Medicare Advantage plans have become popular recently due to the enormous benefits they offer. Thanks to them, Medicare beneficiaries are able to stay more days in the hospital, pay low rates for physician visits, and generally pay less for prescription drugs. In addition, no more need to be referred by their primary care physician – you can go to any doctor or hospital of their choice without any reference. It’s easy to get this type of plan, as they are available in the U.S. through private insurance providers. By law, the Part A and Part B are required to include in the Plans.

A Medicare Advantage plans can be an HMO, a PPO, or Private Fee for Service or Private Fee for Service plan. Advantage HMO plan remains a popular option, especially for Medicare beneficiaries who want to pay only the minimum most out of pocket expenses and low or no monthly premiums. The Medicare Advantage HMO plans, however, are only offered in metropolitan areas with large numbers of Medicare beneficiaries.

On the other hand, a Medicare PFFS or Private Fee for Service plan allows benefit Medicare beneficiary to go to any doctor, any hospital of their choice in the United States. Not surprisingly, this type of Medicare Advantage plans is enjoying great popularity among Medicare beneficiaries.

Advantage is now offered in 98% of the counties in the United States. This is a far cry from 1996 when only 15% of U.S. counties offered. According to 2007 statistics on Medicare Advantage plans, the average American pays $ 736 per month in premiums, although the actual monthly payment varies among states from over $ 500 to over $ 800 per month.

The Medicare plan holders who do not have end-stage renal disease or kidney failure, can qualify for a Medicare Advantage plans, but in some counties have special offer for people with kidney failure.

Medicare Supplement – A supplement or Medigap insurance is an insurance policy that is offered by a private insurance company to cover the gaps left by Medicare. The beneficiary is responsible for some level of cost sharing. Overall, the beneficiary is responsible for a hospital deductible, co-payments after prolonged hospitalization and 20% of outpatient expenses.

Medicare Advantage plans – A Medicare Advantage plans is also offered by a private insurance company, but instead of filling the void left by Medicare Advantage plans is another way to receive their Medicare benefits. Insurance companies under contract and approved by CMS (Centers for Medicare and Medicaid Services) to administer Medicare. Plans are required to meet certain criteria, and in many cases offer benefits beyond traditional Medicare. You may still have cost-sharing, but is in the form of deductibles, copayments and coinsurance. Plans typically include a maximum out of pocket. Advantage plans include Part D prescription drug coverage.

Medicare is a comprehensive Medicare Advantage plans. It is available in some areas of service as a PPO and others are offered in an HMO, Medicare does not fully fill the gaps left by Medicare, but is not a Medicare Advantage plans with certain out of pocket costs. Unlike a standard supplement, full Medicare may have different levels of coverage and benefits depending on the plan’s service area. You can have a regional PPO plan available in your county, while someone in a neighboring county may be available as a full Medicare HMO plan.

If you are looking for a plan that includes coverage for Medicare Part D and a low monthly cost, then you may want to look at when comparing Medicare Complete Medicare Advantage plans. If, however, does not mind a higher monthly premium and are looking for a plan that will fill the void left by Medicare, you may want to consider a Medicare supplement.

To enroll in a Medicare Advantage Plans, a beneficiary/member usually must:

1.) meet the Medicare Part A and Part B criteria;
2.) live in the service area of the plan;
3.) continue to pay the monthly Part B premium (unless paid for by Medicare);
4.) not have End Stage Renal Disease (ESRD); and
5.) must enroll during the enrollment periods set by the Center for Medicare Services (CMS).

A beneficiary must enter into a MA plan through an enrollment period. There are several different types of these periods. The Initial Coverage Enrollment Period (ICEP) is the period of time, in which the beneficiary first becomes eligible. This window is 3 months before and 3 months after their eligibility date. When this 7 month window closes, the ICEP is over. Each member has only one Initial Coverage Enrollment Period. The Annual Enrollment Period (AEP) is from November 15th to December 31st of each year. Therefore, enrollment is effective January 1st of the following year. There is one AEP enrollment or disenrollment choice during this period.

Open Enrollment Periods (OEP) applies to Medicare Advantage Plans only and the enrollment period is January 1st to March 31st. Enrollments during the OEP are limited to the type of coverage. For example, a member with Part D coverage must choose another Part D plan. A member without Part D coverage must choose another with Part D benefits. Health insurance agents that sell MA plans are encouraged to understand enrollment periods and marketing ruless by reading the “Medicare and You” booklet provided by CMS. This updated publication describes updated Medicare guidelines and can be viewed the Medicare web site.

Many providers will terminate contracts with health insurance agents if they engage in forgery, high pressure sales tactics, fraudulent misrepresentations, backdating, and offering gifts/money. Health insurance agents should follow ethical guidelines related to presenting information appropriately, as to not confuse, mislead or pressure a prospective client. It is best to walk away from a potential sale and seek appropriate advice when potential confusion or a misunderstanding exists. Make sure to check with your State Department of Insurance and your Field Marketing Organization to help with state or program specific questions.