What is a Medicare Advantage Plan?
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare health plans in your area. One of our state-licensed agents could help you save time and money, call or TTY: 1 (855) 840-7123 to schedule a plan review at no cost to you!
Once you understand the plan’s rules and costs, you can join.
When Can You Join a Medicare Advantage Plan?
When you join a Medicare Advantage Plan, you’ll have to give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.
You can generally join a Medicare Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), or Medicare Medical Savings Account (MSA) Plan if you meet all of the following conditions:
- You live in the service area of the plan you want to join. The plan can give you more information about its service area. If you live in another state for part of the year, check to see if the plan will cover you there.
- You have Medicare Part A and Part B.
- You don’t have Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.End-Stage Renal Disease (ESRD).
If you have ESRD, you’ll usually get your health care through Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Part A and/or Part B benefits.
Original Medicare.You can only join a Medicare Advantage Plan in certain situations:
- If you’re already in a Medicare Advantage Plan when you develop ESRD, you may be able to stay in your plan or join another plan offered by the same company.
- If you have an employer or union health plan or other health coverage through a company that offers Medicare Advantage Plans, you may be able to join one of its Medicare Advantage Plans.
- If you’ve had a successful kidney transplant, you may be able to join a Medicare Advantage Plan.
- You may be able to join a Medicare Advantage Plan with ESRD if one is available in your area.
If you have ESRD and are in a Medicare Advantage Plan, and the plan leaves Medicare or no longer provides coverage in your area, you have a one-time right to join another plan. You don’t have to use your one-time right to join a new plan immediately.
If you go directly to Original Medicare after your plan leaves or stops providing coverage, you’ll still have a one-time right to join a Medicare Advantage Plan later.