Medicare Advantage Plans are another option for getting Medicare Parts A and B coverage. These plans are provided by private companies that must follow Medicare rules. Medicare Advantage Plans are sometimes referred to as Medicare Part C Plans. Medicare Advantage Plans usually include drug coverage (Part D). You’ll often need to use a provider who’s in the plan’s network and service area to get the lowest rates.
To help protect you from unexpected costs, these plans limit what you will be required to pay out-of-pocket for covered services each year. Out-of-network coverage is sometimes available with some plans, but at a higher price. To access Medicare-covered services, you must use the card from your Medicare Advantage Plan. When you switch back to Original Medicare, you’ll need your red, white, and blue Medicare card.
Here are some of the most common Medicare Advantage Plans.
HMO Medicare Plans
Medicare Health Maintenance Organizations (HMOs) are private plans that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, HMOs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs.
In HMO plans, you generally must get your care and services from providers in the plan’s network, except:
- Emergency care
- Out-of-area urgent care
- Out-of-area dialysis
In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. Most HMO plans require referrals to see specialists as well.
PPO Medicare Plans
Medicare Advantage PPO plans, you can visit providers in or out of the provider network who accept Medicare and the plan terms. Every Medicare PPO plan has a provider network. However, these plans also offer coverage for out-of-network care. In addition, PPO plan members may see specialists without a referral. See the chart below for the difference between a Medicare HMO and PPO plan.
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Medicare SNP (Special Needs Plans)
Special Needs Plans are Medicare Advantage plans for people living with certain conditions or diseases, or those with low incomes. These plans are offered by private insurance companies and may help to cover additional costs that traditional Advantage plans don’t cover. The three types of SNPs are:
Chronic Condition SNPs (C-SNPs): For individuals with specific chronic conditions, such as cancer, dementia, diabetes, HIV/AIDS, stroke, End-Stage Renal Disease (ESRD), and certain neurologic disorders
Institutional SNPs (I-SNPs): For individuals who live in an institution, such as a nursing home, long-term care skilled nursing facility (LTC SNF), intermediate care facility, or assisted living facility
Dual Eligible SNPs (D-SNPs): For individuals enrolled in Medicare and Medicaid (dually eligible individuals)
What do Medicare Advantage Plans Cost in Los Angeles, CA?
Most Medicare Advantage plans cost around $25 per month but most are $0 premium in Los Angeles. Generally, they include prescription coverage and some dental and vision, but that depends on the specific plan. It is important to note that you still need to pay for your Medicare Part B premium, which goes to the federal government.
How To Sign Up?
The best time to sign up for a Medicare plan is when you are starting Part B for the first time or coming off an employer plan. Also, you can sign up for an Advantage plan each year between October 15th and December 7th, this is referred to as the “Annual Enrollment Period.”
Why Work With Us?
We are completely independent and work with all the top companies and plans in Los Angeles, CA. We are able to compare all plan options and help you pick the plan that fits your unique needs and preferences.
During our initial consultation, we ask what your preferences are such as doctors, hospitals, budget, etc. These are things that help us determine what specific plan is best for your situation. In addition, we help our clients each year when it comes time to review your plan. We charge nothing for our services, we are compensated directly by the insurance companies and it does not affect the premium you pay.
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