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Medicare Advantage Plans

Medicare Advantage

A Medicare Advantage plan, also known as Medicare Part C, is a type of health insurance plan offered by private insurance companies that provides an alternative way for Medicare beneficiaries to receive their Medicare Part A (hospital insurance) and Part B (medical insurance) benefits.


Here are some key features of Medicare Advantage plans:

 

  • All-in-One Coverage: Medicare Advantage plans typically include all the benefits of Original Medicare (Part A and Part B) in one plan. Additionally, many Medicare Advantage plans also offer extra benefits beyond Original Medicare, such as prescription drug coverage (Part D), dental, vision, hearing, and fitness benefits.

 

  • Private Insurance Companies: Medicare Advantage plans are offered by private insurance companies that contract with Medicare. These companies must follow rules set by Medicare, but they have flexibility in designing their plans and determining costs, coverage, and provider networks.

 

  • Network Restrictions: Most Medicare Advantage plans use provider networks, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). This means that beneficiaries may need to use doctors, hospitals, and other healthcare providers within the

      plan network to receive full coverage, although emergency and urgent care services are typically covered regardless of network.

 

  • Premiums and Cost-Sharing: While Medicare Part A usually does not require a premium for eligible individuals, Medicare Part B and Medicare Advantage plans often do. Medicare Advantage plans may have premiums in addition to the Part B premium, as well as copayments, coinsurance, and deductibles for covered services. However, some Medicare Advantage plans have low or no monthly premiums beyond the Part B premium.

 

  • Prescription Drug Coverage: Many Medicare Advantage plans include prescription drug coverage (Medicare Part D) as part of their benefits package. These plans are known as Medicare Advantage Prescription Drug (MA-PD) plans. Beneficiaries can enroll in an MA-PD plan instead of a standalone Medicare Part D plan if they want both medical and prescription drug coverage.

 

  • Annual Enrollment Period: Medicare beneficiaries can generally enroll in, switch, or disenroll from a Medicare Advantage plan during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. Some beneficiaries may also have other opportunities to enroll or make changes to their Medicare Advantage coverage during special enrollment periods. Medicare Advantage plans can offer an attractive alternative to Original Medicare for some beneficiaries, providing additional benefits, potentially lower out-of-pocket costs, and the convenience of having all healthcare coverage through one plan. However, it's essential for beneficiaries to carefully review plan options, including costs, coverage, provider networks, and prescription drug formularies, to ensure that they select a plan that meets their healthcare needs and budget.

This site is not affiliated with or endorsed by the government or federal Medicare program. 

Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan in your area. Please contact medicare.gov or 1-800-Medicare to get information on all your options.

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