SNP Plans

Special Needs Plans

Plans offered to Medicare Eligible with specific diseases or characteristics. The plan typically have specialists in the diseases or conditions that affect the member and must provide Medicare drug coverage.

Medicare Advantage Plans

If you join a Medicare Advantage Plan, you’ll still have Medicare, but you’ll get most of your Part A & Part B coverage from your MAPD not Original Medicare.

Some Plans will include Part D Prescription Drug Coverage
Additional Benefits not Covered by Original Medicare may be offered
With Medicare Advantage are referrals required?
Each plan has an outline of benefits and will note if referrals are required. Not all plans require referrals.
How does a Medicare Advantage Plan limit out of pocket expenses?
Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for all Part A and Part B services. Once you reach this limit, you’ll pay nothing for services Part A and Part B cover.
Is Medicare Advantage the Same as Original Medicare?
No. A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
When Can I Enroll or Change my Medicare Advantage Plan
For General Enrollment : Medicare Eligible Individuals with an active part B can apply during the AEP of Oct 15 - Dec 7. In addition, MAPD applications can be submitted Jan 1 - March 31.
Can I have Supplemental Medicare Insurance and Medicare Advantage at the same time?
No. You can’t buy Medicare Supplemental Insurance while you’re in a Medicare Advantage Plan. You can’t use Medicare Supplemental Insurance to pay for any costs (copayments, deductibles, and premiums) you have under a Medicare Advantage Plan.
How much will I pay for my Medicare Advantage Plan?
Premiums & other costs (like deductibles, copayments & coinsurace) will vary by plan and amounts can change each year. You must have Part B and continue paying your Part B premium to keep your MAPD plan. Once you reach the out of pocket limit on your plan, it will pay 100% of your covered health services for the rest of the calendar year.

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