Why do some Medicare Advantage plans have a $0 premium?
When you enroll in a Medicare Part C Advantage plan, Medicare pays a fixed monthly amount to the plan insurance carrier to provide your care. The insurance carriers will offer you a monthly premium as low as possible to attract you to their plan. Some carriers will even offer their plan at a $0 premium to you, but this can change from year to year as each carrier must renew its contract with Medicare annually.
You will also still pay your monthly premium for Part B when you are enrolled in Medicare Advantage plans. You must be actively enrolled in both Part A and Part B to qualify for enrollment into a Advantage plan.
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What are the Medicare Part C enrollment periods?
Medicare Part C annual election period begins on Oct 15th each year.
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Unlike Medigap policies, you can only enroll into or dis-enroll from your plan during certain periods. You can enroll in a plan during your initial enrollment period when you first get Part B. You can also change during the annual election period each fall, which runs from October 15 – December 7th, with your benefits beginning January 1st.
The annual election period exists because if you are enrolled in Medicare Advantage or Part D, your plan’s benefits, formulary, pharmacy network, provider network, premium and/or co-payments and co-insurance may change on January 1 of each year. Medicare wants you to have an opportunity to change your plan if you don’t like the changes coming for next year.
There are also special election periods for Medicare Advantage plans, such as when you leave employer group coverage or move out of your plan service area. A good insurance agent who specializes in Medicare-related insurance products can help you learn the enrollment periods available.
©2020 ABC Medicare Help | Not affiliated with any government agency.​
HMO Vs PPO
Two of the more popular kinds of Medicare Advantage Plans include Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. Generally speaking, the difference between HMO and PPO plans includes the size of the plan network, the ability to see specialists, plan costs, and coverage for out-of-network service.
In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. HMO plans typically have lower monthly premiums and you can expect to pay less for out-of-pocket medical services. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
PPO plans provide more flexibility when picking a doctor or hospital. For example, you are not required to select a primary care doctor. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate. Thus, you will have to pay a higher fee if you go out of your network.
Additionally, Private-Fee-for-Service (PFFS) plans are also Medicare Advantage plans, and generally have no network or a very small network. The company will allow any doctor to bill the plan as long as they agree to the plan’s terms and conditions upfront. This puts the burden on you to ask your providers whether they will accept the plan before you seek medical services.
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​Below is a chart outlining the differences between an HMO and a PPO plan.
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