Medicare Advantage Coverage — Tom Fesperman Insurance Services

Medicare Advantage Plans

Medicare Advantage Plans work quite differently than Medicare Supplements. The insurance companies sponsoring Medicare Advantage plans are paid directly by Medicare to assume full responsibility for your healthcare. The private insurance company then pays approved claims to healthcare providers according to the benefit design of the Medicare Advantage plan. Medicare Advantage plans are closely monitored and each plan must be approved annually by the Centers for Medicare & Medicaid Services (CMS) before being marketed during the Medicare Open Enrollment Period (OEP) also known as Annual Election Period.

Medicare Advantage plans have a contractual relationship with network healthcare providers, and most Medicare Advantage plans require members to use contracted healthcare providers in order to obtain the full benefit of the Medicare Advantage plan. Here are a few additional facts about Medicare Advantage plans:

Most healthcare providers only accept a limited number of Medicare Advantage plans, so patients are strongly encouraged to confirm which Medicare Advantage plans their healthcare providers accept before applying for coverage.
Medicare Advantage plans usually include member coinsurance and copayments. A Medicare Advantage Summary of Benefits, the official document summarizing member cost-sharing requirements, should be carefully reviewed prior to applying for Medicare Advantage coverage.
Most Medicare Advantage plans charge a monthly premium that is less than the average Medicare Supplement premium; and Medicare Advantage premiums vary considerably by insurer, by plan and by market. Medicare Advantage plans cannot adjust plan premiums based on the member’s age, health or claims experience.
Medicare Advantage plans do not require medical underwriting (answering health-related questions). The only qualifications for Medicare Advantage coverage are that the applicant cannot have End Stage Renal Disease (kidney failure), they must have Medicare Parts A and B, and they need to reside within the Medicare Advantage plan’s service area.
Enrollment in Medicare Advantage plans is generally limited to certain periods of time. The Medicare Open Enrollment Period (OEP) also known as Annual Election Period, is the time when most Medicare beneficiaries may choose or change their Medicare Advantage plan. Additional periods of time are provided for people who are new to Medicare and to those who have lost their Medicare Advantage coverage because the Medicare Advantage plan has left the market or the Medicare beneficiary has relocated. There is also an additional time period for those losing their group coverage.
Medicare Advantage plans often include a Part D Prescription Drug plan and they must include emergency care when traveling abroad.
Some Medicare Advantage plans feature added benefits that are not included with Original Medicare such as preventive dental, vision care, an annual hearing exam, or alternative medicine.
Medicare Advantage plans must submit their proposed benefit package each year to Centers for Medicare & Medicaid Services (CMS) for the upcoming year. CMS must then review and approve the Medicare Advantage plan’s benefit package before marketing can begin during the Open Enrollment Period. When reviewing Medicare Advantage plan benefits during Open Enrollment, understand that the Medicare Advantage plan benefits will not change during the plan year that runs from January 1st to December 31st.
People who already have a Medicare Advantage plan will receive an Annual Notice of Coverage (ANOC) letter from their Medicare Advantage plan before the start of Open Enrollment. The ANOC letter indicates how their Medicare Advantage benefits will change for the upcoming plan year. Medicare Advantage members are strongly encouraged to carefully review their ANOC letter.