Medicare Advantage (MA) plans are health insurance plans offered by private companies that contract with Medicare to deliver the same coverage you’d receive under Original Medicare (Parts A and B). The only exception is hospice care, which remains covered by Original Medicare, even if you’re enrolled in a Medicare Advantage plan.
Many MA plans go beyond basic coverage by offering additional benefits not included in Original Medicare. These extras—such as dental, vision, hearing, and prescription drug coverage—are a major reason why millions of beneficiaries choose Medicare Advantage each year.
Some plans even come with $0 monthly premiums, though you’ll still need to pay your Medicare Part B premium. For many, the convenience and added value of combining medical, drug, and supplemental benefits into a single plan make Medicare Advantage an attractive, cost-effective option.
HMO (Health Maintenance Organization)
HMO plans typically require you to use a network of local doctors and hospitals, and you’ll usually need a referral to see a specialist. These plans often have lower out-of-pocket costs but offer less flexibility when it comes to choosing providers.
PPO (Preferred Provider Organization)
PPO plans offer more flexibility by allowing you to see both in-network and out-of-network providers without a referral—though you’ll pay less when using in-network doctors. These plans are ideal if you travel often or want more provider options.
PFFS (Private Fee-for-Service)
PFFS plans let you visit any Medicare-approved provider that accepts the plan’s payment terms and conditions. While provider access can vary, these plans don’t require referrals or a primary care doctor, offering more freedom for some beneficiaries.
SNP (Special Needs Plan)
SNPs are designed for people with specific health conditions, those who live in institutions, or who qualify for both Medicare and Medicaid. These plans offer tailored coverage, coordinated care, and often include extra services to support complex health needs.
Medicare offers four key enrollment periods.
Your Initial Enrollment Period (IEP) starts 3 months before your 65th birthday and ends 3 months after your birth month, giving you 7 months to enroll. If you’re already receiving Social Security benefits, you’ll be enrolled automatically; otherwise, you’ll need to sign up to avoid late penalties.
You can delay enrollment without penalty if you qualify for a Special Enrollment Period (SEP)—most commonly because you have creditable coverage through an employer (yours or your spouse’s). When that coverage ends, your SEP allows you to enroll in a Medicare Advantage plan without a penalty.
Other life events may also trigger an SEP. These include moving, losing current coverage, or becoming eligible for both Medicare and Medicaid. Most SEPs give you at least 2 months to enroll in or switch to a Medicare Advantage plan—visit Medicare.gov for the full list of qualifying situations.
Medicare also includes two annual election periods:
The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, you can switch between Medicare Advantage and Original Medicare, change Advantage plans, or join/change a Part D drug plan.
If you’re currently enrolled in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (OEP) takes place from January 1 to March 31. This allows you to switch to another Advantage plan or return to Original Medicare—with the option to enroll in a Part D plan if needed.
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Wed, Oct 09, 2024
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