
Medicare Advantage FAQ
What are Medicare Advantage Plans?
A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. These plans, sometimes called “Part C” or “MA” Plans, are offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).
How do Medicare Advantage Plans work?
When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the company offering your Medicare Advantage Plan. These companies must follow rules set by Medicare, but each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services.
What do Medicare Advantage Plans cover?
Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding clinical trials, hospice services, and, for a temporary time, some new benefits that come from legislation or national coverage determinations. They may also offer some extra benefits that Original Medicare doesn’t cover, like fitness programs, and some vision, hearing, and dental services.
What are the costs associated with Medicare Advantage Plans?
Each year, plans set the amounts they charge for premiums, deductibles, and services. The plan decides how much you pay for the covered services you get. You have to pay the Part B premium, and in addition to your premium, deductible, copayments, and coinsurance, you should also consider the type of health care services you need and how often you get them.
Who can join a Medicare Advantage Plan?
To join a Medicare Advantage Plan, you must have Part A and Part B, live in the plan’s service area, and be a U.S. citizen or lawfully present in the U.S. You can join a Medicare Advantage Plan even if you have a pre-existing condition.
When can I join, switch, or drop a Medicare Advantage Plan?
You can only join, switch, or drop a Medicare Advantage Plan during certain enrollment periods, including the Open Enrollment Period, Medicare Advantage Open Enrollment Period, Initial Enrollment Period, and Special Enrollment Period.
Why would I want a Medicare Advantage Plan?
There are several reasons why you might consider a Medicare Advantage Plan:
- Additional benefits: Medicare Advantage Plans often offer extra coverage, such as prescription drugs, dental care, vision care, and fitness programs.
- Cost savings: Medicare Advantage Plans can have lower monthly premiums compared to separate Medicare Part D and supplemental insurance plans. They may also have lower out-of-pocket costs.
- Care coordination: Medicare Advantage Plans typically have care coordination programs and networks that help manage your healthcare and coordinate with specialists.
- Convenience: Medicare Advantage Plans bundle different types of coverage into a single plan, simplifying administration and providing one point of contact.
- Prescription drug coverage: Many Medicare Advantage Plans include prescription drug coverage as part of their benefits package.
- Financial predictability: Medicare Advantage Plans often have annual out-of-pocket maximum limits, providing financial protection against excessive healthcare costs.