Overwhelmed by Medicare Advantage Options?

We’ll Help You Choose the Right Plan Without Coverage Gaps.

How Medicare Advantage Works

Medicare Advantage Plans are comprehensive health plans from private insurers that bundle Medicare Part A (hospital insurance), Part B (medical insurance), and often Part D (prescription drug coverage) into one cohesive plan. These plans operate within Medicare's guidelines and provide a one-stop-shop for all your healthcare needs, often including additional benefits and services that Original Medicare does not offer.

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Medicare Advantage Coverage

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    Prescription Drug Coverage

    Covers a variety of prescription medications, both generic and brand-name, with different cost tiers.

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    Dental Care

    Covers routine services like exams, cleanings, and x-rays, as well as more complex procedures.

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    Vision Care

    Annual eye exams and corrective eyewear are typically covered, with some plans offering discounts on surgeries like LASIK.

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    Hearing Care

    Coverage extends to hearing examinations and often includes partial or full coverage for hearing aids, which is not usually provided by Original Medicare.

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    Wellness Programs

    Many plans promote wellness through benefits like gym memberships, health education, and smoking cessation programs, aiming to improve overall health.

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    Over-the-Counter (OTC) Benefits

    Some plans come with an allowance for over-the-counter medications and health items, enhancing the basic medical coverage.

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    Transportation Services

    Some plans offer non-emergency transportation to healthcare appointments, easing the burden of travel for medical care.

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    Telehealth Services

    Remote access to a range of medical services, from primary care to mental health support.

Different Plans for Different Needs

Medicare Advantage Plans can be in the form of HMOs, PPOs, PFFS Plans, and SNPs, each with its own network rules and costs. These plans provide at least the same level of coverage as Original Medicare, with the added convenience of having all health and drug benefits under a single plan provider.

  • Typically require choosing a primary care physician within the network and getting referrals to see specialists, occasionally offering lower premiums with in-network care limitations.

  • Provides flexibility to see any doctor, with cost savings for using network providers and usually no need for referrals.

  • Allows you to see any Medicare-approved doctor who accepts the plan's payment terms, with varying costs and provider acceptance.

  • Caters to specific health needs or populations, such as those with chronic conditions or dual Medicare and Medicaid eligibility, offering tailored care coordination.

Choosing the Right Plan

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    Costs

    Understand the full spectrum of costs including premiums, deductibles, and co-pays. While some plans boast $0 premiums, remember that you're still responsible for the Medicare Part B premium.

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    Provider Network

    Verify if your preferred doctors and hospitals are within the plan’s network, as out-of-network services can significantly increase out-of-pocket expenses.

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    Quality

    Consider the Medicare Star Rating, which evaluates plans based on several metrics including quality of care and customer service, to choose a plan with a history of excellence.

Annual Enrollment Period

The Medicare Annual Enrollment Period (AEP), also known as the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, runs from October 15th to December 7th each year.

During this time, Medicare beneficiaries have the opportunity to make changes to various aspects of their coverage:

  • Switch from Original Medicare to a Medicare Advantage Plan.

  • Change from one Medicare Advantage Plan to another.

  • Enroll in a Medicare Part D plan if you did not enroll when you were first eligible.

  • Switch from one Medicare prescription drug plan to another.

Any changes made during the AEP take effect on January 1st of the following year.

Special Enrollment Period

In addition to the AEP, there are circumstances under which you may be eligible for a Special Enrollment Period.

An SEP allows you to make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, such as if you:

  • Move to a new address that is outside of your current plan's service area or offers additional plan options.

  • Lose other credible insurance coverage (from an employer or union).

  • Qualify for additional aid such as Medicaid with Medicare prescription drug costs.

  • Have a chance to get other coverage offered by your employer or union.

  • Your plan changes its contract with Medicare.

SEPs give you a chance to join, switch, or drop Medicare Advantage or Part D plans at irregular times throughout the year. The rules about when you can make changes and the types of changes you can make are different for each SEP, and the length of the SEP varies depending on the situation.

Explore Your Medicare Options Today.

Contact Nexus Insurance Advisors to learn more about your Medicare coverage options and how we can help you navigate your healthcare journey.