Compare and Change Medicare Advantage Plans (Part C)

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Medicare Benefits Solutions

Sep 9, 2021

 5 minutes read

Got a Medicare Advantage plan (also known as Part C) and looking to switch to another? Before you use a Medicare Advantage comparison service, it’s worth understanding a little more about Medicare Advantage – what it is, the different types of plans, and when you can enroll in or switch your plan. Knowing these things can help you compare Medicare Advantage plans with more confidence.

What is Medicare Advantage?

Medicare Advantage is an alternative to Original Medicare for anyone 65 or older, or people under 65 who qualify due to disabilities. It offers the same basic healthcare coverage and benefits as Original Medicare – the parts typically referred to as Part A and Part B. Part C plans will usually offer extra benefits in addition to those covered under Original Medicare, such as prescription drug coverage (known as Part D), gym membership, and routine hearing, vision and dental care.

Medicare Advantage plans are offered by private health insurance companies, and there are certain times of the year when you can enroll in or switch your plan. It’s possible you’ll want to do a Medicare Advantage plan comparison before you decide whether or not to switch, so you can compare Medicare Advantage plans on key factors such as cost, maximum out-of-pocket limits, copays, deductibles, additional benefits and more.

A key difference between Original Medicare and Medicare Advantage is that with Part C plans, you may be required to use a defined network of doctors, hospitals and other healthcare providers. It could mean paying more to see a physician or visit a facility outside of your plan’s network. With Original Medicare, you can see any physician that is enrolled in Medicare and is accepting new Medicare patients.

What are the different types of Medicare Advantage plans?

Before you begin any Medicare Advantage comparison, it’s useful to know about the different types of Part C plans available.

  • Health Maintenance Organization (HMO)
    With the exception of emergency care/urgent out-of-area care or dialysis, HMO plans usually limit you to a defined network of healthcare providers. You choose your primary doctor, and in most cases need a referral to see any specialists. When you compare Medicare Advantage plans, check to see which offer prescription drugs as part of the plan, as not all do.
  • Preferred Provider Organization (PPO)
    Choosing a PPO plan means you’ll pay less to use doctors, hospitals and other healthcare providers within your plan’s network than those outside of it. This gives you the flexibility to use the service provider you like, but doing so comes with a higher price tag. Once again, you should check to see if prescription drugs are included with a PPO plan.
  • Private Fee-for-Service (PFFS)
    With a PFFS plan, a private insurer works out how much it will pay doctors, hospitals and other healthcare providers, and how much you have to pay when you receive care. Most PFFS plans don’t have a network, but if your plan does, you may pay less if you visit a provider within the plan’s network. Drug costs aren’t always covered, and not all care providers may accept your PFFS plan’s terms.
  • Special Needs Plans (SNPs)
    These Medicare Advantage plans are for those with specific diseases or illnesses, or those who share particular circumstances. Each plan tailors its offering to meet the special needs of the people it’s designed for. Generally speaking, you must use the healthcare providers stipulated in your plan, except in cases of emergency care. All plans cover prescription drugs

When can you enroll in Medicare Advantage?

The time of year when many people make changes to their Medicare Part C plans is between October 15th and December 7th. This is known as the Annual Election Period (AEP), and it’s open to everyone who’s eligible for Medicare.

What if your circumstances change outside of AEP? You may be eligible for what’s known as a Special Enrollment Period (SEP). A change in living arrangements, like moving to a location outside of your current plan’s network, for example, might mean you’ll have the opportunity to enroll in a new Medicare Advantage plan under the rules of an SEP. You could be entering or leaving long-term care – or you may no longer be covered by Medicaid or other federally subsidized healthcare provision.

As well as making changes or switching plans during AEP and SEP, you’re allowed to make a change to your existing Medicare Advantage plan (or switch to an entirely new one) just once between January 1st and March 31st each year.

Let us help you compare Medicare Advantage plans

Get your Medicare Advantage plan comparison off to the right start by using our online plan finder and comparison tool. It recommends plans that may include the additional benefits or improvements you’re after, without losing the good things you already have. By focusing on these little details, we may find you plans that make a big difference.

Or if you prefer, you can call our dedicated, fully licensed sales agents at (866) 576-2956 or TTY 711.

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