Medicare Advantage Plans

Medicare Advantage (or Part C) plans operate in specific counties under annual contracts with the Centers for Medicare and Medicaid Services (CMS).  If you move out of the service area, you will have a Special Enrollment Period to choose a new plan.  Advantage plans provide benefits for all medically necessary services covered by original Medicare with a different cost structure that can save money for a light to moderate user.

Most include Part D drug coverage and may have additional benefits like fitness, hearing, vision, or dental coverage built-in or available as an add-on rider.  We help you select a Medicare Advantage plan by determining the provider networks that include your preferred physicians and hospitals, confirming coverage for all your prescriptions on the formulary, and comparing copays for each option available where you live.

    • HMO (Health Maintenance Organization) plans have some of the lowest maximum medical out-of-pocket (MOOP) amounts and copays, but require all services to be received from network providers.
    • HMO-POS (Point-of-Service) plans allow many services to be received out-of-network, but usually at higher cost than in-network copays or coinsurance amounts.  Like strict HMO’s, they always include prescription drugs and have some extra benefits built-in.
    • PPO (Preferred Provider Organization) plans allow all services to be received out-of-network, but usually offer lower copays in-network.  Extra benefits such as routine dental and vision coverage are often available with optional supplemental packages for additional premium.  A Medical only PPO plan would be appropriate for a Veteran who receives all prescriptions from the VA to have access to local physicians.
    • PFFS (Private Fee-for-Service) plans allow you to see any provider who agrees to accept the plan for that visit, but generally require this to be reconfirmed for each appointment.  In addition to MAPD, PFFS plans may be available as MA-only without Part D benefits.  This is the only type of Advantage plan that can be paired with a standalone PDP.
    • SNP (Special Needs Plan) options are available for people diagnosed with diabetes or chronic heart failure and in some area for Dual Eligibles covered by both Medicare and Medicaid.  These usually include dental and vision care and may also offer medical transportation and over-the-counter benefits.

Part C (Medicare Advantage Plans) and Part D (Prescription Drug Plans) operate under contract with the Centers for Medicare and Medicaid Services (CMS).  After your Initial Enrollment Period, you can enroll in or change Part C or Part D plans for the following year during each Annual Enrollment Period (AEP): October 15 – December 7.