Medicare Advantage Explained

What is Medicare Advantage?

Medicare Advantage plans are sometimes called Medicare Part C plans. These are private insurance plans offered by major insurance companies. The Medicare system pays these private insurance companies to offer these plans. The companies, in turn, provide you with benefits.

What does a Medicare Advantage Plan cover?

Evert Medicare Advantage plan differs. However, each will offer benefits similar to Original Medicare.

• Most plans offer all Original Medicare Part A (hospitalization) and Part B (medical) coverage. Still, some exclude hospice services normally covered by Part A & B.

• All plans will cover emergency service care outside the plans coverage area (within the U.S.).

• Many Advantage plans also offer Part D prescriptions, dental, vision, and hearing services coverage.

Medicare Advantage is not the same thing as MediGap insurance or Medicare Supplementals. Medigap plans only supplement costs not covered under Original Medicare. Advantage plans, on the other hand, have their own cost structure.

What are the types of Medicare Advantage Plans?

All Advantage plans vary. Most of them will include networks of providers, along with various financial responsibilities.

• HMOs (Health Maintenance Organizations): You'll visit a provider within the plans network for all services.

• HMOPOS (HMO Point-of-Service) plans: For a higher co-payment or coinsurance, you can visit certain service providers outside of your plan network.

• PPOs (Preferred Provider Organizations): PPOs have plan networks. However, you can receive care outside your network for a higher cost. Therefore, it's often better to see doctors within the network.

• PFFS (Private Fee-for-Service) plans: As long as a provider accepts the terms of these plans, you can receive services. The costs you pay for different services will vary.

• Special Needs plans: These plans apply to those with exceptional medical needs. Those who qualify might range from nursing home residents to those with disabilities or chronic illnesses.

• Medicare Savings Accounts (MSAs): You'll carry a high deductible health plan alongside a specialty savings account. Medicare will pay into the account, which will allow you to pay for certain care during the plan year.

How can I enroll in a Medicare Advantage?

In order to enroll in a Medicare Advantage plans.

• You must have Original Medicare (Parts A & B) before applying for an Advantage plan.

• Not every Medicare Advantage plan is available in all areas.  Therefore, you'll have to enroll in a plan within your service area.

• Most applicants cannot have End-stage Renal Disease. Exceptions to this rule exist, however.

When can I enroll in a Medicare Advantage Plan?

You can start enrolling in Medicare Advantage as soon as you qualify for Original Medicare at age 65. You can also enroll during the Annual Election Period from Oct. 15 to Dec. 7. 

You can also enroll in a Medicare Advantage plan if you qualify for a Special Enrollment period (SEP) due to moving, losing coverage or are new to Part B. View more enrollment information here.

Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.   Description - Medicare Advantage

Medicare & You

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare.    

If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. In most cases, you’ll need to use health care providers who participate in the plan’s network.    

Some plans offer out-of network coverage. Remember, in most cases, you must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

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