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Buying a Medicare Advantage Plan

Medicare Advantage Plans have election periods that govern when you can join a plan. It’s important that you understand these election periods so you don’t miss your opportunity to join a plan if that is your intent.

When beneficiaries first become eligible for Medicare, they are considered “age-ins” and have the ability to enroll into a PDP or Medicare Advantage plan. This period is for all beneficiaries becoming eligible for Medicare whether it is due to turning 65 or by becoming eligible due to a qualifying disability.

The Annual Election Period (AEP), which runs from October 15 to December 7, (new enrollment time frame for 01/2012 effective date) enables beneficiaries to change or add prescription drug plans (PDPs), change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time.

The traditional Open Enrollment Period has been eliminated starting in 2011. Those people who have enrolled in an Anthem Advantage plan do have an opportunity to dis-enroll from their plan and return to original Medicare. This dis-enrollment period begins January 1 and ends February 14. Dis-enrolling from an Advantage plan will allow you to purchase a Part D plan during this time frame.

PPO Advantage Plans are another type – These plans are fairly predictable making them quite popular among seniors on Medicare. you’ve got a huge network of doctors and hospitals to choose from with a PPO, but using an out-of-network provider is an option for a specific service, it will be at a much higher price. With a PPO plan referrals are not needed and you can see as many different doctors as you’d like. You can get a PPO  with Part D prescription coverage included or without the coverage. The rest of it is on this guide

Special Election Periods (SEP) allow beneficiaries to make an enrollment change in accordance with applicable requirements anytime during the year, including during the “lock-in” period, which is outside of the regular enrollment periods. The SEPs vary in the qualifications to use them as well as the types of elections allowed. Situations such as dual-eligible status and institutionalization provide the ability to switch plans at any time during the year. All SEPs are determined and announced by CMS.

Marketing Medicare Advantage Plans (Important stuff to know!)
The rules for marketing Medicare Advantage Plans are strict, with the intent to protect Medicare beneficiaries during the enrollment process.
Here are a few things that agents representing an Advantage Plan may not do:

  • Agents may not “cold call” you.They may not show up unannounced at your home.You are not to be approached by agents in common public areas, such as a parking lot or a hallway.
  • Agents may hold educational events, but cannot distribute plan specific information register your contact information.
  • They can give you a business card if you ask for one.
  • Meals cannot be served at a meeting to inform you about a particular plan.
  • Agents cannot sell or attempt to sell you a non-medical related product at a meeting for a Medicare product.
  • Agents cannot meet with you with out a written scope of appointment form, signed by you granting them permission to discuss the Medicare products detailed on the form.An inducement cannot be offered to you to enroll in a plan or to give referrals.

These rules were enacted because of inappropriate marketing practices in the past. Given these restraints on the individual agent, it becomes incumbent upon you to request plan information. Whether you are responding to a direct mail solicitation, a radio or TV ad, or are requesting plan information online, you need to be proactive to get the information in time to take advantage of the appropriate enrollment period.

Summing it all up
Medicare Advantage Plans can be a good way for you to get Medicare Coverage if you do your homework and understand the rules of the plan that you are preparing to join. Advantage Plans are not for everyone. A Medicare Advantage Plan may be a good option for you one year, and not your best option another year. You may choose a plan that has great benefits and decide to change to a different plan the next year.

If you are knowledgeable about the election periods and stay abreast of any plan changes from year to year, you can maximize your benefits and have a positive experience with a Medicare Advantage Plan.

A Look At The Benefits Of Advantage Plans
Anyone who has Medicare knows that there are some gaps in its coverage. And this form of health insurance was really never intended to provide full coverage for its users. So, those who are concerned about paying for their medical bills should consider medicare advatage plans. These Advantage plans offer certainty and assurance for those who are living on a low or fixed income, that they will have the coverage they need without worrying about surprise expenses.

With these plans, one usually is quoted an annual out of pocket maximum figure. This allows beneficiaries to plan accordingly, setting aside this money and knowing that they will not need any more than that. And it does not matter how you reach that amount, as long as it was an out of pocket expense.

For instance, you may pay it in deductibles and copays, but it really does not matter, as long as you have paid it out toward medical expenses. When you reach that pre-determined dollar amount, then the rest of your medical expenses will be paid that year by the company.

These plans also usually include additional coverage for health services that are not covered by other Medicare plans, from dental to vision or hearing. When you get older, it seems that you experience a lot of health problems in all of these venues. So having the right coverage is important, especially if you are already somewhat strapped financially.

Medicare advatage plans can give you great peace of mind, especially in knowing that there are not unforeseen medical expenses in your future. Nothing can make you feel more financially secure than knowing how much your bills are going to be up front. And when you know that you are going to have the appropriate coverage, you can seek the medical assistance you need without worrying that you will not be able to afford it.

Next: How to Save on Medigap.

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