Medicare Advantage Plans

Medicare Advantage Plans

Medicare Advantage plans are administered by private insurance companies under contract with Medicare. Pursuant to those contracts, each Medicare Advantage plan provides you with all of your Part A and Part B benefits.

Although its benefits are provided by a private insurance company, a Medicare Advantage plan should not be confused with Medicare Supplement plans. As its name suggests, a Medicare Supplement actually supplements benefits provided by original Medicare, but when you are enrolled in an Advantage plan, that plan essentially becomes your Medicare provider. You do not give up benefits provided by original Medicare when you enroll in an Advantage plan; it’s just that the benefits will be provided by a private insurance company contracted with Medicare to provided those benefits, and in many cases, the benefits will be enhanced over what is provided under original Medicare.

There are several types of Medicare Advantage plans, including HMO’s, PPO’s, PFFS, POS, and MSA plans. Available plan types vary by area. Plan designs vary based on a number of factors, so it’s always important to find out exactly what plan options are available in your service area.

Things to consider include monthly premiums, deductibles, co-pays, co-insurance, and total out-of-pocket maximum costs, both in and out of a plan’s network. Also consider availability of physicians and other providers. Some Advantage plans may have restricted networks with limited or no coverage when you go outside that network (although most emergency care is provided at in-network rates).

Most, but not all, Medicare Advantage plans include Part-D Rx drug coverage. Those that do include Part-D coverage are known as MA-PD plans. If an Advantage plan does not include Part-D coverage, it is known simply as an MA plan. Someone who already has creditable Rx drug coverage elsewhere might consider an MA plan.

In order to enroll in a Medicare Advantage plan, there are three requirements. You must:

  1. Reside in the plan’s service area
  2. Be covered under Parts A and B of Medicare, and
  3. NOT have ESRD.

In general, you can only enroll during the Annual Election Period (AEP), between Oct. 15 and Dec. 7 for the next plan year, which begins Jan. 1 and ends Dec. 31. Some exceptions may apply, including but not limited to:

  • A change of residency from a prior plan’s service area
  • Low income subsidy
  • Health condition(s) that qualify for Special Needs Plans (such as diabetes, chronic lung disorder, etc.)
  • Losing coverage through a group or union plan

If a special exception applies, you may be able to enroll in a Medicare Advantage plan at certain points throughout the calendar year.
An excellent source of information to learn more about Medicare Advantage plans is Medicare’s official website: Medicare.gov

Our agency represents all Medicare Advantage plans both in Clark and Nye counties, in addition to several plans in the greater Reno area. If you would like for us to assist you in determining which Medicare Advantage Plans may be available in your area of Nevada, you can contact us by phone at the number listed at the bottom of this page. Or if you prefer, you can click the link below and submit a request for additional information via a secured link on our site.

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