Medicare Advantage Plans Offered in the State of Florida
Most people get their Medicare coverage in one of two ways: either from original Medicare or with a Medicare Advantage Plan.
Original Medicare has two parts: Part A (hospital insurance) and Part B (medical insurance). Original Medicare is a fee for service health plan. You pay deductibles and coinsurance and Medicare pays its share of the Medicare-approved amount. To avoid those deductibles and copays, one can purchase a private Medicare Supplement plan for a monthly premium.
A Medicare Advantage Plan is a type of Medicare plan offered by a private company that contracts with Medicare to provide you with all of your Medicare Part A and B benefits.
Medicare Advantage Plans, or Medicare Health Plans as they are sometimes called, come in a variety of plan formats such as Health Maintenance Organization plans (HMO), Preferred Provider Organization plans (PPO), Private Fee-For-Service plans (PFFS), or Special Needs Plans (SNP). When you are enrolled in a Medicare Advantage Plan, Medicare services are paid for by the plan.
Medicare Advantage Plans can provide additional benefits that Medicare does not cover; they may charge a monthly premium (usually a minimal one) in addition to the Medicare Part B premium; and they also generally charge a fixed amount called a co-payment whenever you receive a service.
When to Enroll in a Medicare Advantage Plan?
You become eligible to join a Medicare Advantage Plan if you have Medicare Parts A and B; if you live in the health plan's service area; and if you do not have End-Stage Renal Disease. You are limited as to when you can change your Medicare Advantage Plan during the year.
Medicare Advantage Plan enrollment periods include:
Initial Enrollment Period (IEP): You may first enroll in Medicare in your IEP which is sometime during the three months prior to your 65th birthday, the month of your 65th birthday, and the three months after your 65th birthday. You may become eligible for Medicare prior to age 65, if you meet certain disability requirements. You may enroll in a Medicare Advantage Plan at this time as well.
Special Enrollment Period (SEP): Under certain and very specific circumstances, you may become eligible for a Special Enrollment Period to change your drug coverage and/or health plan. Your new coverage will begin on the first of the month after you enroll in or dis-enroll from a Medicare Advantage Plan. SEPs include such situations as: if your Medicare Advantage Plan leaves your area, if you move out of your plan’s service area or if you lose employer group coverage.
What you Should Ask About Medicare Advantage Plans Before Enrolling in One?
Medicare Advantage Plans may vary from county to county in in your state. Before you join any Medicare Advantage Plan, make sure you understand that Plan’s rules, copays, etc. You can do this best by consulting with an independent agent or broker who is appointed with a range of different plans.
The Medicare Rights Center, the largest independent non-profit source of Medicare information and assistance in the U.S., encourages you to consider 6 key points - namely: choice of doctor; ease of access to specialists without unexpected bills; coverage away from home; prescription drug coverage; and whether the plan works with Medicaid. Conversations with your health care providers, your friends and family members, and with the health plan representatives and agents may help define what a particular plan will offer you. Here are some of the questions the Medicare Rights Center suggests you ask and receive answers to before you enroll in a Medicare Advantage Plan:
- Will I be able to use my doctors?
- Are my preferred doctors in the plan's network and are they taking new patients?
- Do my doctors recommend joining this plan?
- What will happen if my doctors leave the plan?
- Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan's network?
- What extra benefits does the plan offer? (dental services, vision care, gym memberships, etc) and what rules do I have to follow to get them?
- Are my prescription drugs on the plan's formulary?
- Are there limits or caps to prescription drug coverage?
- Do I have to pay a monthly premium? If so, how much is it?
- How much is my co-payment for a visit with my Primary Care Physician or specialist?
- How much will I pay for brand-name drugs? How much for generic drugs?
- How much will I pay for a hospital stay?
- How much will I pay if I use a non-network doctor or hospital?
- Are there higher co-pays for certain types of care, such as hospital stays or cancer treatment?
- What service area does the plan cover?
- What kind of coverage do I have if I travel outside of the service area?
Is There a Significant Difference Between Medicare Advantage Plans?
Enrollment in any health insurance plan deserves a lot of homework because the Medicare plan you choose can affect the kind of care you receive as well as impact you financially. For more details about Medicare Advantage Plans or any Medicare or other health insurance issues, contact