Medicare Advantage
Medicare is the health insurance option that most people go on when they near or enter retirement. Parts A and B are known as Original Medicare, which is not full coverage.
To get more healthcare coverage, millions of Americans enroll in Medicare Advantage (Part C) plans. This page will explain more about this popular option.
What Is Medicare Advantage?
Medicare Advantage is a private version of Medicare, aka another way to get your Part A (hospital) and Part B (medical) benefits. The plans are only offered by private companies — you can’t get one from the government.
Many Medicare Advantage plans include prescription drug coverage and some offer additional benefits that Original Medicare does not, including dental and vision care.
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Who Qualifies for Medicare Advantage?
To qualify for a Medicare Advantage plan, there are three criteria:
- You must have Parts A and B of Medicare.
- You have to live in the plan’s service area, which is by county (some plans will be available in one county but not in another).
Policyholders will continue to pay the Part B premium while enrolled in their Advantage plan.
How Does Medicare Advantage Work?
Medicare Advantage is paid for by federal funding, subscriber premiums, and copayments.
You pay a premium for the plan. When you have a health issue, the Medicare Advantage benefits pay the costs.
If you decide to join a Medicare Advantage plan, you don’t need to carry your Medicare card (don’t throw it away, just set it aside) because you’re now getting your A and B benefits from a private insurance company. When you go to the doctor, you simply show your Advantage plan card.
HMO vs. PPO Plans
There are several different plan types (HMO, PPO, etc.).
If you enroll in a Medicare Advantage HMO plan, that plan has a network. You must stay in the network unless it’s an emergency. If you want to see an out-of-network provider and it’s not an emergency, the HMO plan won’t pay for it.
A PPO plan also has a network. If you stay in the network, you pay less. But PPOs give you a little more freedom, in that you can go to any provider or hospital that takes Medicare. And if it’s out of network, you simply pay more than an in-network rate.
If you enroll in a Medicare Advantage HMO plan, that plan has a network. You must stay in the network unless it’s an emergency. If you want to see an out-of-network provider and it’s not an emergency, the HMO plan won’t pay for it.
A PPO plan also has a network. If you stay in the network, you pay less. But PPOs give you a little more freedom, in that you can go to any provider or hospital that takes Medicare. And if it’s out of network, you simply pay more than an in-network rate.
Max Out of Pocket Limit
All Medicare Advantage plans have an annual maximum out of pocket limit, which can vary from one plan to another. That’s a big reason to shop around for plans, as the copays, benefits, and max out of pocket will vary by plan.
Remember, Original Medicare has no annual max out of pocket, so this can make Medicare Advantage plans an appealing option for seniors.
Extra Benefits
One of the biggest reasons people enroll in Medicare Advantage plans is because of the additional benefits, like dental, vision, hearing, and fitness programs.
It’s wise to look at the extra benefits that Medicare Advantage plans in your county offer. Advantage plans have fixed copays for specific services. These copays can vary from one plan to the next. That’s why you should compare plans, and ABC Medicare can help you with that.
When to Enroll in Medicare Advantage
You can join a Medicare Advantage plan around the time when you’re transitioning into Medicare, during your Initial Enrollment Period (IEP). This is a seven-month window between the three months before you turn 65 to the three months after.
You also have other options. Once you have Parts A and B, you can enroll in a Medicare Advantage plan during the Annual Enrollment Period (AEP), which is October 15 to December 7.
If you missed your IEP, you’ll need to wait until the General Enrollment Period (GEP) to enroll in Original Medicare. This window will go from January 1 to March 31, and then you can switch to Medicare Advantage during AEP of the same year.
What Else You Should Know
There are a few more things to keep in mind. Those who enroll in a Medicare Advantage plan aren’t eligible to enroll in a Medicare Supplement plan or a stand-alone Part D plan. So if you need Part D, make sure your Advantage plan includes prescription drug coverage.
Also, not every hospital that accepts Medicare will accept Medicare Advantage.
We Can Connect You with a Plan
Interested in Medicare Advantage but not sure which plan you should be on? At ABC Medicare, we work with A+ carries to connect you with the right plan in your area. Contact us today!
