Senior mature older woman watching business training

What is Medicare Advantage?

Medicare Advantage is a policy that bundles all of Original Medicare’s features into one cohesive plan. You get inpatient, outpatient, and in some cases, prescription drug coverage. Other coverage can include dental, hearing, and vision services, and more.

There are multiple types of Medicare Advantage plans. Medicare Advantage plans include:

• Health Maintenance Organization (HMO). HMOs only provide coverage within a network, but are less expensive. They require choosing a primary care physician and getting referrals to see specialists.

• Medicare Savings Account (MSA). MSAs work differently from the other Medicare Advantage plans in that these deposit funds into your account. You can then use those funds to pay Medicare-related expenses. Funds left over in your account at the end of the year will remain there the next year.

• Preferred Provider Organization (PPO). PPOs have more relaxed coverage options because policyholders can get out-of-network treatment, though it is at a higher out-of-pocket cost. This plan incentivizes policyholders to get treatments from certain doctors within the network, because you can see some healthcare professionals for a much lower cost than others.

• Private Fee-for-Service (PFFS). PFFS plans make payments predictable. Your insurance provider makes contracts with doctors in the network, which is why your payments are decided ahead of time.

• Special Needs Plans (SNPs) are for those who are disadvantaged, financially and/or physically. Three versions of this exist - Institutional (I-SNP) for individuals living in institutions such as nursing homes; Chronic condition (C-SNP) for those with serious chronic diseases and major illnesses; Dual Eligible (D-SNP) for those who qualify for both Medicare and Medicaid. 

How Do I Get It?

In order to get Medicare Advantage, you have to have Medicare Part A and Part B first. You can join Medicare Advantage during your Initial Enrollment Period, which takes place three months before you turn 65 to three months after. If you don’t join then, you can join during the Annual Election Period, which lasts from October 15 to December 7.

Since Medicare Advantage is only available through private insurance, you will need to contact us during one of those times.

What Do I Pay?

There is no standard payment for Medicare Advantage itself. Some policies are premium-free while others charge a small monthly premium.

You will still need to pay your Medicare Part A and Part B premiums in order to keep your Medicare Advantage policy.

What Should I Know Beforehand?

Medicare Advantage has some restrictions when it comes to other health insurance plans. This is a plan you need to have by itself. Getting Medicare Advantage while you are still under your employer’s health insurance plan may cause you to lose your employer group health plan, and you may not be able to get it back.

You will also not be able to get a Medicare Supplement plan if you have Medicare Advantage. You will need to choose between one or the other.

We Know Medicare Advantage!

If Medicare Advantage is right for you, Cashmore Financial Group is ready to help! We help seniors obtain the policies that meet their wants and needs. We aim to make the most out of every day and every interaction, so give us a call today.

How can we help you?