Medicare Advantage Plans

A Medicare Advantage Plan (sometimes called part C or MA plan) is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

 

Consider these facts in deciding if a Medicare Advantage Plan for hospital and medical coverage is right for you:

  • Medicare Advantage Plans may cover costs & services not covered by Original Medicare.
  • Medicare Advantage Plans may have lower deductibles & co-payments than Original Medicare.
  • Medicare Advantage Plans often have low premiums — plans with monthly premiums as low as $0 may be available in your area.

No health questions asked. All Medicare beneficiaries, including people on Medicare due to a disability, are guaranteed acceptance regardless of health conditions (except for End Stage Renal Disease).

 

Medicare Advantage Plans cover all Medicare services

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care and some care in qualifying clinical research studies. Original Medicare covers hospice care and some costs for clinical research studies, even if you’re in a Medicare Advantage Plan.

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, health and wellness programs, as well as the very popular silver sneakers gym membership.  Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you might pay a monthly premium for the Medicare Advantage Plan.

 

Drug Coverage in a Medicare Advantage Plan:

You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan.

You can’t have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you’re in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

 

Medicare Supplement Insurance (Medigap) policies and Medicare Advantage Plans:

Medigap policies can’t work with Medicare Advantage Plans. If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy. Your Medigap policy can’t be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.

If you want to cancel your Medigap policy, contact your insurance company.  If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare.