Medicare Advantage Plans

What is Medicare Advantage ?

Instead of joining Original Medicare, a Medicare Advantage Plan offers you a different path to receiving health care coverage than you would normally receive from the combined benefits of Medicare Part A and Medicare Part B (known as Original Medicare.) 

HOWEVER, when you join a Medicare Advantage Plan you are LEAVING original Medicare and the money you pay into original Medicare is paid by the government to the private company that provides your Medicare Advantage Plan. In addition, if you have employer coverage for yourself and/or members of your family, joining a Medicare Advantage Plan could result in your losing employer medical coverage for yourself or other family members which you might not be able to get back. Check with your employer or union first.

Medicare Advantage Plans are also known as Medicare Part C or simply “MA” Plans.

Available from private companies, these plans have been approved by Medicare and, therefore, must abide by the guidelines established by Medicare for your protection. 

Coverage for prescription drugs, also known as Medicare Part D, is a benefit included with the majority of Medicare Advantage Plans.  Some MA Plans offer dental, vision and/or hearing benefits as well.

Medicare Advantage Plans can safeguard you from unexpected out-of-pocket costs when you use their in-network health care providers. Most plans set limits on your annual spend for in-network services. However, you can expect to pay higher out-of-pocket costs if you go outside of their network. 

Below are a few important points to remember when making the Medicare Supplement vs. Medicare Advantage Plan comparison.

When you enroll in a Medicare Advantage Plan (MA), you are leaving Original Medicare (run by the federal government) and privatizing your medical coverage with an independent insurance company. 

Health care and costs for Medicare Advantage (MA) plans are managed via an HMO (Health Maintenance Organization), a PPO (Preferred Provider Organization), or some other framework. MA Plans are required to provide for every service provided by Original Medicare .

Prescription Drug coverage is frequently included within the Medicare Advantage (MA) plan. Such plans are referred to as "MAPD" plans. When enrolled in an MAPD, you have to use the prescription coverage within the plan (you can't purchase a separate prescription drug plan).

When reviewing and comparing MA plans, you want to understand the coverage area, and look to see if the doctors and health care providers you desire participate in the plan.  

What makes many MA plans attractive is the inclusion of additional items such as dental, vision, hearing, and/or health and wellness programs.  (These items would have to be paid out-of-pocket, or by separate coverage along side Original Medicare).

If you choose a Medicare Advantage Plan you still enjoy the benefits of Medicare Part A and Medicare Part B, but these benefits come from your MA Plan, not Original Medicare.

Emergency care and urgently required care are covered in all MA plans.

Whether you’re in a Medicare Advantage Plan or not, hospice care is covered by Original Medicare.   

Services not covered by Medicare insurance may or may not be covered under MA plans. When in doubt as to your coverage in your Medicare Advantage Plan for a certain service, always consult your medical care provider or medical plan provider prior to receiving the service.  

The Medicare Advantage Open Enrollment Period is January 1 through March 31. You will only be able to make one change during this time, and changes you make will become effective the first day of the month after the new plan receives your request.

Here are some of the changes you CAN make during the Medicare Advantage Open Enrollment Period:

• If you’re already in a Medicare Advantage Plan you can leave it to enroll in Original Medicare. If you wish, you can also join a Medicare Drug Plan at that time.

• If you’re already in a Medicare Advantage Plan with or without drug coverage, you can move to a different Medicare Advantage Plan with or without drug coverage.

However, during the Medicare Advantage Open Enrollment Period you CANNOT leave Original Medicare to join a Medicare Advantage Plan. Also during this period, if you’re already in Original Medicare you CANNOT join a drug plan or switch from one drug plan to a different one.

If you were wondering "what is Medicare Advantage", we hope the above information helped answer your questions. Still, there is a myriad of options to consider when exploring a Medicare Advantage Plan. Why not call us today? As a Medicare Agent we can help you explore your options to get the best health care coverage at the lowest cost.