Medicare Advantage Plans

Medicare Advantage Plans in Zanesville, OH, and beyond

Medicare Advantage Plans, sometimes called Part C, are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through the Medicare Advantage Plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there generally are extra benefits and lower co-payments than in the Original Medicare Plan. Most Medicare Advantage Plans are managed care plans, usually a health maintenance organization (HMO) or a preferred provider organization (PPO) and you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you may have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. In 2024, the standard Part B premium amount is $174.70 (or higher depending on your income). However, some people who get Social Security benefits pay less than this amount.

The Advantages Of A Medicare Advantage Plan

Medicare Advantage Plans cap your maximum out-of-pocket expenses

Unlike Original Medicare, Part C plans are required to have out-of-pocket maximums. This means there is an automatic limit on the amount of money you will spend for covered healthcare during any given year. For in-network services in 2021, the highest Medicare out-of-pocket maximum a Part C plan could allow was $7,550. Many Part C plans also offer much lower out-of-pocket limits,

Many Medicare Advantage plans feature low premiums (sometimes $0).

Most Medicare Advantage plans include benefits you may need that are not covered by Original Medicare, including:

Routine dental care, including X-rays, exams, and dentures.
Vision care, including glasses and contacts.
Hearing care, including testing and hearing aids.
Prescription drug coverage.
Wellness programs and fitness center membership
OTC Benefits for thing like bandages, pain relievers, cold remedies, toothpaste and much more.

Questions To Ask While Comparing Medicare Advantage Plans

Finding the best Medicare Advantage plan may be worth it for the extra coverage. Be sure to ask the right questions to get the most out of the plan you pick.

Are your preferred hospitals or preferred doctors included in the Medicare Advantage plan?

Doctors and hospitals in a plan’s network can change yearly, so it’s best to make sure your family doctor is still in the plan after your initial enrollment. Just ask when you go for a doctor visit.

Which prescription drugs are covered?

We can look to see what drugs are available in the plan. If you need medications, are they available and affordable under a selected plan?

What is the maximum out-of-pocket amount?

A lower out-of-pocket maximum may be preferable, so you have coverage for unexpected injuries or illnesses.

When can I enroll in Medicare?

Keep in mind that Medicare limits when you can join, switch, or drop a Medicare Advantage Plan. You can join a plan when you first become eligible for Medicare. This is anytime beginning three months before the month you turn 65 and ends three months after the month you turned 65.

For example, if you turn 65 on May 5, your eligibility period starts on February 1 and ends on August 31.
If you are disabled and have Social Security Disability Insurance, you can join an advantage plan three months before to three months after month 25 of your disability.

There are two main Medicare Advantage enrollment periods when you can make changes each year. Each period is slightly different.

Medicare Annual Enrollment

The Medicare enrollment begins October 15 and runs through December 7 each year. During this time, you can switch from Original Medicare to a Medicare Advantage plan and vice versa, and you can add, drop, or change your Part D coverage for prescription drugs.

Medicare Advantage Open Enrollment Period

The new Medicare Advantage Open Enrollment Period (OEP) takes place every year between January 1 and March 31. If you are already enrolled in a Medicare Advantage plan, you can switch to another plan with or without Part D prescription drug coverage during this time. You can also switch from Medicare Advantage to Original Medicare. However, you can only make one change during this period and you cannot switch from Original Medicare to Medicare Advantage during the new Medicare Advantage enrollment period.

Special Enrollment Period

A Medicare Special Enrollment Period is an opportunity for people in special circumstances to enroll in Medicare. During a Special Enrollment Period (SEP), you can join, switch or drop a Medicare Advantage or prescription drug plan outside the basic enrollment periods. In order to qualify for an SEP, certain events must occur that require you to change your coverage.

You may qualify for a Medicare Special Enrollment Period in the following situations:

You move out of your plan’s service area.
Your plan closes, stops serving the area where you live, significantly reduces its provider network or your plan consistently receives low Medicare star ratings.
You want to enroll in a 5-star plan at any time or drop your first Medicare Advantage plan within 12 months of enrolling.
You move into or out of a qualified institutional facility, like a nursing home.
You are enrolled in or lose eligibility for a qualified State Pharmaceutical Assistance Program.
You have Medicare financial assistance such as Medicaid, a Medicare Savings Program or Extra Help, or you gain or lose eligibility for any of these.
You enroll in or leave the Program of All-Inclusive Care for Elderly (PACE).
You gain or lose eligibility for a Special Needs Plan.

Some situations not listed here may qualify for a Special Enrollment Period as well. If you have questions about your personal situation, call us at 1 (800) 459-6087 or email at vic@myneighborinsure.com.

The 5-Star Enrollment Period

The 5-star enrollment period for Medicare Advantage. This SEP lasts for nearly a year as it runs from December 8 to November 30 of the following year.

If a Medicare Advantage plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period (SEP) to switch from their current Medicare plan to a Medicare plan with a “5-star” quality rating.

Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent.

CMS rates Medicare Advantage and Part D plans annually, using a scale from one to five, with more stars equating to better performance and quality. A five-star rating is the highest a Medicare Advantage or Part D plan can receive, and half-ratings also exist (1.5, 2.5, 3.5, 4.5).

Here’s what the star ratings mean:

Medicare Advantage Trial Right Period

If you enroll in a Medicare Advantage plan during your Initial Coverage Election Period when you were first eligible for Medicare, OR you have dropped a Medicare Supplement policy to enroll in a Medicare Advantage Plan for the first time, you are entitled to a 12-month trial period. During this 12-month window, you have a Special Enrollment Period you can use at any time to cancel your Medicare Advantage plan and return to Original Medicare.

At the same time, you’ll have a guaranteed issue right to enroll in a Medicare Supplement plan. The guaranteed issue right will last for 63 days after you disenroll from your Medicare Advantage plan.

This same trial right applies to those who drop a Medicare Supplement plan and enroll in a Medicare Advantage plan for the first time.

In this scenario, you also get a 12-month window offering you a Special Enrollment Period to change your mind. Once you disenroll from your plan, you have 63 days to re-enroll in a Medicare Supplement with guaranteed issue rights.