MEDICARE
Part C: Medicare Advantage
Coverage that is just as good or better than original
medicare. Many include Prescription Coverage and extras.
MEDICARE
Part C: Medicare Advantage
Coverage that is just as good or better than original medicare. Many include Prescription Coverage and extras.
What is Medicare Advantage?
Medicare Advantage plans, also known as Medicare Part C, are medical insurance plans administered by private insurance companies. Medicare Advantage (MA) plans are paid a sum of money for each enrollee by the federal government. In turn, the insurance company pays for the cost of care and provides benefits based on the government’s rules.
Who is Eligible for Medicare Advantage?
To be eligible for Medicare Advantage (MA) insurance, you must be:
- Enrolled in Medicare Parts A & B (Original Medicare)
- Live within the Plan’s Service Area
Common Types of MA Plans
Common types of Medicare Advantage plans include:
- Health Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- Private-Fee-For-Service (PFFS)
You may also see these plans:
- Special Needs Plans (SNP)
- Dual Special Needs Plans (DSNP)
What are Medicare Advantage Costs?
Before you enroll in an Advantage plan, you will want to find out the costs associated with these types of plans. Because these plans are tailored by the insurance company and geographic region, below you will see what is common.
Deductibles
Very few Advantage plans have an annual deductible for medical and hospital costs. However, many Advantage plans will have a deductible for higher-tiered prescription drugs.
Copays and Coinsurances
For each medicare advantage plan, you’ll have a Summary of Benefits or a Benefit Highlight sheet that lists the copays and coinsurances for each service you might expect.
It will typically looks something like this:
| Service | Cost |
|---|---|
| Primary Care Physician: | $0 |
| Specialist Visit: | $35 |
| Inpatient Hospital Visit: | $275/day for days 1 through 5 |
| …etc… | …etc… |
These Summary of Benefits and Benefit Highlight documents are imperative to your understanding of what to expect to pay for various services on each plan.
Tip
If mentioning premiums, website will need to be submitted to CMS for approval.
I would update the information for 2022.
Medicare Advantage plans put a cap on your out-of-pocket costs for covered medical services. This offers financial protection. The maximum is $7,550 in 2021, but plans may set lower limits. There is no limit with Original Medicare.
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FREQUENTLY ASKED QUESTIONS
Does Medicare Advantage Include Dental Or Vision Coverage?
Medigap plans are not required to provide benefits other than what is included in original Medicare. It is common to purchase a standalone dental and/or vision plan when enrolling into Medicare Supplement.
When can I change Medicare Advantage plans?
If you wish to switch from one Medicare Advantage plan to another, you can do so each year during the Annual Enrollment Period, which runs October 15 to December 7. You can make as many changes during this short window as you’d like, however, the plan that will become effective January 1, will be the last plan you enrolled into.
You will be automatically disenrolled from your previous Medicare Advantage plan, or Prescription Drug Plan. If you had a Medicare Supplement plan, you will still need to call and cancel coverage once your new coverage begins.
Kellie Reed
Insurance Services
Medicare and Health
insurance Plans
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