Eleanor Finch
Medicare Advantage plans are an alternative to traditional Medicare, providing Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. These plans are offered by private companies that contract with Medicare and must follow rules set by Medicare. They are paid for by the federal government and include additional benefits not covered by traditional Medicare, such as telehealth services, fitness club memberships, caregiver support, meal delivery, and acupuncture. Medicare Advantage plans are growing in popularity, with 49% of Medicare beneficiaries enrolled in 2023. However, switching between Medicare Advantage and traditional Medicare is uncommon, and beneficiaries often seek advice from experts before making a choice. Insurance companies decide on the availability of Medicare Advantage plans in specific states or counties and can offer multiple plans with varying benefits and costs.
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What You'll Learn
Medicare Advantage Plans vs. Original Medicare
Medicare Advantage Plans, also known as Part C, are offered by Medicare-approved private companies. They provide an alternative way to receive Part A (Hospital Insurance) and Part B (Medical Insurance) benefits instead of Original Medicare. Medicare Advantage Plans typically include drug coverage (Part D) and may have zero-dollar premiums, extra benefits, reduced cost-sharing, and an out-of-pocket spending limit.
Original Medicare, on the other hand, offers more flexibility in choosing healthcare providers as long as they accept Medicare. With Original Medicare, you can access care anywhere in the United States, whereas Medicare Advantage Plans are usually limited to specific geographic areas and have provider networks. Additionally, Original Medicare does not cover routine dental, hearing, and vision care, while many Medicare Advantage Plans offer some coverage in these areas.
When considering Medicare Advantage Plans, it is important to be aware that joining one might result in losing your employer or union coverage. This could also affect the coverage of your spouse and dependents. It is always a good idea to consult with your employer, union, or benefits administrator before enrolling in a Medicare Advantage Plan.
In terms of costs, with Original Medicare, you pay the government-set annual Part B premium and the Part A premium if required. Medicare Advantage Plans may have additional premiums, but they typically have set copay amounts for physician visits, and they have an annual cap on out-of-pocket expenses.
Both Original Medicare and Medicare Advantage Plans are required by law to cover the same medical services, including blood work, diagnostic tests, doctor visits, hospitalizations, and outpatient surgery. However, Medicare Advantage Plans may have different copayments and deductibles than Original Medicare, and they often come with prior authorization requirements.
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Medicare Advantage Plans and Part C
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans", are offered by private companies approved by Medicare. These plans provide Part A (Hospital Insurance) and Part B (Medical Insurance) coverage, and may offer extra benefits such as vision, hearing, dental, and health and wellness programs.
Medicare Advantage Plans are an alternative to Original Medicare, allowing beneficiaries to receive their Part A and Part B benefits through a private insurance company that contracts with Medicare. These companies must follow rules set by Medicare, but they can also charge different out-of-pocket costs and have different rules for how you access services. For example, you may need a referral to see a specialist, or you may be required to use only in-network providers.
Most Medicare Advantage Plans include prescription drug coverage (Part D). This means that, in addition to hospital and medical insurance, you will also have coverage for prescription medications.
Before enrolling in a Medicare Advantage Plan, it is important to speak with your employer, union, or benefits administrator to understand the potential impact on your existing coverage. Joining a Medicare Advantage Plan may result in losing your current coverage, and consequently, the coverage of your spouse and dependents. Additionally, insurance companies decide on the availability of plans in specific states or counties, and they can choose to offer multiple plans in an area with varying benefits and costs.
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Medicare Advantage Plans and drug coverage
Medicare Advantage Plans, also known as Part C, are offered by Medicare-approved private companies. They provide Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. Most Medicare Advantage Plans include prescription drug coverage (Part D). These plans are called MA-PD plans.
The Medicare Annual Enrollment Period (October 15 to December 7) is a good time to explore prescription drug plans. During this period, you can review your existing prescription drug coverage and make an informed decision on which option is best for you. It is important to note that not all pharmacies charge the same for prescription drugs, even those that are in-network. If a drug isn't covered by your MA-PD plan, you can call different pharmacies to ask about their costs for that medication.
Medicare Advantage Plans are a popular choice for those seeking prescription drug coverage. Prescription drug coverage is essential, especially for those 65 or older, as a reported 90% of people in this age group take at least one prescription drug regularly, with 80% taking at least two. Medicare Advantage Plans can greatly lower the costs of the medications needed to stay healthy.
