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What is a Medicare Advantage Plan?
Often referred to as Medicare Part C, a Medicare Advantage Plan is an additional health plan choice offered to those eligible for Original Medicare (Part A and Part B). Unlike Medigap insurance, these types of plans do not offer supplemental coverage but are instead a private insurance alternative to Original Medicare. With this option, you generally get all your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage through one plan.
When you join a Medicare Advantage Plan, you are still in the Medicare program; however, your Medicare services are covered through this one plan, and are not paid for under Original Medicare.
There are three main types of Medicare Advantage Plans: Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Private Fee-for-Service (PFFS) plans. Less common options include HMO Point-of-Service plans, Medical Savings Accounts, and Special Needs plans.
What does a Medicare Advantage Plan cover?
It is important to know that Medicare Advantage Plans do not supplement your Original Medicare benefits. A Medicare Advantage Plan is actually an alternative to Original Medicare coverage.
- Medicare Advantage Plans must cover all of the medical and hospital services that Original Medicare covers, except hospice care (Original Medicare covers hospice care even if you're in a Medicare Advantage Plan).
- All types of Medicare Advantage Plans cover emergency and urgent care.
- Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, or health and wellness programs.
- Many plans include Medicare prescription drug coverage (Part D). If the plan provides prescription drug coverage, it is called a Medicare Advantage Prescription Drug (MAPD) plan.
How do I qualify for a Medicare Advantage Plan?
You can generally qualify for a Medicare Advantage Plan if you meet these conditions:
- You have Medicare Part A and Part B coverage.
- You live in an area serviced by the plan you want to join.
- You do not have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
What will a Medicare Advantage Plan cost?
The costs of a Medicare Advantage Plan depend on a number of factors. Here are some questions to consider when purchasing a Medicare Advantage Plan:
- Does the plan charge a monthly premium in addition to your Part B premium?
- Does the plan pay any of the Part B premiums?
- Does the plan have a yearly deductible?
- Does it charge any deductibles for any of the services?
- How much will you pay for each service or visit (copayments), both in network and out of network?
- What type of health services do you need? How often?
- Will you be using network providers or out-of-network providers?
- Are there any additional benefits in the plan, such as vision and dental coverage? Do you need them? What do these benefits cost?
Since private companies sponsor Medicare Advantage Plans, costs will vary. It's important to do your homework and call any plan before joining to find out the rules, determine your costs, and make sure the plan meets your needs.