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Medicare Advantage

Oregon Medicare Advantage Plans

Medicare Advantage is a combination of your Medicare Part A and Part B options; it must cover all medically necessary services. The plans work somewhat like traditional health insurance plans. You typically have a list of providers you can use for services. Many Medicare Advantage plans offer extra benefits that traditional Medicare does not offer, such as dental, preventive care, and even gym memberships. Below you will find an illustration on how the plan works in relation to Medicare, a list of pros and cons to consider, the enrollment periods and types of Advantage plans.

medicare advantage

What to consider when selecting a Medicare Advantage plan:

 

Medicare Advantage Pros Medicare Advantage Cons
  • Typically covers Medicare Part A, B and D (Rx) all in one simple to use plan.
  • There is typically a copay for each service performed until you meet the Out of Pocket Maximum.
  • Preventive and routine services covered.
  • Higher copays or no coverage for out-of-network providers.
  • Premiums as low as $0 per month.
  • You must live within the plan’s service area.
  • Extra benefits include dental, vision, alternative care and hearing may be covered.
  • You may require a referral for specialists (HMOs).
  • Premiums do not increase based on age, gender or health.
  • You can switch to any other Advantage plan during the open enrollment period.

Enrollment periods for Medicare Advantage plans:

Below is a list of common enrollment periods that a member will want to keep in mind. These apply to  Medicare Advantage Plan members. Contact us is you have a specific situation that you do not see below. You can find the Medicare enrollment publication here.

Type of enrollment period Medicare Advantage enrollment dates Your restrictions
Initial Enrollment (IEP/ICEP)
  • Three months prior, the month of, and three months after your birth month.
  • You can enroll in any Advantage plan, Part D (Rx) or MediGap plan.
  • The plans are guaranteed regardless of health.
General Enrollment (GEP)
  • Jan 1st – Mar 31st
  • For those that did not enroll in Part A, Part B or both.
  • Coverage begins July 1st.
Annual Enrollment (AEP)
  • October 15 – December 7th
  • Can move to any other Advantage plan.
  • Can add or drop Part D (Rx).
  • Can move between original Medicare and Advantage plan.
  • One change allowed.
  • Coverage begins Jan 1st.
Open Enrollment (OEP)
  • Jan 1st – Mar 31st
  • Can move between Advantage plans or original Medicare.
  • Cannot make changes to Part D.
  • Coverage starts the following month.
Special Enrollment (SEP)
  • Varies
Some examples are:

  • You move to another service area.
  • Your Advantage plan is involuntarily cancelled.
  • You retire from a group plan.
  • Enrolled in Part A and B during GEP.

Types of Medicare Advantage plans:

Type of Plan: Your restrictions:
Original Medicare with Medigap
  • You can go to any provider that accepts Medicare.
  • Common examples are: Mutual of Omaha or Gerber Life.
Preferred Provider Organization (PPO)
  • Higher copays or no coverage if you use physicians outside the network.
  • Typically, no referrals are needed for specialists.
Health Maintenance Organization (HMO)
  • You can only use doctors within the HMO network.
  • A referral is usually needed for specialist.
Private Fee for Service (PFFS)
  • The doctor or specialist must accept the PFFS’s fees, terms, and conditions.
  • No referral is needed.
  • A doctor may drop off the plan at any time.