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Apr 10, 2020

Are Medicare Advantage Plans Right for You?

Maybe you're nearing retirement or turning 65. Either way, you're probably wondering about your Medicare options and possibly trying to figure out exactly what is a Medicare Advantage plan? How do they differ, and which plan is right for you?


Well, we've got the answers you've been looking for. Read on as we break down the basics of Medicare Advantage Plans, so you can decide which one is the best choice for you and your health coverage needs.

What Are Medicare Advantage Plans?

Medicare Advantage, also known as Medicare Part C, is a component of Medicare that let's interested parties sign up for coverage through private healthcare insurers who contract with the government. All Medicare Advantage Plans are legally required to offer the same benefits as Medicare Part A and Part B but are allowed to have different rules, costs, and coverage constraints. Most Medicare Advantage plans also include Medicare Part D (prescription drug coverage) within their benefits as well. These plans also offer services that Original Medicare does not cover, such as vision, hearing, dental, and more.

In addition, Medicare Advantage Plans can help save you money. These plans have a yearly limit on what you pay out-of-pocket for Medicare Parts A and B covered services. Once you reach your plan's limit, you won't spend another dime for covered services for the rest of the year. The idea behind these types of plans is to offer subscribers health insurance and prescription drug coverage in a more convenient and potentially cost-saving way.

How Do I Know If a Medicare Advantage Plan is Right for Me?

More and more people are choosing a Medicare Advantage Plan, in fact, enrollment has nearly doubled over the last decade, reports the Kaiser Family Foundation. But before you jump ahead to the sign-up portion, first consider factors such as plan costs, doctor options, any travel plans, and current health conditions that require medical attention to see if the plan's health benefits make sense for your situation. Medicare Advantage plans may not be the right choice if you currently have insurance from an employer or through your union that pays costs that Original Medicare doesn't cover.

The most common types of Medicare Advantage plans are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). HMOs typically offer lower monthly premiums to subscribers but also tend to require prior authorization from your insurer to visit any specialists. PPOs, on the other hand, may be a bit more costly but come with greater flexibility as you can generally visit any in-network doctor or specialist without a referral. These plans can vary in cost and coverage by region, so it's best to talk with a private insurer to get one-on-one advice and address any questions you may have.

What Does the Enrollment Process Look Like?

You can apply for a Medicare Advantage plan when you first become eligible for Medicare or during what's referred to as your "Initial Enrollment Period." Think of this first enrollment time as a sort of grace period, where you can enroll in Medicare Advantage plans, add coverage, or even switch plans if need be. The Initial Enrollment Period or (IEP) is based around your 65th birthday. Your IEP begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday.

If you choose not to enroll during the IEP, don't fret, there are other dates you can apply. There is what's known as the Annual Enrollment Period, which takes place every year from October 15 to December 7. You may also qualify for the Medicare Special Enrollment Period (SPE) based on certain qualifying life occurrences, such as changing jobs or losing current health coverage.

Learn More About Medicare Advantage

Medicare Advantage plans can save you money and provide additional benefits not seen with traditional Medicare. The best way to navigate the Medicare Advantage selection and enrollment process is to work with a licensed insurer such as Anthem. Anthem agents can serve as helpful resources for determining what Medicare Advantage plans are available, which plans you should consider, when your benefits will start and how to get the full health coverage you deserve.
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