Slide presentation highlighting the history of Medicare Advantage plans, how Meidcare Advantage plans work, types of Medicare Advantage plans, and enrolling in a Medicare Advantage plan

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How do Medicare Advantage Plans Work? 2014 edition
Presented by MedicareMall.com

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History on Medicare Advantage Plans
o Implemented as Medicare Part C, 32 years after Original Medicare
as part of the Balanced Budget Act of 1997
o Known as “Medicare + Choice” from 1997-2003
o Known as “Medicare Advantage” after Medicare Part D was
introduced in 2003

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How Medicare Advantage Plans Work
o Medicare Advantage is the alternative to Original Medicare.
o Companies compete to offer managed care plans. Plans may offer
modest copayments or $0 monthly premium
o Enrollees are assigned a Primary Care Physician (PCP)
o Most of these plans have network restrictions
o Geographic area affects availability and cost to administer those plans.
o Medicare pays the company to administer the Medicare Advantage
Plan you are enrolled in

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Types of Medicare Advantage Plans
o Health Maintenance Organization (HMO) Plans and
Preferred Provider Organization (PPO) plans are the most common plans sold
o HMO plans typically require a visits to a PCP for referrals to in network specialist and
hospitals
o PPO plans usually have a higher monthly premium than HMO plans. These plans typically
give more flexibility with the network
o Private Fee-for-Service (PFFS) plans determine how much you pay doctors and
healthcare providers that accept the plans payment terms. This plan does not assign
you a PCP nor are referrals required to see specialist.
o Special Needs Plans (SNPs) are offered to individuals with certain debilitating or
chronic conditions. In most instances, these plans assign you a PCP.
o Medical Savings Account (MSA) plans chains together a high deductible health
plan and a bank account. Medicare deposits money
into this account for healthcare cost.
o Plans that include Part D are
usually called MA-PD plans.

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Enrolling in a Medicare Advantage Plan
o You may enroll in Medicare Advantage during one of these Enrollment
Periods
 Initial Enrollment Period: Newly eligible for turning 65 or for qualified disability
 Open Enrollment Period: October 15th to December 7th
, 2013
 Disenrollment Period: You may switch / enroll in a new plan one time only; from
January 1st
to February 14th
, 2014
o You must have Medicare Part A and Part B
o Research and compare your Medicare Advantage, Part D, and
Medicare Supplement options before making a purchase.
o Use the Medicare Plan Finder or consult with a broker to find a list of
plans available near you.
o All Medicare Advantage plans must offer you an enrollment/sales consent
form before being contacted by an agent to
discuss your Medicare Advantage plan options.
o Some Medicare Advantage companies may allow
you to enroll online, over the phone, or
through a broker (an insurance agent).

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