What to know about Medicare Advantage coverage
Private health insurance companies offer Medicare Part C, or Medicare Advantage, plans. These are alternatives to Original Medicare parts A and B.
All Medicare Advantage plans must offer at least the same basic coverage as Original Medicare, and they may include other benefits, such as dental, vision, and hearing.
Medicare Advantage plans often include prescription drug coverage, too.
This article looks at how Medicare Advantage plans work and the different types, plus the costs and how to enroll.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What does Medicare Advantage cover?
This article originally appeared on Medical News Today
Private health insurance companies administer Medicare Advantage, or Medicare Part C, plans as an all-in-one alternative to Original Medicare.
These plans must offer the same coverage level as Original Medicare. This includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Some plans also offer prescription coverage as an alternative to Medicare Part D.
They usually include additional benefits, such as:
prescription drug coverage
vision care
hearing care
Many plans also include wellness and fitness services.
Medicare Advantage plans pay a fixed amount each month to the company offering the plan. Each plan has different out-of-pocket costs and rules.
Some plans require people to choose a primary care physician to coordinate their care. People may have to pay more if they use a provider outside the plan’s network.
What are the different Medicare Advantage plans?
Types of Medicare Advantage, or Medicare Part C, plans include:
Preferred Provider Organization (PPO)
If a person’s Medicare Advantage plan stops participating in Medicare, the person has a choice to enroll in another Advantage plan in their area or switch back to Original Medicare.
If a person is enrolled in Original Medicare, they can switch to a Medicare Advantage plan. Costs may include the plan premium as well as deductibles and copays.
Learn more about changing Medicare plans.
When can I enroll in Medicare Advantage?
Most people become eligible for Medicare Advantage, or Medicare Part C, 3 months before they turn 65 years old.
If an individual has received disability benefits for 24 months, or if they have received a diagnosis of amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD), they also qualify for Medicare.
Enrollment periods
Medicare has several enrollment periods each year, including the following:
Initial enrollment period (IEP): The IEP begins 3 months before a person turns 65 years and lasts for 3 months after their birthday month. People who do not enroll during the IEP may have a late enrollment penalty.
General enrollment period (GEP): The GEP runs from January 1 to March 31 each year.
Medicare Advantage open enrollment period: This runs from January 1 to March 31. During this time, a person can change their Medicare Advantage plan or switch back to Original Medicare.
Open enrollment period (OEP): The OEP runs from October 15 to December 7 each year. During this period, a person can change their plan.
Special enrollment period (SEP): Events such as a change in marital status can trigger an SEP. Medicare will waive late enrollment penalties during this period.
How to enroll
People can enroll in Medicare in several ways. For example, they can:
use the Medicare “Plan Finder” tool
call 800-633-4227 to find out which plans are available in their area (TTY users can call 1-877-486-2048)
ask the Medicare Advantage plan provider for a paper enrollment form, and then complete and return the form
Medicare will automatically enroll people into parts A and B if Supplemental Security Income or the Railroad Retirement Board has provided a person with disability benefits for 24 months.
Learn more about enrolling in Medicare.
How much does an Advantage plan cost?
A person enrolled in a Medicare Advantage, or Medicare Part C, plan will pay the premium to the plan provider, and they must also pay their Original Medicare premiums.
The Medicare Part B monthly premium in 2024 is $174.70. There is no Medicare Part A premium cost for most people.
The average monthly premium for Medicare Advantage plans in 2024 is projected at $180.
People with a Medicare Advantage plan must also pay annual deductibles, copays, and coinsurance. These will vary according to the plan provider.
How can I compare Medicare Advantage plans?
A Medicare online tool can help a person compare Medicare Advantage, or Medicare Part C, plans. People can also visit their local State Health Insurance Assistance Program (SHIP), which provides impartial and free advice about Medicare.
In general, a person may pay higher monthly premiums with Original Medicare than with a Medicare Advantage plan, but they may also have fewer out-of-pocket costs. Medicare Advantage plans may have lower monthly premiums but higher out-of-pocket expenses, but it can depend on each individual situation.
Some Medicare Advantage plans offer zero monthly premiums and include prescription drug coverage, which means a person has to pay only the Original Medicare Part B premium.
A person can check coverage details and costs with the Medicare Advantage plan provider before enrolling. Another online tool can also help a person calculate out-of-pocket costs.
Summary
A person may choose to enroll in a Medicare Advantage plan, or Medicare Part C, which is an alternative to Original Medicare. Original Medicare includes Part A, which is hospital insurance, and Part B, which is medical insurance.
Medicare Advantage plans provide the same healthcare coverage as Original Medicare, but may also include other benefits, such as dental, vision, and hearing care. Many plans also include prescription drug coverage.
The Medicare website and SHIP program provide information that people can use to compare plans and approximate costs.
View the original article on Medical News Today
