![]() ![]() Living in an institution, such as a nursing home.Having a certain chronic condition, such as diabetes, ESRD, or HIV/AIDS.These vary by plan, but generally amount to: Special needs plans (SNPs) are limited to Medicare beneficiaries who meet certain criteria. Most PFFS plans have a provider network but allow members to go out-of-network for a higher cost. Private fee-for service plans (PFFS) determine how much they'll pay providers. In addition, PPOs do not require members to choose a primary doctor or get a referral to see a specialist. However, you may visit an out-of-network provider for a higher cost. Preferred provider organizations (PPOs) have networks that are similar to HMOs. HMOs also require members to choose a primary care physician who manages their care and provides referrals to specialists. Just know that your out-of-pocket cost will be higher. However, if you choose an HMO that has a point-of-service (POS) option, you may be able to get out-of-network care. Most HMOs will only cover care received from an in-network provider. ![]() These plans use a provider network that may include pretty much any entity that provides healthcare services: The most popular by far are health maintenance organizations (HMOs). There are four main types of Medicare Advantage plans in California. Types of Medicare Advantages Plans in California provides the full list of special circumstances here. There are dozens of ways to qualify for an SEP. Please note that you cannot have both an MA-PD plan and a Medicare Part D plan.įinally, Medicare created Special Enrollment Periods for beneficiaries who experience certain life changes, such as moving or losing their current coverage. If making that change means you lose your prescription drug coverage, you may also enroll in a standalone Part D plan at that time. If you currently have an MA plan, you may switch to another one or return to Original Medicare during the Medicare Advantage Open Enrollment Period. During this time, you may make any change you want to your Medicare coverage, including joining an Advantage plan. It is available to anyone who is currently enrolled in Medicare. The Medicare Annual Enrollment Period (AEP) lasts from October 15 through December 7. Once General Enrollment ends, you then have from April 1 through June 30 to sign up for a Medicare Advantage plan. This lasts from January 1 through March 31. If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period (SEP), you may sign up for Medicare Part A and/or Part B during the General Enrollment Period. However, if your birthday falls on the first of the month, those dates are pushed forward one month (May 1 through November 30 if your birthday is September 1). For example, if your 65th birthday or 25th month of collecting RRB or Social Security disability occurs in September, then your IEP starts on June 1 and ends on December 31. Your Initial Enrollment Period (IEP) begins 3 months before you first become eligible for Medicare. Signing up for a Medicare Advantage plan in California is restricted to specific enrollment periods. When Can You Sign Up for a Medicare Advantage Plan in California? ![]()
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