MEDICARE ADVANTAGE

Medicare Advantage Plans, also known as Part C, are a type of Medicare health plan offered by private companies that contracts with Medicare to provide Part A and B benefits. Most Medicare Advantage plans also offer prescription drug coverage. Most Medicare Advantage plans have dedicated networks of doctors and hospitals, much like employer or individual insurance you may have had in the past. Team Martinez will provide options for members to choose the right plan for them, everyone has different needs and we will make sure you make the correct choice. Below are the most common types of Medicare advantage plans:

• Health Maintenance Organization (HMO) Plans
• Preferred Provider Organization (PPO) Plans
• Private Fee-for-Service (PFFS) Plans
• Special Needs Plans (SNPs)

Most Medicare Advantage plans offer coverage for things that are not covered by Original Medicare such as vision, hearing, dental and wellness programs such as gym membership. Plans can also offer extra benefits such as over-the-counter drugs and transportation to your doctors, pharmacies and other health related visits. Take advantage of the benefits you deserve.

Supplemental plans also known as Medigap plans help fill in the gaps of Original Medicare and is sold by private companies.   Original Medicare pays for some but not all of the costs for your health care services and supplies.  A Medicare supplemental plan can help pay for the remaining costs such as copayments and co-insurance.  They can also cover emergency medical care when you are outside of the US.   

You must have part A and B to enroll in a Medigap policy.   A Medigap policy is different than a Medicare Advantage plan.   A Medigap policy supplements your Original Medicare benefits.    You can add a Part D plan through same Medigap company or another depending on premium and needs.

Initial enrollment period (IEP)

Enrollment period of 7 months, including three months before, the month of, and the three months following your 65^th birthday.

Annual Enrollment Period (AEP)

When Medicare beneficiaries can add, change, or drop their Medicare Part D or Medicare Advantage plan coverage for the following year.  It occurs from Oct 15^th to December 7^th.

OEP (Open enrollment Period)

Period when beneficiaries can make changes if they are enrolled in a Medicare advantage plan.  You can also disenroll from a Medicare advantage plan and return to Original Medicare, you will be able to add a prescription drug plan.  If you have Original Medicare, you are not able to make any changes.  OEP occurs from Jan 1 to March 31^st.

Special enrollment period (SEP)

You can make changes to your Medicare advantage plan when certain events happen or have current health conditions.  Some examples that help beneficiaries qualify for an SEP are:

• *Moved to new address that is not in current plans service area.
• *Beneficiary moved back to U.S. after living outside of United States.
• *Beneficiary eligible for both Medicare and Medi-Cal.
• *Lost Medi-Cal coverage.
• *Beneficiary qualifies for extra help (LIS) that helps lower cost for prescription drugs.
• *Chronic condition and qualifies for a Special Needs Plan(SNP) if offered in service area.

Medicare health plan benefits may change every year and most importantly your needs may change as well. The current plan you have may no longer be your best option. It is important that you look at your current plan and compare to other companies to make the correct choice for your current health care needs. We are here to assist to give you peace of mind. Let our Team provide you the information and you make the best choice based on physicians in network, contracted hospitals and medications covered.