Seniors should be very careful when it comes to the unfortunate coverage gaps which are inherent in Medicare Parts A and B. They may seem insignificant now when you are relatively new to Medicare, but they can become quite expensive over time if you don’t protect yourself from them early. There are many different supplements which are designed to protect retirees from the out of pocket costs associated with these coverage gaps. Medicare Advantage, or Medicare Part C, is one of them. We’ll give you valuable information on this popular insurance policy below, as well as some informational resources for you to learn more.
Federal Regulations for Medicare Advantage
First, you should understand what Medicare Advantage plans are. A Medicare Advantage plan is sometimes called a Medicare “replacement” policy because that’s what it effectively does. Once you purchase a Medicare Part C health insurance policy from a private company, the government is no longer responsible for paying out claims on your federal Medicare benefits. That responsibility is transferred to your new insurance provider. Also, keep in mind that no insurance company can legally sell you less coverage than what Original Medicare offers.
Medicare Advantage Enrollment In Oklahoma
Medicare Advantage isn’t the preferred option for Oklahoma seniors, but it still has a strong presence in the state. More than 18% of retired persons in the state are protecting their Medicare benefits with a Medicare Advantage policy (82% are not, currently). In the chart below, you can see which of these plans (yes, there are several to choose from) are the most popular among seniors:
|Plan Type||Enrollment Percentage|
|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
Several different factors regarding your health status and where you live will all be factored together when your rates are calculated. A female smoker in Yukon will probably pay a different monthly premium than a male beneficiary in Tulsa. Below, you can see a sample of estimated rates available near you:
Most Popular Medicare Advantage Plans in Oklahoma
In order to make it easier for seniors to shop around, we came up with a simple five star rating system for evaluating Medicare Advantage plans. If the company is financially stable, has high customer service ratings, and a good record of managing care – among other positive qualifications – it can earn a maximum of five stars. Companies that fall short in any of those areas will be awarded fewer stars. That way, you can figure out which companies are worth looking at and which ones are worth passing over.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
One major feature which varies from one Advantage plan to the next is the provider network attached to the plan. Different provider networks offer more (or fewer) options when it comes to choosing your doctors, hospitals, and facilities. Some networks come with fees for getting care outside of your network, and some have such stringent restrictions that you can be refused service by a non-network provider (unless you are having a medical emergency, of course).
- HMO Plans – The good thing about HMOs is that they tend to cost less overall. The bad thing, unfortunately, is that you don’t have access to as much affordable care as you might want. When you belong to an HMO, you can only get care from your primary care doctor unless they give you a referral for someone or somewhere else. The only exception is if you need to get emergency care from an out-of-network doctor or hospital. Your insurance will help you cover the costs if it is in fact deemed an emergency.
- PPO Plans – PPO Networks give you more freedom to see the doctors or get care from the places you want. But they tend to be a little pricier. Your monthly premiums and amount of costs shared might be higher, but you aren’t specifically limited to the providers which are preferred by your insurance company. If you have the money and want more options, then a PPO Network might work well for you.
- PFFS Plans – Private fee-for-service plans require that the doctors/facilities you get your care from and your insurance provider negotiate payment terms on a case-by-case basis. You can technically see any doctor you want, but they might not always agree to the payment terms set by your insurance company. If that happens, you either have to pay for your care out-of-pocket or find a different provider.
- Special Needs Plans – These networks function in a similar way to HMOs, but maybe even slightly more limited in order to keep costs affordable. These plants are also usually reserved for seniors who have specific and demanding medical needs, like treatment for chronic diseases. Like an HMO, though, you won’t have to pay out-of-pocket for out-of-network care in the event of an emergency. But you will have to struggle with them to get out-of-network care for any non-emergency reasons.
- HMO Plans – There’s virtually no difference between a private health insurance HMO and a Medicare Advantage HMO. Both insurance policies will restrict the doctors and facilities you have access to in order to keep costs down. Both will make exceptions for emergency care. But the Medicare Advantage HMO might give you more options at a more affordable price because they have to adhere to the benefits provided by Original Medicare.
- PPO Plans – Because Medicare tends to lower the costs of most health insurance plans for seniors, Medicare Advantage PPO plans are very popular. They cost more than a Medicare Advantage HMO, but typically cost less than a private insurance PPO. This gives seniors more bang for their buck when it comes to getting the care they really need at a more affordable price.
- PFFS Plans – Somebody Care Advantage Plans offer private fee-for-service options. But like with a private PFFS plan, your insurance and your chosen caregiver must agree on payment terms first. When they can’t agree, you’ll have to get care somewhere else. But it’s highly likely that the affordability of Medicare will still give you plenty of options.
- Special Needs Plans – If your medical needs qualify you for a Special Needs Plan, you may have an easier time finding affordable care on a Medicare Advantage plan. Chronic diseases like end-stage renal disease are costly and may require the coordination of many different doctors and facilities. Medicare Advantage plans are uniquely qualified to help seniors with these conditions get the care they need at a more affordable cost. You will be limited to a very specific network, however – but you’ll get the same emergency care exceptions that you would get with an HMO.
You don’t have to play the “will I get to keep my doctor?” guessing game if you’re shopping around for a Medicare Advantage plan. The official Medicare website provides a search tool which lets you see whether or not your preferred doctors and facilities are available based on the plan you’re looking for. For more information, we suggest you click on that link and go try it out for yourself.
Drug, Vision and Dental Coverage
If you don’t want to manage your health care coverage and your vision coverage on separate insurance plans, then a Medicare Advantage plan might be more convenient for you. Almost all Medicare Advantage policies will give you the option to add vision coverage, usually for a small fee. Original Medicare and Medigap insurance, unfortunately, do not offer vision coverage bundled in with their plans.
Dental coverage is another benefit which Original Medicare and Medigap insurance does not offer for seniors. But Most seniors will have the option to add it to their plan if they decide to enroll in Medicare Advantage. From there, it’s as simple as choosing your preferred dentist and making sure you get your dental care within the network that your insurance provider has established.
Enrollment Options & Best Time To Enroll
Enrolling within your first 6 months of turning 65 is your best option when it comes to Medicare and Medicare Advantage. The sooner you get in, the easier it will be to get approved for coverage. If you already have coverage but decide to enroll later, you may qualify for a Special Enrollment Period (more on that below). However, applying outside of these timeframes could make it difficult and more expensive to get covered. There are additional challenges for people with pre-existing conditions, such as End Stage Renal Disease. Your state department will have more information, as will your local insurance agent. You should also take a look at our Medicare Advantage Enrollment Options page.
- Initial Enrollment Period: The enrollment period during your first 6 months of being enrolled in Medicare.
- 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): Circumstances which happen outside of the AEP window, such as employer coverage loss or moving out of state, which may require you to find new coverage immediately.
What Medicare Advantage Plan Is Best For Me?
Enrolling in the right Medicare Advantage policy is a pretty big decision. You have to make sure you choose the right company. Ideally, your chosen provider should be financially stable for as long as you need your care. The company must also be competent at helping you manage that care as well as reasonably affordable. It’ll help if you sit down and figure out what your future medical needs will be before you narrow down your choices.
And you have to make your decision fast if you don’t want to risk missing out on your open enrollment window. Your enrollment period will vary based on your unique circumstances. But if you want to have enough time to shop around and find an affordable policy, you might need our help. We’ll be more than happy to assist you with comparing quotes among different providers in your area – all you have to do is reach out and contact us.