Medicare Advantage Plans
One private plan that bundles Part A, Part B and usually Part D together. Lower monthly premiums, a network to stay inside, and copays as you use care.
Medicare Advantage Plans
A Medicare Advantage plan works differently from a supplement. Medicare sends funding to a private insurance company, which administers one plan that bundles Part A hospital coverage, Part B medical services, and Part D prescription drugs together.
With Original Medicare and a supplement, the doctor or hospital bills Medicare, Medicare pays its portion, and then passes the bill to the Medicare supplement company, which pays the remaining costs. You buy a separate Part D prescription drug plan yourself. With an Advantage plan, one insurance company handles all of it.
In Santa Barbara County there are two kinds available: Medicare HMO and Medicare PPO. Which plans are offered is set for each plan year, so we check the current year's list with you.
Medicare HMO and Medicare PPO
Medicare HMO
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You use doctors and hospitals in the HMO network only. In practice that means one medical group and its network hospital.
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You choose a primary care physician who manages your care and makes referrals to specialists within the network.
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Often there is no deductible for medical services. You pay copays for most medical services, including hospital costs.
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There is an annual out of pocket maximum on those copays. Medicare sets a ceiling on that maximum each year and the insurance company may set a lower one.
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A prescription drug plan is included.
Medicare PPO
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The PPO provider network is larger than an HMO network.
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Often there is no deductible, and you pay copays for services.
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You can go outside the network to any provider contracted by Medicare, for a higher copay.
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There is an annual out of pocket maximum on those copays. Medicare sets a ceiling each year and the insurance company may set a lower one. If you use both in network and out of network providers, there is a higher combined out of pocket maximum.
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A prescription drug plan is included.
How Advantage plans work in practice
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Often there is no deductible for medical services. You pay copays as you use care.
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There is an annual out of pocket maximum on those copays. Medicare sets a ceiling on that maximum each year and the insurance company may set a lower one.
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A PPO that mixes in network and out of network care has a higher combined out of pocket maximum.
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Prescription drug coverage is included in most Advantage plans, so you usually do not buy a separate Part D plan. We confirm it plan by plan.
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Copays and benefits can change in small ways each year.
Before you switch from a supplement
Returning to a Medicare Supplement later can require answering medical questions, and the request can be declined for a pre existing condition. There are two exceptions: the 12 month trial right the first time you ever join an Advantage plan after dropping a supplement, and the California Birthday Rule. Both are explained on Our Philosophy.
You can enroll in an Advantage plan every year during the Annual Open Enrollment, October 15 to December 7, and certain life events open a Special Enrollment Period at other times. If you are already in an Advantage plan, you get a second window, January 1 to March 31, to switch to a different Advantage plan or return to Original Medicare.
Ask Us About Advantage Plans
Which Advantage plans are offered here changes each plan year. We go through the current year's list with you. There is never a charge.