MEDICARE ADVANTAGE (PART C)

A Medicare Advantage Plan is a Medicare health insurance plan option. Medicare Advantage Plans, sometimes called “Part C”, are offered by private insurance companies that are approved by Medicare.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan (associated with HMO or PPO networks) are a Medicare health plan choice you can make instead of Medicare Supplement.

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies and offer Medicare approved plans.

If you join a Medicare Advantage Plan, the plan will provide coverage for Part A (Hospital Insurance) and Part B (Medical Insurance) and often include Part D prescription coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. 

The Center for Medicare Services pays a monthly fixed dollar amount to the insurance companies that offer Medicare Advantage Plans. The insurance companies must follow minimum benefit coverage requirements set by Medicare. However, each Medicare Advantage Plan (as set by the insurance company), is able to charge different copay, coinsurance, and out-of-pocket maximum amounts for each service offered. For example,some plans require referrals to see specialists, each plan has a network of physicians to choose from, fitness benefits, vision, dental and hearing benefits may be included. These requirements update in January of each year.

Different Types of Medicare Advantage Plans

  • (HMO) Health Maintenance Organization - provides in- network coverage only, unless urgent or emergent
  • (PPO) Preferred Provider Organization - providens in and out-of-network coverage at different costs  
  • (HMO-POS) HMO- Point of Service - provides limited services out-of-network at a higher cost
  • SNP) Special Needs Plan- *requires specific conditions
  • (D-SNP) Dual Special Needs Plan. * Medicaid eligibility is required

How Much Does a Medicare Advantage Plan Cost?

In addition to your Medicare Part B premium, you usually pay a monthly premium to the insurance company for the plan itself. That said, there are a number of zero premium ($0 premium) options available to consumers. In addition to the plan premium and Part B premium, each Medicare Advantage Plan can charge different copay, coinsurance, and out-of-pocket maximum amounts for each service offered. The combination of factors changes your true overall cost for a Medicare Advantage plan.

 Costs to consider before purchasing a plan:

  • Monthly plan premium, if any.
  • Monthly Medicare Part B premium reimbursement, if any.
  • Plan deductible, if any for medical and/or prescription.
  • Copayment or coinsurance for each visit or service obtained.
  • The type of health care services you need and how often you use them.
  • Are you using in-network or out-of-network providers.
  • Do you need or want additional benefits offered by the plan that may add premium.
  • The plans annual out-of-pocket maximum.

Different Types of Medicare Advantage Plans

Not all Medicare Advantage Plans work the same way. Before you enroll into a plan, please take the time to find and compare all available Medicare plans in your county. Our agency is here to provide the information to you at your request, or you may use our enrollment tools located on each carrier page and quote page.  

A Few Extra Things You Should Know about Medicare Advantage Plans

  • There are specific Enrollment Periods that determine when enrollment into a plan can occur.  
  • As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.  
  • Check with each plan you are considering for coverage on any specific service or prescription you want covered.
  • You must follow plan requirements for care, such as getting a referral to see a specialist, or getting prior approval for certain procedures to avoid higher costs.
  • You can join a Medicare Advantage Plan even if you have a pre-existing condition.
  • If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher depending on the type of Medicare Advantage Plan.
  • If the Medicare Advantage plan you are enrolled with decides to stop participating in your county; you‘ll have a Special Enrollment Period to select another plan or return to Original Medicare.

Annual Enrollment Period

This year, the Annual Enrollment Period (AEP) starts October 15th and ends on December 7th for a January 1st effective date.

Medicare Advantage (MA) plan options are limited by the county you reside in. They are available with prescription drugs (MAPD), and without prescription (MA) benefits.

Annual Enrollment Period (AEP) is a specific time each year when you can change plans. During the AEP you can switch from one you switch from one plan to any other plan that is available in your county.

NOTE: If you do not select a plan with prescription benefits (MA) at your enrollment, you will not be able to make a change until the next AEP to a plan which cover prescription drugs (MAPD).

During the AEP you can also switch from a Medicare Supplement (Medigap) plan with or without a Prescription drug plan (PDP) to an MA or MAPD plan. This is also the time where you can move from an MA or MAPD plan to a Medicare Supplement. To do this you will need to complete an application with a health questionnaire. AEP starts October 15th and ends on December 7th for a January 1st effective date. Other than this time, you would need to have a Special Enrollment Period (SEP) available to you. 

