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Medicare Advantage Plans

What is a Medicare Advantage plan?

A Medicare Advantage plan, also referred to as a Medicare Part C or MA plan, is an additional health plan option offered to those eligible for Original Medicare (Part A and Part B). Unlike Medigap insurance, MA plans do not offer supplemental coverage. Instead, these plans are 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, and you are still required to pay your monthly Part B premium; however, your Medicare services are covered through this one plan, and are not paid for under Original Medicare.

There are four main types of Medicare Advantage plans: Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SNPs). Less common MA plan options include HMO Point-Of-Service (HMOPOS) plans and Medical Savings Account (MSA) 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 enrolled in a Medicare Advantage plan).
  • All types of MA plans cover emergency and urgent care.
  • Medicare Advantage plans may offer extra coverage, such as vision, dental, or hearing benefits, as well as memberships to health and wellness programs.
  • Many plans include Medicare prescription drug coverage (Part D). If the plan provides this 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), in most cases.

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 have an annual deductible?
  • Does it charge other deductibles for any of the services?
  • What type of health services do you need? How often?
  • Does this plan have network restrictions? Will you be using network providers or out-of-network providers?
  • How much will you pay for each service or visit (copayments), both in-network and out-of-network?
  • Are there any additional benefits in the plan, such as vision and/or dental coverage? Do you need them? What do these benefits cost?

Since private insurance companies offer Medicare Advantage plans, costs and benefits will vary. It’s important to do your homework and compare plans before joining to make sure that the benefit and rules of the plan you select meets your needs and budget.

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Medicare Advantage plans, and the insurance companies that offer them, do vary depending on your location. Ask me about anything else you’d like to know. You can learn more about who I am with my photo and profile below. Or, use one of the links below to set aside some time to talk with me by phone or ask me to email you with more information. If you want to start comparing the plans available in your area, click the blue Find Your Plan button above. If you’re ready to discuss your Medicare needs now, call me at 1-844-847-2659; if you need TTY services, please call 711.

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