The major problem with Original Medicare is that it does not pay for many out-of-pocket expenses. One solution to this problem is to join a Medicare Advantage Plan, a privately-run health plan that must follow Medicare rules and guidelines. With these plans, you'll save on out-of-pocket expenses by participating in a designated network of providers and resources. Here, we explain how to enroll in a Medicare Advantage plan, using the official U.S. government website for Medicare as a guide.
Choose the Type of Medicare Advantage Plan
The first step for enrolling in a Medicare Advantage plan is to decide on the basic type of program you want. The four most common types are:
- Health Maintenance Organization (HMO) Plans: Your care is limited to in-network doctors, otherwise you pay more. You'll need to choose a primary doctor and will need a referral to see a specialist.
- Preferred Provider Organization (PPO) Plans: You can see out-of-network providers, but you save money if you see “preferred” doctors. You do not need a primary care doctor and do not need a referral to see a specialist.
- Private Fee-for-service (PFFS) Plans: You can see most doctors if they accept your plans. Some PFFS plans have a preferred network that can save you money. You don’t need a primary care doctor and don’t need a referral to see a specialist.
- Special Needs Plans (SNPs): These plans are limited to people with specific chronic conditions, like cancer or heart failure. There are limitations on the providers you can see, and you’ll need a primary doctor to direct your care.
It’s important to review the costs of each different plan and evaluate your own personal preferences when choosing the type of plan you want.
Understand Medicare Open Enrollment
It’s important to understand Medicare enrollment periods, which are the time periods during which you can first sign up for a Medicare Advantage plan. The two enrollment periods for initial sign-up are:
- Initial Enrollment Period: You can enroll in a Medicare Advantage plan when you first become eligible for Medicare coverage. You must enroll during the 7-month period that begins three months before the month you turn 65 and ends 3 months after the month you turn 65.
- Open Enrollment Period: You can enroll in a Medicare Advantage plan from October 15 until December 7 of each year. Your coverage will then start on January 1 of the next year.
Once you sign up for a plan during one of these two periods, you are good to go. But what happens if you don’t like your plan? You'll need to keep paying attention for the next Medicare Advantage Open Enrollment Period.
Understand Medicare Advantage Enrollment Periods
If you are not happy with your health plan, you can change plans, but only during a certain time. The period between January 1 to March 31 of each year is called the Medicare Advantage Open Enrollment Period. During this time, you can switch from one Medicare Advantage Plan to another, or even switch back to Original Medicare—but you can’t use this period for initial enrollment.
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