A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. You can think of Medicare Advantage as an alternative option sold by private insurance carriers.
Medicare Advantage Plans go by many names, so if you see Medicare Part C or MA Plan, that’s the same thing as Medicare Advantage.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. By law, Medicare Advantage must provide you with at least the same coverage as Original Medicare.
In addition to that, Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most Medicare Advantage plans also include prescription drug coverage, which means you don’t have to buy a Part D plan.
Many Medicare Advantage plans are $0 premium, which can be a bit confusing. How can insurance be $0 premium?
Well, Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans, which allows for more affordable premiums. These companies must follow rules set by Medicare.
Different Types of Medicare Advantage Plans
Medicare Advantage Plans are structured a lot like the health insurance plans you’re probably used to. You have HMO plans (Health Maintenance Organization) and PPO plans (Preferred Provider Organization) which are your most popular plan choices.
However, there are other plan types, such as Special Needs Plans (SNP), Private Fee-for-Service plans (PFFS), HMO Point-of-Service (HMOPOS) plans, and Medicare Medical Savings Account (MSA) plans.
The plan options depend on where you live, and here in Arkansas, our most popular plan choices are going to be HMO and PPO plans. These are network-based, so we do want to make sure your preferred doctors, hospitals, and pharmacies are covered by your plan choice.
Enrolling in Medicare Advantage
To enroll in a Medicare Advantage plan, you must have both Medicare Part A and Medicare Part B coverage. (This means you still have to pay the Medicare Part B premium.)
You can enroll in a Medicare Advantage plan when you’re new to Medicare or doing the Annual Enrollment Period which lasts from October 15-December 7 each year.
We can help you figure out the enrollment details, so if you’re interested in what Medicare Advantage options are available to you, give us a call!
How Much Does a Medicare Advantage Plan Cost?
There are a lot of plans to choose from, and each plan comes with different costs. In fact, in our area in Arkansas, there are 18 Medicare Advantage plans to choose from. Each plan is a little bit different.
Your out-of-pocket costs in a Medicare Advantage Plan depend on:
- The monthly premium, which is usually very low or even $0
- The plan’s deductible
- Copayments or coinsurance
- Whether or not you see in-network doctors
- Your out-of-pocket maximum (the most you would be responsible in a worst case scenario)
What Does a Medicare Advantage Plan Cover?
Like we mentioned before, Medicare Advantage plans are required by law to cover at least the same amount as Original Medicare
That means that you’re always covered for emergency and urgent care.
In addition, Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most plans also come with drug coverage included.
FAQs About Medicare Advantage
Q: Can I join an MA plan at any time?
A: You can only join a plan at certain times during the year, such as when you first join Medicare or doing the Annual Enrollment Period from October 15-December 7. In most cases, you're enrolled in the plan for a year.
Q: Do you have to worry about prior authorization with MA plans?
A: Most Medicare Advantage plans do have rules that you must follow. For example, you may be required to get a referral to see a specialist or you may need prior approval for certain procedures to avoid higher costs.
Q: What happens if I see a doctor that’s not in my Medicare Advantage network?
A: If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
Q: What happens if my Medicare Advantage plan closes down?
A: If your plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.
When you’re looking for a Medicare Advantage plan, you should search for premiums that fit your budget, benefits that fit your health needs, and a doctor and hospital network that includes your health care providers.
If you choose a Medicare Advantage plan with drug coverage, you should make sure your prescription medications are on its drug list. Rest assured that MediSource will guide you securely though this process so you can make your best decision.
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