Medicare Advantage is the private health insurance alternative to Original Medicare. Also known as Medicare Part C, a Medicare Advantage Plan is available to those who are eligible for Medicare Part A and Part B.
Unlike Medicare Supplements, Medicare Advantage is not supplemental coverage. With this option, all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage benefits are delivered to you through one plan.
When you enroll in an Advantage Plan you do not give up your Medicare rights, benefits and protections; however, your health care services are provided by your plan provider. That means you cannot use the providers you choose and bill Medicare, you follow the rules established by your Advantage Plan.
There are three main types of Medicare Advantage Plans: Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Private Fee-for-Service (PFFS) plans. Other options include HMO Point-of-Service plans, Medical Savings Accounts, and Special Needs plans.
What is covered by a Medicare Advantage Plan?
As previously mentioned, Medicare Advantage Plans do not supplement your Original Medicare benefits. A Medicare Advantage Plan is a private health insurance alternative that’s regulated by the federal government.
All Medicare Advantage Plans cover the medical and hospital services that your Original Medicare covers, but not necessarily in the same way. Also, your Original Medicare covers hospice care even if you’re enrolled in a Medicare Advantage Plan.
All Medicare Advantage Plans cover your emergency and urgent care needs.
Unlike your Original Medicare, Advantage Plans may offer extra benefits, such as vision, hearing, dental, or health and wellness programs. In fact, most plans include Medicare prescription drug coverage (Part D).
Do I qualify for Medicare Advantage?
You can enroll in a Medicare Advantage Plan if you meet these basic requirements:
- You have Medicare Part A and Part B coverage;
- You live in an area serviced by the plan you want to join; and
- You do not have End-Stage Renal Disease (permanent kidney failure).
How much do Medicare Advantage Plans cost?
Medicare Advantage Plan range in price from $0 per month to as much as $200 per month. It all depends on a number of factors, including the benefits offered and the maximum out of pocket expense. Here are some questions to consider when purchasing a Medicare Advantage Plan:
- Does the plan charge a monthly premium in addition to your Part B premium?
- Does the plan have an annual deductible?
- What are the deductibles for hospital and medical services?
- How much are the per-visit copayments?
- What health services do you need and how often do you use them?
- Will you be using network providers or out-of-network providers? Is their a cost difference?
- Are there any additional benefits in the plan, such as prescriptions, hearing, vision and dental coverage? Do you need the extra benefits? What do these benefits cost by themselves?
It’s important to do your homework and call plans before joining to find out if your primary care doctor accepts the plan, and to determine your actual costs. You can change your plan annually, but it’s best to make sure the plan you choose meets your needs before you need their services.