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How do Medicare Advantage Plans pick what areas to work in?

Medicare Advantage Seniors enjoying trail

When someone shops Medicare plans sometimes the question comes up asking why isn’t a specific plan that they saw on television or the internet is offered in Chelan or Okanogan County?

Imagine Medicare Advantage plans are like ice cream trucks. They want to visit neighborhoods where they know people love ice cream. But, they can’t go everywhere – they have to pick and choose based on a few things:

  1. Map Check: They look at a map and say, “Hmm, can we drive our truck easily in this county? Are there enough roads (hospitals and doctors) for us to serve ice cream (healthcare)?” It’s why you may have one plan in Chelan and not in Douglas County.
  2. Rules of the Road: They also have to follow the traffic rules. Medicare is like the traffic police, saying, “You can drive here, but not there.”
  3. Neighborly Advice: They think about the neighbors (that’s you!). They ask, “Do the lovely folks here like our flavor of ice cream (healthcare services)?”
  4. Counting Coins: They check their piggy banks and see if visiting a neighborhood makes sense. No point in going if the ice cream melts (costs are too high) before they can sell it!
  5. Competition: If there are too many ice cream trucks on the same street, it might be tough to find a good spot. They look for streets with just enough room for them.
  6. Permission Slip: Before they start the engine, they need a permission slip from Medicare. It’s like a golden ticket to drive into your county.

So, every year, these ice cream trucks (Medicare Advantage plans) figure out which neighborhoods (counties) they’ll visit. They want to make sure they can bring you the tastiest and most affordable ice cream (healthcare) with a smile! 🍦🚚

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We do not offer every plan available in your area. Currently, we represent 16 organizations which offer 62 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.

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