What is a Medicare Advantage Plan (And Do I Need One?)
February 23, 2021 | Tom Peterson
What Is a Medicare Advantage Plan?
A Medicare Advantage Plan offers coverage through a private company instead of through government-provided Medicare. 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.
Do I Need a Medicare Advantage Plan?
The answer to that question is: it depends on your needs. The reason why some people choose a Medicare Advantage Plan is because the coverage offered under Medicare is not sufficient for their needs. If you have a chronic condition, frequently visit the doctor, need prescription drug coverage or just require more care that Medicare accounts for, this can be an attractive option.
Some people chose a Medicare Advantage Plan because, for them, that plan is more affordable than singing up for Medicare and then a supplement plan to fill in gaps. Deciding if you want a Medicare Advantage Plan is best decided through careful thought and a conversation with a dedicated agent.
What Do Medicare Advantage Plans Cover?
Medicare Advantage Plans must cover all the services that Original Medicare covers, and have a maximum out of pocket (MOOP). Original Medicare does not have a MOOP or a cap on out-of-pocket costs.
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.
Who Can Join a Medicare Advantage Plan?
To join an 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. 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 and help you find the best plan for you.