Medicare Advantage Plan

What is a Medicare Advantage Plan?

Medicare Advantage Plans, sometimes called Part C, offers an alternative way for beneficiaries who are currently enrolled in Original Medicare, Part A, and Part B, to get that coverage.  These plans provide all the same medical and hospital coverage as Original Medicare, but often includes additional coverage for services like routine vision and dental care. In all types of Medicare Advantage Plans, you are always covered for emergency and urgent care.  Medicare Advantage Plans must cover emergency coverage outside of the plan’s service area, sometimes even out of the country. They don't include hospicecare, which Medicare Part A still covers when you have a Medicare Advantage plan.  The plans are offered by private insurance companies in the state with Medicare's approval, and some include prescription drug coverage.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans.  These companies must follow rules set by Medicare.  

 

 However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). Plan benefits can change from year to year, including the drug formulary and provider network.  Make sure you understand how a plan works before you join.

Through a Medicare Advantage (Part C) plan, you will pay the following:

 

What type of Medicare Advantage plans are there?

 

There may be a number of  Medicare Advantage plans available to choose from, depending on what county you live in.  These type plan options available may include:

Beneficiaries may also choose a Medicare Medical Savings Account (MSA), which is a high-deductible health plan that allows them to choose their providers and health-care services.

 

How Much Does a Medicare Advantage Plan Cost?

 

In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs depend on:

  • Whether the plan charges a monthly premium.

  • Does the plan pay any of your monthly Part B premium.

  • Whether the plan has a yearly deductible or any additional deductibles.

  • How much you pay for each visit or service (copayments or coinsurance).

  • The type of health care services you need and how often you get them.

  • Whether you follow the plan‚ rules, like using network providers.

  • Whether you need extra benefits and if the plan charges for them.

  • The plan's yearly limit on your out-of-pocket costs for all medical services

 
Enrolling in Medicare Advantage /Medicare Part C

 

You may only enroll in a Medicare Advantage Plan during specified enrollment periods.  In most cases, when you enroll, you’re enrolled in a plan for a year.  Here are the different Enrollment Periods

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