Medicare Advantage Glossary of Terms
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans” or “MAPD Plans” are offered by private insurance companies approved by Medicare. Simply put, a Medicare Advantage Plan provides your Medicare coverage through a private company rather than directly from the federal government. You can enroll in a Medicare Advantage Plan once you’ve signed up for Medicare Parts A and B.
There are several different types of Medicare Advantage plans. Some of the main differences between each type include how the provider network works, the benefit and coverage structure, including cost-sharing, the ancillary benefits and even geographical availability.
Some of the most common types include:
Ultimately, a Medicare Advantage Plan can include as much or as little as you need it to. Many Medicare Advantage Plans 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.
Medicare Part C, also known as Medicare Advantage Plans, covers all the services included in Original Medicare Parts A and B. Additionally, Medicare Part C plans offer extra benefits beyond those provided by Original Medicare, such as an annual maximum out-of-pocket limit on covered services.
Many Medicare Advantage plans include Part D prescription drug coverage. They often also provide benefits for vision, hearing, and dental care. Some plans even offer additional perks like wellness programs, fitness memberships, or allowances for over-the-counter items. Since these extra benefits can vary significantly from one plan to another, it's important to compare options carefully when selecting the right coverage for you.
When you have Part C, you will continue to pay your Part B premium. In addition to paying your Part B premium, there will be a premium to enroll in a Medicare Advantage (Part C) Plan. This amount varies by plan, and typically ranges from $0 to $200 per month.
Find Out How Can Medicare Advantage Plans Have No Premium Cost?
In addition to your plan’s monthly premium, you may have a deductible to meet. Deductibles are less common for approved medical services but more common for prescription medications. Keep in mind that every plan is different, so the deductible amounts and where they apply can vary.
Along with your plan's premium and any deductibles, you will be responsible for specificcopayments and coinsurance for the covered care and medical services you receive. The amounts for copays and coinsurance depend on the specific Part C plan you choose and may vary for different services.
To enroll in a Medicare Advantage plan you must meet certain eligibility requirements, including:
8 Questions to Ask When Enrolling in a Medicare Advantage Plan
Download our comprehensive guide for a step-by-step breakdown of how Medicare works and how to enroll.
There’s a good reason why over half of Medicare beneficiaries are enrolled in a Medicare Advantage (Part C) plan. We’ve covered many of the advantages of these plans, but here’s another summary of why so many people choose to sign up for a Medicare Advantage plan:
Medicare Advantage vs Medicare Supplements: Which One Is Right For Me?
Medicare Advantage plans can vary significantly in the coverage they offer when traveling outside their designated service area. Typically, MA Plans provide coverage for urgent care and emergencies both inside and outside of their coverage areas. If traveling abroad, coverage may be limited.
For individuals who travel frequently or spend extended periods in another state, it's essential to ensure that the Part C plan you choose provides adequate coverage while you're on the road or snowbirding for the winter.
Keep Reading:Traveling with Medicare Advantage and What You Need to Know
Can I switch Medicare Advantage plans mid-year?
You can switch Medicare plans during the Annual Enrollment Period (October 15 – December 7). For those currently enrolled in a Medicare Advantage plan, you may also be able to change during the Medicare Advantage Open Enrollment Period (January 1 - March 31). Certain circumstances, like moving or leaving an employer plan, may also allow changes outside these dates.
What happens if my doctor isn’t in my Medicare Advantage network?
Ideally you shop for a new plan during an enrollment period. Using out-of-network providers may cost more or your plan may not cover the visit at all depending on the coverage. Always check your plan’s network before enrolling.
Are prescription drugs always included in Medicare Advantage?
Not always. Many Medicare Advantage plans include prescription drug coverage, but some do not, known as an ‘MA Only’ plan. Choosing a Medicare Advantage plan that does provide coverage for medications, you will want to check the formulary to see which medications are covered and at what tier. How much the plan charges per tier. And the pharmacies they prefer you use when enrolled in the plan.
Are dental, vision, and hearing always covered?
Although common, these benefits are not automatically included. Some Medicare Advantage plans offer them as supplemental benefits. If your plan doesn’t offer these benefits and you prefer to have that coverage, there are standalone plans available.
Can I keep my Medicare Advantage plan if I move to a different state or even a different county?
Medicare Advantage plans are not only state-specific but can be county specific. If you move, you might need to enroll in a new plan during a special enrollment period that will correlate with your move.
Can I have both a Medicare Advantage plan and a Medigap plan?
No. Medigap policies are designed to work with Original Medicare, not Medicare Advantage. You must choose one or the other, not both.
Can I have more than one drug plan?
No. If you get a drug plan with your Medicare Advantage plan, you cannot have a standalone drug plan. If you choose a Medicare Advantage plan with no drug plan, you cannot add a standalone drug plan. You must choose one or the other, not both.
How do I know if a Medicare Advantage plan is right for me?
Consider your healthcare needs, preferred providers, prescription coverage, travel habits, and budget. A licensed Medicare advisor, such as the team at Twin City Underwriters, can help you compare plans and make an informed choice.
Deciding if a Medicare Advantage is right for you requires careful consideration and comparison of all your Medicare plan options. At Twin City Underwriters, we are a team of insurance professionals who have helped thousands of Medicare beneficiaries over the years; we are proud to provide comfort, confidence and support to seniors as they make these impactful decisions.
Join one of our upcoming Medicare 101 sessions or contact us to schedule a free no-obligation consultation for personalized Medicare plan matching and hands-on support throughout your entire Medicare journey.
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