Medicare Advantage plans

Medicare Advantage plans are a type of health plan offered through private insurance companies that contract with Medicare to provide all your Part A and Part B benefits as well as additional benefits not included with original Medicare. 

You must be enrolled in original Medicare to qualify for this plan, also known as Medicare Part C, as it is not a replacement. However, these plans can sometimes be provided at no additional cost. 

Eligibility is simple. In most cases, if you have Medicare Part A and Part B, you are eligible for an Advantage plan. The only catch is you must live in the service area.

How does Medicare Advantage work?

MA Plans are essentially all-in-one health coverage plans offered by insurance companies that are approved by Medicare. You still have Medicare when you are enrolled in a Medicare Advantage plan and you still pay your Part B premium.

Medicare actually pays a fixed amount for your care every month to the insurance companies offering Medicare Advantage. That is how companies offering these plans can sometimes provide them at no extra cost to you. If not, there will be some sort of premium for your Advantage plan.

Typically, Advantage plans are managed and have networks of contracted health care providers. You’ll select a primary care physician who helps control your care. If your plan includes prescription drug coverage, you may also receive medication management. This coordination surrounding your health care is very convenient.

What does Medicare Part C cover?

This plan includes Medicare Part A and B while usually including prescription drug coverage as well. 

In addition to those benefits, your plan offerings could also include dental, vision, and hearing. 

Other extra benefits can include: 

  • Wellness programs
  • Fitness center membership
  • Transportation to doctor visits
  • Over-the-counter drugs
  • Adult day-care services

And because these plans can come at no additional cost to you in some cases, it’s worth it to see if you can take advantage of all the extras you’ll receive.

Cost of Medicare Advantage

Some Part C plans have no premium. The only way to find out if your Advantage plan has a premium is by calling a licensed Medicare insurance agent. 

Other important information to know to determine your costs associated with a Part C plan is: 

  • Whether the plan pays any of your Part B premium
  • What the yearly deductible is or if there are any other deductibles
  • How much copay or coinsurance is
  • The limit on your out-of-pocket costs for all medical services

It’s also important to remember that each year, plans can change the amount they charge for premiums, deductibles, and other services. What you pay can change only once per year on January 1. You will receive an annual notice of change that details any changes in coverage, costs, or the service area in which your policy is effective.

Enrollment periods

You can only enroll in an Advantage plan during certain periods:

Initial coverage election period — You can enroll when you first become eligible for Medicare. Your initial coverage election period is a seven-month period that start three months before the month you turn 65 and ends three months after the month you turn 65. If you are under age 65 and you receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that pertains to you, you can enroll into a Medicare Part C plan three months before your month of eligibility until three months after your eligibility. 

Annual election period — Also known as open enrollment, the annual election period for Medicare Advantage is October 15 through December 7 every year. Coverage for the plan you choose during this time will begin January 1 the next year. During this time, you can also add, change, or drop current coverage.

Medicare Advantage Open Enrollment Period — If you enroll in a Medicare Advantage plan but decide you want to switch back to original Medicare, you can do so January 1 through March 31. If your Advantage plan included Part D prescription coverage, you can enroll into a stand-alone plan during this time to replace that piece of lost coverage.

Special Election Period — If you move outside your Medicare Advantage plan’s service area, qualify for extra help (such as a program that helps pay for your prescription drugs), or move into an institution (nursing home and etc.) you might qualify for a special election period. During this time you can also make changes to your Part C coverage.

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