What Is a Medicare Advantage Plan?

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Private insurers offer a Medicare Advantage Plan, which is an alternative to traditional Medicare. These are the drawbacks and benefits.

Medicare Advantage is an all in one alternative to Original Medicare. Private insurers offering Medicare Advantage Plans contract to the federal government to provide Medicare-qualified individuals with health insurance benefits.

Medicare Advantage: The pros and cons

Medicare Advantage plans come with both benefits and drawbacks. They are a great choice for some, but not for all.

Pros

  • Other benefits include vision, hearing and dental care.
  • Coverage may be offered at a lower price.
  • There are limits on the amount you can pay out-of pocket for hospital and medical coverage.

Cons

  • You have less freedom to choose your own medical providers
  • You must reside in the plan’s service area and receive your non-emergency medical care there.
  • Limits on your ability to switch back to Original Medicare with a Medicare Supplement Insurance policy.

How Medicare Advantage Plans Work

Medicare Advantage Plans, also known as Medicare Part C, or MA Plans, must provide the same benefits to Medicare Part A. This covers hospitalization and Medicare Part B covers doctor’s visits. Medicare Advantage Plans also typically include Medicare Part D prescription drug coverage and may include benefits not covered by Medicare, such as routine dental care, eye exams and glasses, and hearing aids.

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Medicare Advantage vs. Medicare

Medicare Advantage Plans might have provider networks that restrict your options. Your care may not be covered if you travel outside the network. Original Medicare allows you to use any doctor or facility that accepts Medicare assignments.

You may pay less in exchange for less freedom. While you would still need to pay a monthly Premium for Part B, the cost of a Medicare Advantage plan may be lower than a Medigap. The Medicare Advantage Plan might have a $0 premium.

Medicare Advantage Plans may have a maximum out of pocket limit for covered services. This limit limits the amount that you will be required to pay, in addition to your premiums. Original Medicare and most Medigap plans do not have any out-of-pocket limits.

Medicare Advantage vs. Medigap

Medicare Supplement Insurance is sometimes confused with Medicare Advantage Plans. While both are offered by private insurance companies and can be purchased by anyone who has Original Medicare (Part A or Part B), Medigap policies are for people who have Original Medicare. They fill in the gaps by covering copays and coinsurance. Medicare Advantage Plans are an alternative to Medicare Part A or Part B. It is not possible to have both a Medicare Advantage plan and a Medigap policy at once.

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Medigap policies can be compared easily because they are standard. Each Medicare Advantage Plan is different so it can be challenging to compare costs.

How to select the best Medicare Advantage plan

Comparing Medicare Advantage Plans requires you to understand your health care needs and think about what each type of plan offers. You will need to ensure that your doctor accepts you if you have a chronic condition. Prescription drugs may be covered by some plans with lower out-of pocket costs.

These are some questions you can ask:

  • Do you need to be referred to specialists?
  • What are their benefits? (Do you require vision or dental?
  • What will it cost to buy your drugs?
  • Are your doctors covered?
  • What’s their Medicare star rating?

How to enroll in Medicare Advantage Plans

After you have done your research to find the right Medicare Advantage Plan for your needs, there are many ways that you can enroll.

  • Use Medicare’s Plan Finder to find the plan in your area. Click on “Enroll.”
  • To see if enrollment can be done online, visit the website of the plan. To obtain a paper enrollment form, contact the plan. It should be completed and returned to the plan provider.
  • For more information, call the provider.
  • 1-800-633-4227 to speak with Medicare
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Your Medicare number and date that your Medicare Part A or Part B coverage began will be required.

You can only enroll in a Medicare advantage plan during your Initial Enrollment Period (when Medicare eligibility is first established) or during the Open Entry Period, which runs from Oct. 15 through Dec. 7. You can change plans from January 1 through March 31 each year, once you are enrolled in a Medicare Benefit Plan.

How to change Medicare Advantage Plans

If you want to change Medicare Advantage Plans, you can do so once a year, either during Medicare’s fall open enrollment period (Oct. 15 to Dec. 7) or the Medicare Advantage open enrollment period (Jan. 1 to March 31).

These periods allow you to switch to Original Medicare, but it may be difficult to obtain a Medicare Supplemental Insurance Policy if you do so after the first year. Your Medigap policy must be issued by your insurers during the initial Medigap enrollment period. This is typically six months after your turn 65. If you change your Medicare Advantage Plan within the first year, or for the six months following your turning 65. Insurers may refuse to issue you a Medigap plan if you have a medical condition or require that you wait before you are covered.