Introduction to Medicare Advantage (Part C)

A Medicare Advantage plan is also called Medicare Part C, or a “replacement” plan. This type of insurance policy is designed to help individuals on Medicare cover the high costs of healthcare that they would otherwise be exposed to if they kept Medicare by itself—with no additional coverage. A Medicare Advantage plan sort of “replaces” Medicare in the fact that if you enroll in this type of policy—Medicare will no longer be the party directly responsible for paying your claims—but rather your Medicare Advantage plan provider will be the main party responsible for payment.

Federal Regulations for Medicare Advantage

Medicare Advantage plans are closely regulated by Medicare to follow a certain set of guidelines. Medicare mandates that Medicare Advantage plans must cover at a minimum what basic Medicare provides, plus the plan may add additional benefits on top. Some Medicare Advantage plans cover Part D as well, which is the prescription drug plan for people on Medicare. If you purchase a Medicare Advantage plan that includes drug coverage, they refer to this as a MAPD plan. Each company may offer different plans and benefits however, so it is important to shop around many carriers to ensure you have the best plan for your needs.

Medicare Advantage Enrollment In Ohio

Hundreds of thousands of individuals are covered by Medicare Advantage plans in Ohio. Approximately 38% of Medicare-eligible individuals choose a Medicare Advantage plan in Ohio, with the remaining choosing another plan type, such as Medigap insurance. The chart below shows the approximate percentage of enrollment by plan type.

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Medicare Advantage plans range in price by state, county, and zip code, gender, age, height/weight, tobacco status, and possibly other factors. The chart below shows the different plan options and starting price point for each plan.

Most Popular Medicare Advantage in Ohio Plans

There are many different types of Medicare Advantage plans, and the price can vary greatly between different plan types and insurance companies. The main consideration to look out for when selecting a Medicare Advantage plan is the provider network and limitations. HMO plans are generally more restrictive as far as the provider network is concerned—however they are typically the least expensive plan type. Plan types like a PPO are generally less restrictive and give you more options, however have a higher price tag.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

When it comes to Medicare Advantage plans, you need to be careful about the network restrictions that your plan may have. Depending on the plan type and insurance company you choose, you may have many or few restrictions on provider access. As mentioned earlier in this article, there are a few most common plan types, such as HMO, PPO, and PFFS. HMO is the most restrictive plan type, while PPO and PFFS plan types give the consumer more freedom to choose the doctors they want. You will need to look at the network of each plan to ensure they cover the doctors you want. You should also consider the possibility of the doctor leaving the plan’s network and alternative options should this happen.

Doctor/Providers List

Drug, Vision and Dental Coverage

Medicare itself does not offer a special type of plan to cover dental, or vision benefits, however Medicare does have a plan for drug coverage–called Part D. The great thing about Medicare Advantage plans is that many companies offer benefits included in the plan for these ancillary (dental, vision, and drug). Many seniors like having everything combined into one policy, and with Medicare Advantage plans this is completely possible.

Enrollment Options & Best Time To Enroll

There are several enrollment options and ways to qualify for a Medicare Advantage plan. You may or may not be required to answer health questions, and pre-existing conditions also may or may not affect you. Generally the only health question required to pass in most states is whether or not you have End Stage Renal Disease (kidney failure). If you don’t have that you can generally qualify for coverage. However even if you have ESRD you can potentially qualify depending on your state and circumstances. To read more about the enrollment options below, please see our Medicare Advantage Enrollment Options page. It’s best to speak with a licensed agent to determine your exact eligibility and what plans are available to you based on your individual needs.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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