Choosing a Medicare Advantage plan
Medicare Advantage (Part C) plans are offered through private companies as an alternative to Original Medicare. Plans include hospital and medical coverage and may offer additional benefits.
Various Medicare Advantage plan options exist. The cost depends on the plan and other factors.
Many Medicare Advantage plans include prescription drug (Part D) plans, as well as the benefits of Part A (hospital insurance) and Part B (medical insurance). They may also offer additional benefits, such as dental, hearing, and vision services.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What are Medicare Advantage plans?
This article originally appeared on Medical News Today
Medicare Advantage (Part C) plans are health plans that private companies offer. The companies contract with Medicare to provide Medicare Part A and Part B benefits. Many plans also offer prescription drug coverage under Part D.
A person can enroll in or switch to a Medicare Advantage plan if they have Original Medicare (parts A and B), and if the plan they want is offered in their area. A person enrolled in an Advantage plan may need to pay the plan premium, plus copays and deductibles.
Medicare Advantage plans include:
Here is a look at each of these plans:
Advantage plan | Description |
|---|---|
HMO | • Individuals must typically use in-network professionals. |
PPO | • Plans have a list of in-network doctors and hospitals. |
PFFS | • Individuals can go to any Medicare-approved professional or facility. |
SNP | • Plans provide services and benefits for individuals with certain healthcare needs or specific conditions, as well as those who also have Medicaid. |
Other plans are HMO Point of Service (HMO-POS) plans and Medicare savings account (MSA) plans. However, these are less common types of plans.
If a plan stops participating in Medicare, the person enrolled in the plan can choose to go back to Original Medicare or join another Medicare Advantage plan.
What coverage does Medicare Advantage provide?
As an alternative to Original Medicare, Advantage plans provide the same coverage as Medicare parts A and B, including emergency and urgent care.
Many plans offer additional coverage for:
eye care
dental care
prescription drug coverage
hearing aids
fitness membership
wellness services
If a person is not sure whether a service will be covered, they should check with their Medicare Advantage provider before enrolling.
Learn more about Medicare Advantage coverage.
How much do Advantage plans cost?
Advantage premiums vary among plans, and some plans may not charge premiums. According to the nonprofit KFF, average Advantage premiums in 2024 are around $18.50 per month.
A person may also have to pay copays and deductibles, which also vary among plans. Copays are typically a flat fee set by the plan provider.
Out-of-pocket costs may be lower than with Original Medicare and have a yearly limit. The maximum out-of-pocket cost for 2024 is $8,850. Once a person pays this amount, they will no longer have to pay for their services out-of-pocket.
This online tool can help a person find a plan and compare costs.
What to consider when choosing a Medicare Advantage plan
An individual may wish to consider various factors when choosing a Medicare Advantage plan, as explained in the following table:
Advantage plan | What to consider |
|---|---|
HMO | • Most HMO plans offer prescription drug coverage. |
PPO | • Most PPO plans include prescription drug coverage. |
PFFS | • The plan determines how much it pays to the doctor or facility and how much the individual will need to pay at the time of service. |
SNP | • It provides coverage only for individuals with certain healthcare needs or specific conditions, or those who already have Medicaid. |
Read about the pros and cons of Medicare Advantage.
How do I enroll in a Medicare Advantage plan?
An individual can find out more about Advantage plans and the enrollment process in several ways, including:
calling 800-633-4227 (800-MEDICARE) to find out which plans are available in their area
asking for a paper enrollment form from the plan and returning the completed plan to the company
checking this list of things to remember about Advantage plans
using the Medicare plan finder tool to find a plan that suits their needs
A person with end stage renal disease (ESRD) may enroll in an Advantage plan only if it is an SNP that accepts people with the condition.
Learn about ESRD and Medicare.
When can I sign up for a Medicare Advantage plan?
There are three set time periods when a person can join a Medicare Advantage plan, as well as change or drop their current plan.
Initial enrollment period (IEP)
A person can join a Medicare Advantage plan when they first get Medicare. The IEP centers on the day a person turns 65 years old:
It begins 3 months before the month a person turns 65.
It includes the month a person turns 65.
It ends 3 months after the month a person turns 65.
Open enrollment period (OEP)
During the OEP from October 15 to December 7, a person can switch Advantage plans or choose to drop a plan. They can also make changes to a Part D (prescription drug) plan.
Medicare Advantage open enrollment
This period runs from January 1 to March 31. It is a period when people who already have Medicare Advantage can switch to another plan or drop their plan and return to Original Medicare.
Read a comparison of Original Medicare and Medicare Advantage.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Summary
Private companies offer Medicare Advantage (Part C) plans. This is an alternative to Original Medicare (parts A and B), and it may offer additional benefits.
In addition to plan premiums, a person will have to cover copays and deductibles. Costs may vary among plans.
A person can join or change Advantage plans during various enrollment periods.
View the original article on Medical News Today
