What are Medicare Advantage Plans?
Medicare Advantage plans are offered through commercial insurance companies as an alternative way to access your Medicare Part A and Part B coverage. They must cover all the same services as Original Medicare but can also include prescription drug coverage (Part D) as well. Medicare Advantage plans are also referred to as Medicare Part C. Insurance companies are paid a fixed amount annually for each person enrolled in their plans. In exchange, Medicare requires the plan to provide specific benefit protections and quality service.
What do they cover?
In addition to covering all the same services included in Medicare Part A, Part B, and Part D, many Medicare Advantage plans also provide additional benefits such as some coverage for glasses, dental care, and/or hearing services. It should be noted, however, that these vision and dental benefits are not the same as stand-alone vision and dental insurance plans.
How much do they cost?
Costs vary depending on the type of Medicare Advantage plan you choose. You can read more about various plan types available through commercial insurance companies here. While additional monthly fixed premiums are usually very low or even zero, you will still pay for Part B monthly premium, as well as any IRMAA adjustment you may be subject to. Typically under Medicare Advantage coverage, when you use medical services you may also have a flat rate copayment or percentage-based coinsurance to cover before you reach the annual out-of-pocket maximum. One important thing to remember is that you will not be eligible for and won’t need a Medigap Supplemental plan if you are enrolled in a Medicare Advantage plan.
How do I access doctors, hospitals, and facilities through these plans?
A distinguishing feature of Medicare Advantage plans is their use of Provider Networks. You can read more about how insurance companies define their networks and the coverage levels for in-network or out-of-network care here. Some plans also require you to get pre-approval for certain services or be required to get a referral to see a specialist. Emergency services are included in all insurance plans, so even if you receive care from an out-of-network doctor in an emergency you will still have coverage under a Medicare Advantage plan.
Finally, if you sign up for a Medicare Advantage plan you will receive an insurance card from your carrier, and that is the card you will show your doctors when you have a visit. But make sure you keep your original red, white, and blue Medicare card in a safe place. If you move or decide to change your Medicare Advantage plan, which you can do every fall during open enrollment, you will need your original Medicare number to do so.
Medicare Advantage plans are one of two ways to configure your Medicare coverage, and knowing what it is and how it works can help ease any confusion you may have going into Medicare enrollment.
Your HealthPlanning Analysis is also a valuable tool for decision-making.
Learn More:
How do Medicare Advantage Plans work? | Medicare.gov
Understanding Medicare Advantage Plans | Medicare.gov
Choosing between Original Medicare and Medicare Advantage | Medicare Interactive
Last Revised February 14, 2023
