Medicare Advantage

What is Medicare Advantage?

Medicare Part C, also known as Medicare Advantage, is offered by private companies approved by Medicare. You still have Medicare when you join a Medicare Advantage Plan.

If enrolled in Medicare Part C, you get:

Medicare Part A Hospital Insurance 

And

Medicare Part B (Medical Insurance) 

(Part D) – (prescription drug) most Advantage plans include prescription drug benefits.

Unlike the Original Medicare Plan – Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you will pay nothing for covered services. This limit may be different between Medicare Advantage Plans and it can change each year. Keep that in mind when considering a plan.

What Does Medicare Advantage Cover?

Medicare Advantage Plans cover all Medicare services and can offer extra coverage. It may offer extra coverage like Vision, Hearing, Dental, and/or health and wellness programs. Most Advantage plans include Medicare Prescription Drug coverage (Part D).

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. With a Medicare Advantage plan, you will always be covered for emergency and urgently needed care. However, the plan you choose can decide to not cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

How Much Does Medicare Advantage Cost?

In addition to your Part B premium, there may be a a monthly premium for the Medicare Advantage Plan. Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

Another important rule is that you can’t have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you’re in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

Thankfully, you now have the tools you need to select the Medicare Advantage plan that is right for you.

10 Things to Know About Medicare Advantage

1. Plans and their coverage can change – be sure to double check each year for your plan’s co-pays and specific coverage. 
2. You Can Not have Medicare Advantage and Medigap supplement at the same time.
3. A Medicare Advantage plan is an alternative to Original Medicare that is administered through a private insurance company approved by Medicare.
4. You are not allowed to have Medicare Advantage that includes prescription drug coverage and Medicare Part D at the same time. Medicare will automatically dis-enroll the beneficiary from previous enrollment.
5. If you have End-Stage Renal Disease (ESRD), you are not eligible for Medicare Advantage.
6. Medicare Advantage plans differ by county, and some, but not all, offer vision, hearing, dental, and prescription drug coverage.
7. Some plans include fitness club memberships.
8. Under a Medicare Advantage plan, you must use the doctors and hospitals that are in your particular Medicare Advantage plan’s network. (With PPOs, you can use doctors outside the network, but you will usually pay more.)
9. Unlike Original Medicare, Medicare Advantage plans include a limit on how much you will have to spend out of pocket each year.
10. With Medicare Advantage, you still have Medicare and all the rights and protections that come with it.

Enrolling into Medicare Advantage:

There are specific rules and guidelines on when you can enroll into a Medicare Advantage Plan. 

If you are enrolling for the first time, you may enroll the 3 months before, the month of your birthday, or the 3 months after the date you turn 65. If you need to disenroll from an MA plan, the period is January 1 to February 14.

If you miss your window of Opportunity – you can also enroll during the open enrollment period from October 15 to December 7.

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