What is a Medicare Advantage Plan (And Do I Need One?)
April 3, 2018 | Todd Lewison
With all the different Medicare options out there, it can be hard to know what is the best option. You may have heard of a “Medicare Advantage Plan” and wonder if it’s right for you. Simply put, a Medicare Advantage Plan offers coverage through a private company instead of through government-provided Medicare. Here’s what you need to know to decide if it’s the best option for you:
What is a Medicare Advantage Plan?
One way to receive your Medicare Coverage is by enrolling in a Medicare Advantage Plan (like an HMO or PPO). Medicare Advantage Plans, sometimes called “Part C” or “MA Plans” are offered by private insurance companies approved by Medicare. It’s important to remember Medicare Advantage Plans are not Medicare Supplements. These plans will provide coverage for your approved Medicare Part A (hospital) and Part B (medical) coverage. Many of the Medicare Advantage plans will have a network of contracted providers and facilities. It’s important to understand how the network functions and to be sure the plan you choose contracts with the providers you want to use. When you enroll in a Medicare Advantage Plan, The Centers for Medicare and Medicaid Services (CMS) will send a flat monthly rate to the insurance companies while you are enrolled in their plan. That money is sent whether you have claims or not. Check out our FAQ for a full breakdown of Medicare plans.
What Do Medicare Advantage Plans Cover?
Medicare Advantage Plans must cover all the services that Original Medicare covers other than hospice care. Medicare Advantage Plans must offer emergency and urgent care coverage outside of the plans service area (but not outside the US). Most of these plans also include your Part D (prescription) coverage as well. Many of the Medicare Advantage Plans offer additional benefits as well. These may include: dental, vision, wellness benefits and travel coverage.
It’s important to remember when you enroll in a MA plan you still have Medicare, you don’t lose it. You are just choosing to take the Medicare Advantage version of Medicare: a plan that’s administered by a private insurance company rather than the federal government.
Who can join a Medicare Advantage Plan?
To join a Medicare Advantage Plan, you must be enrolled in Medicare Parts A and B. Some of the plans may have a monthly premium in addition to your Medicare Part B premiums which you must continue to pay. You must live within the plan’s service area. Also, in most situations if you have been diagnosed with End-Stage Renal Disease (permanent kidney failure) you cannot join a Medicare Advantage Plan. Plan benefits can change from year to year (annual renewable). There are generally only certain times of the year you can join a Medicare Advantage Plan. The Annual Enrollment Period runs from October 15-December 7th. This is the time of year to compare your options and change your plans if desired. There may be other times to enroll as well. Some examples might be when you first enroll in Medicare or if you qualify for a special election period. It’s important to understand how your plan works before you join.
Do you have more questions about Medicare Advantage Plans? We’re here to answer all your questions.