Acronyms Index

Important Information about Your Coverage

If you’re happy with your current Medicare Prescription Drug Plan and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.

If you have Original Medicare and you want Medicare prescription drug coverage, you can:

  1. Join a Medicare Prescription Drug Plan
  2. Join a Medicare Advantage Plan (like an HMO, PPO, or Private-Fee-for-Service Plan) or other Medicare Health Plan that offers both health coverage and prescription drug coverage

Note: If you didn’t join a Medicare drug plan when you were first eligible, you may have to pay a penalty to join later.

If you’re happy with your current Medicare Advantage Plan with drug coverage and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue.

If you’re happy with your current Medicare Advantage Plan that DOESN’T cover prescription drugs and the plan is offered next year, you don’t need to do anything - your coverage will automatically continue. If you want to add Medicare drug coverage to this plan, call your current plan to speak to a representative. Note that if you didn’t add Medicare drug coverage when you were first eligible, you may have to pay a penalty to add it later.

Call your employer or union benefits administrator to find out how their coverage works with Medicare. You may not be able to have both Medicare drug coverage and your employer/retiree drug coverage at the same time. Joining a Medicare drug plan may limit or end your employer or union coverage for you and/or any family members covered by your plan.

You can apply for Extra Help paying for Medicare prescription drug coverage anytime by filling out and mailing an application to Social Security. There’s no cost or obligation to apply.

Call Social Security toll-free at 1-800-772-1213 (TTY 1-800-325-0778). You can also apply online at www.socialsecurity.gov.

You qualify for Extra Help paying for Medicare prescription drug coverage for one of these reasons:

  • You have Medicare and full Medicaid coverage
  • You get help from your state to pay your Medicare premiums
  • You get SSI
  • You applied and qualified for Extra Help

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Medicare Disclaimers

  • If you need help, please call (800) 884-2343 Mon - Fri, 9am - 4pm PT and licensed insurance agents can assist with finding information on available Medicare Advantage Plans.
  • Estimated annual savings is determined by subtracting a plan's annual cost estimate of the medications entered from the medications' average retail prices. The annual cost estimate for a plan includes covered annual monthly premiums and any annual cost sharing expenses that you must pay out-of-pocket for the medications entered. This number can only be calculated if the consumer enters medication information.
  • Every year, Medicare evaluates plans based on a 5-star rating system.

Important details and dates

  • When you first become eligible for Medicare, you can join during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65. CAUTION: You only have one choice so take your time, ask for help and choose wisely.
  • If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of entitlement to disability payments, includes your 25th month, and ends 3 months after your 25th month of entitlement to disability payments. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.
  • You are also eligible during the Annual Election Period (AEP) which is from Oct.15 to Dec.7. You can change as many times as you want. The last change received by CMS prevails.
  • You have an opportunity to disenroll from your plan and return to Original Medicare and purchase a Part D Prescription Drug Plan during the new Medicare Advantage Open Enrollment Period from January 1 to March 31.
  • You may be eligible for a Special Enrollment Period (SEP) if you reside in a nursing home, join a Special Needs Plan (SNP), move outside the plan's service area, the plan leaves your area, or other special situations.
  • This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-633-4227 (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-633-4227. TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m EST., Monday through Friday. TTY users should call, 1-800-325-0778; or your Medicaid Office.

About the Information Presented

  • This is a web site from CDA Insurance LLC and is not associated with Medicare or the Center for Medicare and Medicaid Services. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (1-800-633-4227) (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • A Medicare Advantage plan is a health plan provided through a private insurer and delivering Medicare Part A and Part B benefits. A Part D Drug plan is a prescription drug plan provided through a private insurer and delivering Medicare Part D benefits. To apply for coverage you must submit an application for the company and plan that you want.
  • Disclaimer: Carriers may have made rate or underwriting adjustments that have not yet been reflected in our database. All data obtained from public sources.
  • CDA Insurance LLC is an agency that represents many companies offering products to Medicare recipients. We market plans using our consumer facing website. We have licensed insurance agents available to assist our clients in understanding the plans that are available and helping them decide which plan will most closely meet their needs. We do our best to assure that all information presented on our web site is compliant, current and accurate.
  • Submitting our online quote request form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage plan or other Medicare plans. To apply for coverage you must submit an application for the company and plan that you want.