Medicare Advantage Plans are “all-in-one” alternatives to Original Medicare. These plans bundle:
- Medicare Part A (Hospital Insurance)
- Medicare Part B (Medical Insurance)
- Often, Medicare Part D (Prescription Drug Coverage)
Many plans also include extra benefits like vision, hearing, dental, fitness programs (e.g., Silver Sneakers), over-the-counter stipends, and $0 copay virtual doctor visits. Specific benefits depend on the plan you choose.
Benefits of Medicare Advantage Plans
Medicare Advantage Plans have become popular for their:
- Low, sometimes $0 monthly premiums
- Low copays for doctor and hospital visits
- Built-in prescription drug coverage
- Extra benefits not typically covered by Original Medicare
Need help choosing the right plan?
We can assist you in finding and enrolling in the best plan for your needs—in person, over the phone, or via Zoom.
- Click Here or call us at 314-890-9200 for free assistance.
Things to Consider When Choosing a Medicare Advantage Plan
- Provider Network:
- Check if your preferred doctors and hospitals are in the plan’s network.
- Using out-of-network providers may result in higher costs.
- Prescription Drug Coverage:
- Review the plan’s formulary (drug list) to confirm coverage for your medications.
- Verify restrictions like prior authorization, step therapy, or quantity limits.
- Ensure your preferred pharmacy is in the plan’s network.
- Maximum-Out-of-Pocket (MOOP):
- Understand the plan’s MOOP—the maximum amount you’ll pay annually for in-network services.
- This is a safety net that caps your medical expenses for covered services each year.
- Flexibility to Change Plans:
- You can change your Medicare Advantage plan annually during the Annual Enrollment Period (October 15 – December 7). Changes take effect on January 1 of the following year.
Trial Rights and Irreversible Choices
- If you switch from a Medicare Supplement Plan to a Medicare Advantage Plan, you have one year to try the Medicare Advantage Plan.
- During this trial period, you can switch back to your old Medicare Supplement Plan without medical underwriting.
- After this one-year period, switching back to a Medicare Supplement Plan will generally require medical underwriting, and coverage may be denied.
Trial Rights Scenarios:
- New Medicare Beneficiaries:
- If you enroll in Medicare Parts A & B and choose a Medicare Advantage Plan, you have one year to return to a Medicare Supplement Plan with guaranteed acceptance.
- Switching from a Medicare Supplement:
- If you move from a Medicare Supplement Plan to a Medicare Advantage Plan for the first time, you have one year to switch back to your previous Medicare Supplement Plan without medical underwriting.
Enrollment Periods
1. Initial Coverage Election Period (ICEP)
- The first time you can enroll in a Medicare Advantage Plan.
- Your ICEP lasts seven months, beginning three months before the month you turn 65 and ending three months after your birth month.
2. Annual Enrollment Period (AEP)
- Dates: October 15 – December 7
- What You Can Do:
- Enroll in or change Medicare Advantage Plans.
- Disenroll from a Medicare Advantage or Medicare Part D Plan.
- Changes take effect on January 1 of the following year.
3. Medicare Advantage Open Enrollment Period (OEP)
- Dates: January 1 – March 31
- What You Can Do:
- Switch Medicare Advantage Plans one time.
- Disenroll from Medicare Advantage and enroll in Original Medicare with a Medicare Supplement and Part D Plan.
- Note: Medical underwriting may be required for Medicare Supplement Plans.
4. Special Enrollment Period (SEP)
- Life Events like losing health insurance coverage or moving to a new area may qualify you for a SEP.
- During a SEP, you can enroll in or disenroll from a Medicare Advantage Plan.
Get Help Choosing a Medicare Advantage Plan
Medicare Advantage Plans have many features to consider. We are here to make the process simple and help you select the best plan for your needs.
Contact us for free assistance:
- Click Here to schedule an appointment
- Or call us at 314-890-9200
(314) 890-9200