Your “All in One” Alternative to Original Medicare

Medicare Advantage (Part C) is an “all in one” alternative to Parts A and B. These are plans sold by private companies — not the government — and each one is required to give you at least the same benefits as Original Medicare. Many programs include prescription drug coverage, and some may offer extra benefits such as dental coverage or a gym membership.

Do You Qualify?

Qualifying is easy. If you’re enrolled in Original Medicare and live in the plan’s service area, you’re eligible for Part C. You must stay enrolled in Parts A and B — meaning you’ll continue to pay your Part B premium to get coverage.

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Your Costs at a Glance

Your Medicare Advantage plan may require you to see doctors or specialists in their network. You may pay a lower monthly premium for your plan (in some cases, it may be $0). Most plans also have copayments, coinsurance, and deductibles — which will vary by plan.

There’s no cap on your spending under Original Medicare. However, all Advantage plans have annual out-of-pocket maximums to protect your finances.

Who May Benefit from Medicare Advantage?

Medicare Advantage gives beneficiaries a lower-premium option than Medicare Supplemental insurance (Medigap). Advantage programs also have little medical underwriting. So, if you missed your Medigap open enrollment period or don’t qualify for health reasons, Medicare Advantage is an excellent choice.

Why Join a Medicare Advantage Plan?

✔ Low Monthly Premiums

✔ Inpatient Hospital Benefits

✔ Outpatient Medical Coverage

✔ Part D Drug Coverage

Common Types of Advantage Plans

Medicare Health Maintenance Organization (HMO) plans generally require you to get health care and services from the plan’s “network” of providers, except for emergency care.

Medicare Preferred Provider Organization (PPO) plans have more flexibility in that you can see in-network and out-of-network doctors — as long as they’re willing to bill your plan.

Medicare Private-Fee-for Service (PFFS) plans allow you to see any doctor in the U.S. who participates in Medicare and is willing to accept your plan’s terms and conditions. If you travel often, a Medicare PFFS plan may be a good option.

When Can You Enroll?

There are certain times of the year when you can join, drop, or change your Medicare Advantage plan. Just because you join one does not mean you’re stuck with it forever if your situation changes.

When you first become eligible for Medicare, you can enroll in a Medicare Advantage plan with or without prescription drug coverage. This is called your Initial Enrollment Period, and it begins the three months before you turn 65 and ends the three months after.

The Annual Election Period (AEP), also called the Open Enrollment Period, is October 15 to December 7 every year. During this time, you can enroll in, change, or drop a Medicare Advantage plan. Coverage will begin on January 1.

The Medicare Advantage Open Enrollment (MAOEP) is January 1 to March 31. You can switch to another Advantage plan or go back to Original Medicare and enroll in a separate Part D plan once during this period.

Also, certain events make you eligible for a Special Enrollment Period (SEP) where you have two months to enroll in a Medicare Advantage plan. Since these are unique to the individual, it’s best to consult Lacayo Group Insurance to see if you qualify for an SEP.

Contact an Agent for Help

If you’re interested in a Medicare Advantage plan in Florida, it’s best to work with a local agent. Lacayo Group Insurance can tell you about the benefits available in your area and make suggestions based on your health needs. We don’t charge you anything extra. Our help really is FREE to you.

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