It is important to note that Medicare Medical Savings Account (MSA) plans, a type of Medicare Advantage Plan, do not offer Part D coverage. If you join an MSA plan and require prescription drug benefits, you will need to enroll in a separate Medicare drug plan. Before joining a Medicare Advantage Plan, it is recommended to consult your employer, union, or benefits administrator about their rules, as enrolling in one might cause you to lose your existing coverage.
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Medicare Advantage Plans and insurance brokers
Medicare Advantage Plans, also known as Part C, are offered by Medicare-approved private companies that contract with Medicare and must follow rules set by Medicare. These plans provide Part A (Hospital Insurance) and Part B (Medical Insurance) benefits to people with Medicare.
Insurance brokers, also known as Medicare advisors or agents, are licensed professionals who help individuals evaluate, select, and enrol in a Medicare plan. They are the link between people in need of Medicare plans and the companies that offer them. Brokers are typically paid by the insurance companies they represent, and they can work with multiple insurance carriers, providing an unbiased opinion on plan options. They can help individuals understand the benefits and restrictions of different plans, compare options, and find a plan that fits their budget and needs.
When it comes to Medicare Advantage Plans specifically, brokers can earn higher commissions for enrolling individuals in these plans compared to Medigap supplemental policies. They can also earn extra income by conducting beneficiary health risk assessments during the Medicare Advantage enrolment process.
It is important to note that insurance brokers are not required to offer all available plans in an area, but they must disclose this information to their clients. Additionally, Medicare beneficiaries should be aware that brokers may have financial incentives that influence their recommendations. While brokers can provide valuable guidance, individuals should also consider seeking objective information about the trade-offs of different coverage options.
In summary, Medicare Advantage Plans are offered by private companies contracted with Medicare, and insurance brokers can assist individuals in navigating and enrolling in these plans. Brokers provide guidance, comparisons, and unbiased advice to help individuals find a suitable Medicare plan, including Medicare Advantage Plans.
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Medicare Advantage Plans and private companies
Medicare Advantage Plans, also known as Part C or MA plans, are offered by Medicare-approved private companies. These companies contract with Medicare and must follow the rules set by Medicare. The plans provide Part A (Hospital Insurance) and Part B (Medical Insurance) benefits to people with Medicare. Most Medicare Advantage Plans also include drug coverage (Part D).
Medicare Advantage Plans are an alternative to Original Medicare, which is the traditional fee-for-service program offered by the government. With Original Medicare, you can see any doctor or hospital that accepts Medicare, anywhere in the United States. On the other hand, with Medicare Advantage Plans, you may be restricted to the plan's network of providers, and you may have to pay additional premiums.
When considering a Medicare Advantage Plan, it is important to review the specific rules and restrictions of the plan. For example, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage, which could also affect your spouse and dependents. Additionally, insurance companies can decide to offer plans in specific counties or states, and they can choose to leave Medicare, which would require you to join another plan.
Medicare Advantage Plans offer a variety of options, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Special Needs Plans (SNPs), and Private Fee-for-Service Plans (PFFS). These plans may provide extra benefits that Original Medicare does not cover, such as certain vision, hearing, and dental services. It is important to carefully review the benefits and costs of each plan to ensure that it meets your individual needs.
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Frequently asked questions
Medicare Advantage plans are private health insurance plans paid by the federal government to provide Medicare-covered benefits as an alternative to traditional or original Medicare.
Medicare Advantage plans include Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. Most plans also include Part D coverage for prescription drugs. Some plans also cover additional benefits such as fitness club memberships, caregiver support, meal delivery, or acupuncture.
You can join a Medicare Advantage plan if you have both Part A and Part B. Talk to your employer, union, or benefits administrator about their rules before joining. You can also contact your local State Health Insurance Assistance Program (SHIP) for free personalized health insurance counselling.
In most types of Medicare Advantage plans, you cannot join a separate Medicare drug plan. However, if you have Original Medicare, you can add a separate Medicare drug plan.
Yes, you may pay a Part D late enrollment penalty if you don't join a Medicare drug plan when you first get Medicare. This penalty goes up the longer you wait to join a plan, and you may have to pay it for as long as you have Part D coverage.
