833-999-0092 (TTY 711)

What are the benefits of having a Medicare Advantage plan?

Medicare Advantage health plans are purchased from a private company that has entered into a contract with Medicare to co-manage your benefits and cover any gaps. This can often lead to you getting more services and better deals.

With Medicare Advantage plans, you:

• Retain all the benefits you always had with original Medicare but also get more coverage.
• Keep coverage for all services under Medicare Part A and Part B (though different rules and copayments may apply).
• Can gain access to other services you didn’t have under regular Medicare health plans, like dental, vision, and hearing coverage and even gym memberships.
It’s important to note that Medicare Advantage plans don’t always cover prescription drugs. Those are covered by Medicare Part D plans.

Who qualifies for a Medicare Advantage plan in Tennessee?

To qualify for a Medicare Part C plan, you must:

• Live within its designated service area
• Use that plan’s provider and pharmacy networks
• Obtain physician referrals as the plan requires for various services
• Apply to enroll during an authorized enrollment period

When can I apply for a Medicare Advantage plan?

To apply for a Medicare Advantage plan, you must apply during a designated enrollment period. Authorized enrollment periods include:

• Your Initial Enrollment Period (IEP), which occurs when you first become eligible for Medicare. For most people, this is a period of 7 months that occurs around your 65^th.
• An Annual Enrollment Period (AEP), which occurs each year between Oct. 15 and Dec. 7.
• Medicare Advantage Open Enrollment Period (OEP), which occurs between Jan. 1 and March 31, a person can leave a Medicare Supplement plan and enroll in a Medicare Advantage plan alongside traditional Medicare.
• A Special Enrollment Period (SEP), which can occur around changes in your life that may affect your health coverage needs. Examples include if you move or lose your current coverage due to employment or eligibility issues.

Plan benefits and cost sharing may all change annually.

What is the difference between an HMO and PPO plan?

Medicare Advantage plans are based on network providers, of which there are two main networks: Health maintenance organizations (HMOs) and preferred provider organizations (PPOs). 

HMOs require you to remain in network for services and may require you to obtain referrals from primary care physicians to see specialists. PPOs give you the option to either remain in network or pay a fee to see out-of-network providers who agree to accept your insurance plan. PPOs don’t require referrals. 

Why are Medicare Advantage plans called all-inclusive?

The Medicare Advantage plans covered in Part C are sometimes called all-inclusive because they bundle services and benefits. This may include hospital, doctor, and sometimes prescription drug benefits.

However, doctors and hospitals are not required to accept Medicare Advantage plans, and some plans may not include your doctor. We recommend checking with your providers about whether they accept Medicare Advantage plans like the ones you may be considering before you enroll in a plan.

What else is important to consider when choosing a Medicare Advantage plan?

• Medicare Advantage plans usually require copays when the service occurs, and premiums can vary.
• Standard Medicare Part B premiums are still applicable for Medicare Part C plans.
• Out-of-pocket costs may vary monthly according to the services you’ve received.
• Advantage plans are only required to cover emergency out-of-network care, so getting coverage while traveling can be challenging.
• A $0 premium plan is not necessarily a zero-cost plan, so be sure to ask questions to make an informed decision.
• You are still required to continue to pay your Part B premium even if you enroll in a Medicare Advantage Part C plan.

Farm Bureau Health Plans has been a trusted Medicare advisor for Tennessee individuals since 1966. We are happy to walk you through any plans you may be considering to find the best fit for your healthcare needs.