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Medicare Part C (Medicare Advantage Plans)...

Medicare Advantage plans are health plans offered by private insurance companies that contract with the government to provide Medicare Parts A and B, as well as may include extra benefits. Medicare Advantage plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service plans, Special Needs Plans, and Medicare Medical Savings Account plans. If you’re enrolled in a Medicare Advantage plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Many Medicare Advantage plans also offer prescription drug coverage.

Health Maintenance Organization (HMO)

In most HMOs, you must choose a Primary Care Physician (PCP) and use in-network providers. In this type of plan you are traditionally required to obtain an authorization prior to receiving specialty services.

Preferred Provider Organization (PPO)

In a PPO you have the option of accessing services both in-network and out-of-network. However, the cost shared by the beneficiary and the provider may be higher for out-of-network providers.

Special Need Plans (SNP)

These types of plans are designed to service groups and for people with Medicare that meet specific qualifications:

  • Chronic Special Need plans (C-SNP)
  • Dual Special Need plans (D-SNP)
  • Institutional Special Need plans (I-SNP)

When Can I Enroll?

Initial Enrollment period
If you are turning 65 you have a 7 month period to enroll in a Medicare Advantage plan. Your Initial Enrollment Period will begin 3 months before the month of your 65th birthday, and 3 months after your 65th birthday.

Open Enrollment Period for Medicare Advantage and Medicare Prescription Drug Coverage (AEP)

Every year from October 15th – December 7th you can renew, review, and enroll into a Stand Alone PDP or a MAPD that includes a PDP.

For more information about Medicare, please go to the website at *www.medicare.gov or call Medicare at 1-800-Medicare (TTY users call 1-877-486-2048) 24 hours a day/7 days a week.

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SBHIS Insurance Services, is a licensed and certified representative of Medicare Advantage [HMO, PPO and PPFS] organizations [and stand-alone prescription drug plans] with a Medicare contract. Enrollment in any plan depends on contract renewal.


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