A Medicare “replacement” policy is a form of private Medicare supplement insurance which replaces your Medicare Part A and B benefits. Why would anyone want to replace their federal Medicare benefits with a private policy? Well, for some seniors, a Medicare Advantage policy can be the most cost-effective way to supplement their benefits and protect themselves from costly gaps in Traditional Medicare coverage.
Federal Regulations for Medicare Advantage
Just because Medicare Advantage replaces your Traditional Medicare benefits doesn’t mean there aren’t consumer protection laws in place to ensure that you get the medical benefits you are owed. Medicare Advantage policies are regulated by federal law to ensure just that. Many of these policies include additional coverage, especially with regard to the potentially expensive gaps in traditional Medicare (Parts A & B). Some Advantage plans, often referred to as MAPD plans, offer prescription drug coverage.
Medicare Part C in Iowa Enrollment
Medicare Advantage has a weaker presence in Iowa than it does in most other states. Only 14% of Medicare-qualified seniors have signed up for Medicare Part C in Iowa. Of those, you can tell by the chart below which Medicare Advantage plans are more popular than others:
|Plan Type||Enrollment Percentage|
|Local PPO Plans||13%|
|Special Needs Plans||11%|
|Regional PPO Plans||9%|
|Private Fee-For-Service Plans||5%|
|Other (Cost Plans, MSA’s, etc.)||3%|
Plan Coverage & Cost
As you can see, there are a variety of different Advantage plans to choose from. The type of plan you choose, as well as your own personal circumstances (age, health, location, etc.) will all determine how much your policy will cost you. Below are estimates for Medicare Advantage policies for seniors in your area:
Most Popular Medicare Advantage Plans in Iowa
When choosing a policy, you will have to decide on a provider network to go along with your plan. Your provider network determines the doctors and facilities from which you may receive your medical care. More restrictive networks (HMOs) cost less, whereas less restrictive networks will naturally be more expensive.
Helpful Medicare Advantage Tips & Tricks
Doctor/Provider Network Restrictions
Choosing your provider network is one of the most important decisions you can make with a Medicare Advantage policy. If you choose a highly restrictive HMO, you may not be able to get the care you need when you need it (at least, not at an affordable price). But if you are living on a fixed budget, a PPO or PFFS might not be within your means. Additionally, even if you are content with your provider network, your insurance company can change the rules on you at any time.
Drug, Vision and Dental Coverage
Medicare Advantage is one of the few Medicare supplement insurance plans which provides for additional coverage options beyond Medicare Parts A, B, and their respective coverage gaps. You have the option to add prescription drug coverage to your policy via Medicare Part D. Additionally, there are optional additions such as vision care or dental coverage which can also be added to your policy. Just remember: the more you add, the more expensive your policy will be.
Enrollment Options & Best Time To Enroll
It is likely that your Medicare Advantage provider will ask for a medical history or want some other verification of your health status before determining whether or not you qualify for coverage. If you are 65, new to Medicare, and in fairly good health, the qualification process should be fairly simple. However, Medicare Advantage providers are more willing to deny coverage for serious pre-existing conditions such as End Stage Renal Disease (ESRD). You can learn more about your coverage options by contacting your state department of insurance, by contacting your local insurance agent, and also by visiting our Medicare Advantage Enrollment Options Page.
- Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
- Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
- Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.