A Medicare Advantage Plan (Medicare Part C) is a Medicare plan issued and administered by authorized private health insurance companies.
When you purchase a Medicare Advantage Plan, you are directing a private insurance company to manage your healthcare coverage instead of Original Medicare. Each plan offered must offer the same coverages as Original Medicare, however, most Medicare Advantage plans offer additional coverages.
Easy Article Navigation
- How do Florida Medicare Advantage Plans Work?
- What are the Four Types of Medicare Advantage Plans?
- When Can I buy a Medicare Advantage Plan in Florida?
- Original Medicare Versus Medicare Advantage Plans
- Pros and Cons of a Medicare Advantage Plan
- How to Buy a Florida Medicare Advantage Plan
A Medicare Advantage plan offers a more comprehensive health plan because in most cases, your Medicare Advantage plan will offer prescription drug coverage and other additional coverages like dental, vision, and hearing.
How do Florida Medicare Advantage Plans Work?
Medicare Advantage Plans (Medicare Part C) are Medicare plans offered by private insurance companies rather than the federal government.
To be approved, these companies must sign a binding contract with Medicare and promise to provide at least the same services Original Medicare offers. The services include in-patient (hospital) and out-patient services that Original Medicare covers.
Additionally, some Medicare Advantage plans offer additional coverages like dental, vision, and hearing depending on which insurance plan you select.
Companies that offer Medicare Advantage are also allowed to charge an enrollment fee and monthly premiums for the coverage they provide even though the applicant must still pay their Medicare Part B Premium.
Medicare Advantage plans generally restrict their policyholders to using a network of healthcare providers to help offset the cost of the medical services. The most common networks are HMO and PPO, however, there are additional plans like Private Fee for Service (PFFS), Special Needs Plans (SNPs), and Medicare Savings Accounts.
What are the Four Types of Medicare Advantage Plans?
Medicare Advantage plans can be especially advantageous over Original Medicare because there are four types of plans available to accommodate your individual circumstances.
Health Maintenance Organization (HMO)
With an HMO plan, policyholders will have access to a defined network of service providers who are contracted members of the network. Although these member companies have agreed to provide healthcare services at a reduced price, policyholders will have a limited number of healthcare providers that they can see for services.
Moreover, an HMO plan will require the policyholder to use a primary care provider who is in charge of all medical needs of his or her patient. If a specialist needs to be involved, the patient is required to get a referral from their primary doctor for services to be covered.
Many Florida Medicare Advantage plans are HMO plans, although there are others available depending on the geographic area your plan covers.
Preferred Provider Organization (PPO)
A PPO plan offers flexibility when choosing a doctor or hospital. Although there is a network of preferred providers, there are not as many restrictions on seeing out-of-network providers. Also, your PPO plan will pay healthcare costs if you see an out-of-network provider, although the company may pay less of the bill than if the doctor was a member of the PPO.
Special Needs Plan (SNP)
A Special Needs Plan is a Medicare Advantage coordinated care plan (CCP) intended to deliver targeted healthcare and limit its enrollment to qualified special needs persons. A special needs applicant is required to meet at least one of the following circumstances:
- An institutionalized individual,
- A dual eligible, or
- An individual with a severe or disabling chronic condition, as specified by CMS.
Private Fee for Service Plan (PFFS)
The PFFS plan is more flexible than an HMO or PPO plan and typically provides for the policyholder to receive healthcare services from any provider who accepts Original Medicare.
Medical Savings Account (MSA)
A Medical Savings Account is a low-cost solution for healthy individuals who can afford to pay a larger portion of their healthcare services. The plan is designed to combine a medical savings account with catastrophic (high-deductible) health insurance.
When Can I buy a Medicare Advantage Plan in Florida?
Unless you are disabled or have end-stage renal disease or ALS (Lou Gehrig’s Disease), the earliest you can buy a Medicare Advantage Plan is during your Initial Enrollment Period which begins three months prior to the month of your 65th birthday and continues for three months thereafter.
During this Initial Enrollment Period, you may also change to another Medicare Advantage plan if you are unhappy with your original purchase.
You can also change your Medicare Advantage Plan to another Medicare Advantage plan or switch back to Original Medicare during the annual Open Enrollment Period which starts October the 15th and runs through December the 7th each year.
You can change from one Medicare Advantage to another Medicare Advantage plan as many times as you’d like as long as your change is done during the Open Enrollment Period.
Additionally, if you qualify for a Special Enrollment Period, you may change from one Medicare Advantage plan to another. There are currently four life events that can trigger a Special Enrollment Period:
- You move to an address that is outside your plan’s service area
- You move to an address that has new plan options
- You move into a skilled nursing facility or long-term care facility
- Medicare terminates your plan
Original Medicare versus Medicare Advantage Plans
Although a Medicare Advantage Plan must offer what Original Medicare offers in Part A and Part B, there are many differences between these two forms of health insurance coverage:
Original Medicare Medicare Advantage
Costs Enrollees will be charged for Part A and Part B. Enrollees will have a 20$ coinsurance for covered services when seeing a participating provider and after the deductible is met. Your cost-sharing will vary from plan to plan. Typically a copayment is required for in-network services. The company may also charge a monthly premium in addition to the Part B premium.
Supplemental Coverage Enrollees have the option to purchase Medigap Insurance to cover all Medicare cost-sharing except the Part B deductible. Applicants cannot enroll in a Medigap Plan while enrolled in Medicare Advantage.
Access to Providers Medicare enrollees make see any service provider that accepts Medicare Depending on the plan you purchase you must use providers in the network.
Referrals to Specialists No referrals required Typically the primary care physician must provide a referral
Prescription Drugs Must purchase Part D to get out-patient prescription drug coverage Most plans offer prescription drug coverage
Additional Benefits No coverage for dental, vision, or hearing Most plans provide coverage for dental, vision, and hearing
Out-of-Pocket Expenses No annual limit Plans assign an annual out-of-pocket limit
Pros and Cons of a Medicare Advantage Plan
Even though a Medicare Advantage Plan provides more insurance coverage than Original Medicare, and in some cases are available for zero premium, there are some pros and cons that you should be aware of:
- Some Medicare Advantage plans may cost you less for healthcare expenses that are covered by Original Medicare.
- Your Primary Care Provider will coordinate your health care among your health care providers.
- A Medicare Advantage Plan acts as a one-stop-shop by offering coverage for doctors, hospitals, out-patient facilities, prescription drug coverage, as well as dentist, eye doctors, and hearing specialists coverage.
- Some plans will limit your freedom of choice in healthcare providers.
- Services from a specialist require a referral from your primary care provider.
- Medicare Advantage Plans have designated service areas. If you move out of the area, you’ll have to reapply for another Medicare Advantage plan which could result in a higher premium.
How to Buy a Florida Medicare Advantage Plan
Whether you have entered your Initial Enrollment Period or are in the annual Open Enrollment Period, it makes sense to purchase your health insurance coverage from an independent agent licensed and located in your state.
The insurance professionals at HealthPlans2Go represent the top-rated Medicare Advantage companies in Florida and we are aware of any and all challenges associated with Medicare Advantage Plans in our state.
We invite you to submit the health insurance quote request on the right side of the page for a personalized quote comparison with no obligation to purchase or call us at 888-773-1181 during normal business hours.
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