What is Medicare Advantage?
Medicare Advantage, sometimes referred to as Medicare Part C or MA plans, offers an alternative way to receive your Medicare benefits. Unlike Original Medicare, which is managed by the federal government, Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans can simplify your coverage by bundling Part A (hospital insurance), Part B (medical insurance), and often Part D (prescription drug coverage) into a single plan.
What you need to know about Medicare Advantage
Benefits of Medicare Advantage
- Cost Cap: Medicare Advantage plans include an annual out-of-pocket maximum, which limits how much you'll spend on covered medical services in a calendar year.
- Integrated Drug Coverage: Many plans include Medicare Part D, eliminating the need to purchase separate drug coverage.
- Lower Costs: Beyond premiums for Part B, Medicare Advantage plans often have lower monthly costs compared to Medicare Supplement plans, making them an affordable option for many.
- Accessible Enrollment: Unlike Medicare Supplement plans, Medicare Advantage plans are open to those with pre-existing conditions during eligible enrollment periods.
Comparing coverage differences
Original Medicare
- Visit any doctor or hospital nationwide that accepts Medicare.
- Pay deductibles and 20% coinsurance
for Part B services.
- No maximum limit on out-of-pocket expenses.
- Requires separate purchases for Medicare Part D and,
optionally, Medicare Supplement plans.
Medicare Advantage
- Restricted to a network of participating healthcare providers.
- Cost-sharing varies by plan and healthcare service.
- Includes an annual out-of-pocket maximum for Part A and
Part B services.
- Often includes additional benefits like dental, vision, and prescription drug coverage.
Enrollment Considerations
To enroll in Medicare Advantage, you must:
- Be enrolled in Medicare Parts A and B.
- Live within the plan’s service area.
- Continue paying your monthly Part B premium.
Medicare Advantage plans are not the same as Medicare Supplement (Medigap) plans. While Medigap works alongside Original Medicare to fill coverage gaps, Medicare Advantage replaces your Original Medicare coverage entirely.
How Medicare Advantage works
When you enroll in Medicare Advantage, Medicare pays a fixed monthly amount to the insurance provider offering your plan. The plan then takes over managing your healthcare and agrees to cover all services included in Original Medicare.
You will still need to pay your Medicare Part B premium, and in some cases, an additional premium for your Advantage plan.
Changes and flexibility in Advantage plans
Medicare Advantage plans differ significantly from Original Medicare in terms of flexibility. Benefits, drug formularies, provider networks, and premiums for Medicare Advantage plans can change annually. Beneficiaries are encouraged to closely review the plan details sent to them in September each year to see what is changing.
Key takeaways
Medicare Advantage is an alternative to Original Medicare and bundles Part A, Part B, and often Part D benefits.
Advantage plans are offered by private insurance companies and typically operate within a network of healthcare providers.
Expect cost-sharing that varies by plan and service, along with an annual out-of-pocket maximum for medical expenses.
Plans can include additional benefits, but these benefits may change from year to year.
Medicare Advantage may be more affordable than Medigap but differs in flexibility and coverage.
By submitting this form, you agree to be contacted by a licensed insurance agent from FTJ Senior Insurance regarding Medicare Advantage, Medicare Part D, or other Medicare-related plans. You may be contacted via phone call, email, or text message at the number and email address provided. Message and data rates may apply. Consent to contact is not a condition of enrollment or purchase. Your information will be used solely for Medicare plan-related communications. You may opt out at any time.