• Facebook

Medicare Advantage

Medicare Advantage - Medicare Part C (MA or MAPD)

These plans combine all the benefits of Medicare Parts A and B and can include Medicare Part D. (MA) plans are available to individuals entitled to Medicare Part A and enrolled in Medicare Part B due to age or disability.

 

This means they are available to people under age 65. You must live within the service area of the plan. They are offered by private insurance companies and offer low or zero premiums plans in addition to the Medicare Part B premium.

 

Medicare Advantage plans have copays or coinsurance for services as well as a maximum out of pocket (MOOP) for the plan year. Many also include vision, dental, hearing, gym discounts or memberships and OTC benefits.

 

Dual Eligible Special Needs Plan (DSNP)

These are Medicare Advantage Plans specifically designed to serve individuals that are entitled to Medicare Part A and enrolled in Medicare Part B due to age or disability, you must live within the plan’s service area and receive certain levels of Medicaid to be enrolled.

 

DSNP plans include prescription drug coverage and feature $0 copays for services. Many include vision, dental, hearing, over the counter (OTC) allowances, transportation services, and meal allowances. They are available as an HMO or PPO.

Health Maintenance Organization (HMO) or (HMO-POS)

  • Requires you to use in-network doctors for services unless an emergency

  • You choose a Primary Care Doctor (PCP) that manages your care

  • Referrals required by your PCP to see specialists

  • Some plans offer out of network doctors. This is called a point-of service option (POS).  You will usually pay a higher coinsurance for services out of network.

 

  • Prior Authorization maybe required for services.

Preferred Provider Organization (PPO)

  • You will have lower copays or coinsurance with the use of in-network providers

  • These plans give you the flexibility to use out-of-network doctors and facilities at a higher copay or coinsurance.

  • Prior Authorization maybe required for services.

Private-Fee-For-Service (PFFS)

  • PFFS plans are different from other types of MA plan. Beneficiaries can seek health care from any Medicare doctor, or hospital that agrees to the plan’s payment terms and grants treatment of services.

  • Nevertheless, not all doctors will accept the PFFS plan’s payment terms. 

  • Of course, the cost will be higher; but you have options for out-of-network health care doctors and hospitals if they agree with the plan’s terms. PFFS plans may cover the costs of prescription drugs; if not, you may enroll in a Part D Plan.

  • PFFS Plans don’t require choosing a primary care doctor; certain PFFS Plans have arrangements with a specific network of doctors. 

  • In contrast, out-of-network doctors and hospitals can choose not to treat you in non-emergency situations. For emergencies, hospitals, and other health care doctors may not refuse you treatment.

Enrollment Periods

Medicare Advantage Plans have specific times of the year you can enroll, change or switch plans.

Initial Enrollment Period (IEP)

  • When you first become eligible for Medicare, you have an initial seven-month period to sign up for coverage including Part D.

 

  • If you’re eligible because you are turning 65, your Initial Enrollment Period (IEP) begins three months before your 65th birthday month and ends three months after your birthday month.

  • During this time you can enroll in Original Medicare parts A & B with out without a Prescription Drug Plan (PDP), a Medigap with or without a Prescription Drug Plan (PDP) or a Medicare Advantage Plan (MA or MAPD).

Annual Election Period (AEP) October 15th to December 7th

  • Change from Original Medicare to a Medicare Advantage Plan.

  • Change from a Medicare Advantage Plan back to Original Medicare.

  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.

  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.

  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.​

  • Join a Medicare Prescription Drug Plan.

  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.

  • Drop your Medicare prescription drug coverage completely.

Medicare Advantage Open Enrollment Period (OEP) Jan 1st to March 31st

  • If you’re in a Medicare Advantage Plan (with or without drug coverage), switch to another Medicare Advantage Plan (with or without drug coverage).

  • Disenroll from your Medicare Advantage Plan and return to Original Medicare. If you choose to do so, you’ll be able to join a Medicare Prescription Drug Plan.

  • If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a Medicare Prescription Drug Plan) within the first 3 months you have Medicare.

You can’t...

  • Switch from Original Medicare to a Medicare Advantage Plan.

  • Join a Medicare Prescription Drug Plan if you’re in Original Medicare.

  • Switch from one Medicare Prescription Drug Plan to another if you’re in Original Medicare.

 

Special Election Period (SEP)

  • Under certain circumstances you may qualify to enroll or change plans during other times of the year. These are called Special Election Periods or (SEP) Call 1-888-885-8361 to see if you qualify

Go to section:

Let us help you find the most comprehensive plan!

517 US 31 N. #400 | Greenwood, IN 46143 | Privacy Policy | Terms and Conditions

Perfiniti Insurance II, LLC is a licensed and certified representative of a Medicare Advantage organization (HMO, PPO and PFFS) and a stand-alone prescription drug plan (PDP). Enrollment depends on contract renewal. The purpose of this communication is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. Government, the Centers for Medicare & Medicaid Services, the Department of Health and Human Services, or the federal Medicare program. Plans are not available in all areas and may be subject to underwriting; terms and conditions may apply. For more information view our Privacy Policy and Terms of Use.

 © 2020 by Perfiniti Insurance II, LLC.