What is a Medicare Advantage Plan and How Can It Help You?

Medicare Advantage, also known as Medicare Part C, may cost less than Original Medicare. This is an important consideration for those living with a smaller income than they had during their working years.
 

What is Medicare Advantage?

Private companies (approved by Medicare) offer Medicare Advantage plans as a replacement for Original Medicare. A Medicare Advantage plan may cover essential healthcare services not covered with Original Medicare such as hearing, dental, and vision. Depending on where you live, you may have access to Medicare Advantage programs that offer discounts on gym memberships, coverage for over-the-counter medications, transportation to doctor visits, and other services promoting overall wellness.

You may have to pay a Medicare Part A and Medicare Part B premium with Medicare Advantage.
 

Can You Get Good Healthcare With Medicare Advantage?

Medicare Advantage plans must follow Medicare’s rules. Before you enroll in a Medicare Advantage plan, you’ll have a chance to review the terms of the plan carefully. You may need a referral to see a specialist, or you may be required to see an approved doctor for non-urgent care.
 

What is the Difference Between Medicare and Medicaid?

Both Medicaid and Medicare are government-run health care programs, but they serve two different groups of people. If you are eligible for both Medicaid and Medicare, you have dual-eligibility status, which means the programs work together, so you pay less money out-of-pocket for healthcare.
 

Original Medicare vs. Medicare Advantage

Medicare Advantage Plans offer an alternative to Original Medicare. While the plans have much in common, Medicare Advantage provides extra benefits like dental, hearing, and vision. Here’s how the two stack up against each other:
 

Original Medicare Basics

• Coverage: Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You can purchase Part D (Prescription Drug Coverage) separately. A Medicare supplement plan, aka Medigap, can help reduce your out-of-pocket costs, including your 20% coinsurance.
• Hospital and Doctor Choice: You can get treatment and routine medical care at any hospital or doctor’s office that accepts Medicare in the United States.
• Access to specialists: You do not need a referral from your general practitioner to see a specialist in most cases.
• Out-of-pocket costs: 20% of the Medicare-approved amount after you pay your deductible, Part B and Part D (optional) premium, no limit on out-of-pocket expenses.
• Medigap options: Medigap helps pay out-of-pocket healthcare costs not covered by Original Medicare.

Medicare Advantage Basics

• Coverage: Bundled plans include Part A (Hospital Insurance) and Part B (Medical Insurance). Depending on which plan you choose, you may also get Part D (Drug Coverage), dental, hearing, and vision coverage.
• Hospital and Doctor Choice: You must use providers in the plan’s network, restricted by geographical area.
• Access to specialists: You may need a referral from your general practitioner to see a specialist.
• Out-of-pocket costs: Varies according to plan’s terms. Must pay plan premium plus a monthly Part B premium.
• Medigap options: People who choose Medicare Advantage do not need Medigap.

How Can Medicare Advantage Help?

Medicare Advantage bundles Medicare Part A, Part B, dental coverage, vision coverage, and hearing coverage, with optional Part D coverage. Many people opt for a Medicare Advantage policy to help reduce their yearly out-of-pocket healthcare expenses while expanding access to medical care that they would have to pay for on their own with Original Medicare.

Medicare Advantage may not be suitable for everyone, however. Rules and certain out-of-pocket costs may affect the medical care Medicare Advantage participants receive. Even if you choose an ideal Medicare Advantage plan, the rules could change each year.
 

What to Expect with Medicare Advantage Out-of-Pocket Costs

If you choose a Medicare Advantage plan, you may pay higher out-of-pocket costs if you have a plan that doesn’t charge a monthly premium. If you choose an out-of-network medical provider, require extensive ongoing care, or if your Medicare Advantage plan includes higher out-of-pocket limits, choosing Medicare Advantage could cost you more in the long run than Original Medicare.

Look closely at your Evidence of Coverage (EOC) document that you receive from Medicare each year. There, you’ll find the exact amount you pay for health care services. Your Annual Notice of Change (ANOC), issued each January, offers information about how your costs and service area may change during the upcoming year.

Use these documents along with information about the Medicare Advantage plans you think may work best for your situation to decide whether Medicare Advantage could save you money while offering the health care you need.

Depending on your Medicare Advantage plan and your estimated out-of-pocket expenses, you may have lower out-of-pocket costs with Original Medicare and a Medicare Supplement Insurance (Medigap) policy.
 

Is a Medicare Advantage Plan Right For You?

People who already have Medicare A and B are eligible to join Medicare Advantage.

Please note that if you join Medicare Advantage and have coverage through your employer or union, your insurance may automatically terminate. It’s crucial to check with your benefits administrator before adding Medicare Advantage.
 

How to Enroll in a Medicare Advantage Plan

Your Medicare Advantage plan choices depend heavily on where you live. You can find a plan that fits your health care needs and financial situation by logging into your secure Medicare account or creating one. You can also call 1-800-MEDICARE to speak with someone who can answer your specific questions about Medicare Advantage.

The Medicare website offers access to websites and phone numbers for organizations in each state to help you understand Medicare options, as well.

You can join Medicare Advantage or switch to a different plan by accessing your Medicare account. When you join a new plan during one of the enrollment periods, your old plan will automatically terminate when the new one starts.

If you currently have a Medicare Advantage Plan and want to switch back to Original Medicare, call 1-800-MEDICARE.

When choosing a Medicare Advantage plan, consider adding medicare prescription drug coverage (Part D).

Here are the most common Medicare Advantage plan types:

• Health Maintenance Organization (HMO) Plans: You must receive medical care from in-network doctors unless you require emergency care or are traveling.
• Preferred Provider Organization (PPO) Plans: You can see out-of-network doctors and specialists, but you may pay more; if your PPO doesn’t offer prescription drug coverage, you must pay out-of-pocket (Medicare Part D is not compatible with Medicare Advantage PPO Plans).
• Private Fee-for-Service (PFFS) Plans: You can choose any Medicare-approved health care provider. If your PFFS plan does not include prescription drug coverage, you can add Medicare Prescription Drug coverage (Plan D)
• Special Needs Plans (SNPs): Designed to provide coverage to those with special medical needs, including nursing home costs, in-home nursing costs, and chronic illness health care. You must be dual-eligible for Medicare and Medicaid to get SNPs.

Bottom Line

If you decide to enroll in Medicare Advantage, be sure to review the terms and coverage limitations carefully. Make sure that your doctors, specialists, and preferred hospitals participate in the plan before you sign up.

Medicare Advantage can help you reduce the amount of money they pay out-of-pocket for healthcare. The only way to know if Medicare Advantage is right for you is to research your current healthcare needs and your location. Limits on out-of-pocket costs offer peace of mind to many people. A Medicare Advantage plan could help you stay in control of your healthcare costs.