Medicare Advantage Plans

Medicare Advantage plans (Medicare Part C) are health insurance plans offered by private insurance companies that provide the same healthcare coverage as Medicare Part A and Medicare Part B (Original Medicare) and some plan options include additional benefits such as dental, vision, and prescription drug coverage (part d).

Medicare Advantage Plan Overview

Medicare is a federal government program in the United States that provides health insurance for people 65 and older, and younger people who meet certain qualifying conditions such as extra help for prescription drugs. Medicare is managed by the Center for Medicare and Medicaid services (CMS).

Four Parts of Medicare

Medicare Part A covers your hospital.
Medicare Part B covers your medical such as doctor visits and outpatient.
Medicare Part C represents Medicare Advantage plans (private health plans).
Medicare Part D specifically focuses on prescription drug coverage.

It’s common to hear the word Original Medicare which means the combination of Part A and Part B which is listed on your red, white and blue card.

Important Tips About Medicare Advantage Plans

Below are some key tips and details to remember about these plans.

Medicare Advantage Plans are sold by insurance agents that must be licensed in your state of residence. For example, our Medicare agents that live in New Orleans and the surrounding areas like Slidell and Baton Rouge are required to have a Louisiana license. However, if they cross state lines, they are required to be licensed in that state in order to process enrollments.
The most common plan types are HMO plans (referrals required) which stands for health maintenance organization and PPO plans which stands for preferred provider organization. Both HMO and PPO have unique network providers for both primary care and specialists and should be thoroughly reviewed for copayments, coinsurance, monthly premiums and deductibles before enrollment. All plans are different, so it’s important to review.
Medicare beneficiaries cannot have both Medicare Advantage plan and Medicare Supplement plans (Medigap) at the same time. And, Medicare Supplements do not include drug coverage, so if you get a Medicare Supplement, you’ll also likely need a prescription drug plan as well.
Eligibility can change for Medicare beneficiaries also receiving Medicaid services. These plans are referred to a special needs plans or snps for short. Health care providers often accept special needs plans as well as traditional Medicare coverage.
Open enrollment period occurs annually from October 15th through December 7th. This is the time to review you plan and make sure your prescription drugs are listed in the plan formulary and your providers are within your plan’s service area.