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What is Medicare Advantage & how does it work?
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How do Medicare Advantage Plans work? When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the company offering your Medicare Advantage Plan.
- Medicare Advantage & other health plans
Explore My Options. Your costs. Learn about Medicare health...
- Medicare Advantage & other health plans
- Overview
- How do Medicare Advantage plans work?
- What does Medicare Advantage cover?
- How much do Medicare Advantage plans cost?
- Who’s eligible for a Medicare Advantage plan?
- How do I enroll in a Medicare Advantage plan?
- The takeaway
•Medicare Advantage plans are Medicare health insurance plans sold by private insurance companies.
•In addition to covering all original Medicare services, most Medicare Advantage plans offer prescription drug, dental, vision, hearing, and other optional coverage.
•Medicare Advantage plan costs vary depending on the plan you’re enrolled in, your location, your medical needs, and more.
Medicare Advantage is a popular health insurance option because it works like private health insurance for Medicare beneficiaries.
In fact, according to the Centers for Medicare & Medicaid Services, more than 60 million Americans enrolled in Medicare in 2019. Of these Medicare enrollees, more than 37 percent were enrolled in a Medicare Advantage plan or another alternate Medicare plan option.
In this article, we discuss how Medicare Advantage works, who these plans might work best for, and things you need to know to enroll in a Medicare Advantage plan.
Medicare is a government-run health insurance option that covers Americans ages 65 and older, as well as those with chronic disabilities.
So, how exactly does Medicare Advantage (Part C) work — and does it operate in the same way that original Medicare does?
Medicare Advantage plans are Medicare plans sold by private insurance companies across the United States. These companies have signed a contract with Medicare to cover the same services that original Medicare covers. This includes any hospital services covered under Medicare Part A and any medical services covered under Medicare Part B.
Some Medicare Advantage plans also cover additional healthcare needs, including:
•dental
•vision
Hospital insurance
Medicare Part A is hospital insurance. All Medicare Advantage plans cover the same services as Medicare Part A, such as: •short-term inpatient hospital care •short-term skilled nursing facility care •limited home healthcare services •hospice care
Medical Insurance
Medicare Part B is medical insurance. All Medicare Advantage plans also cover the same services as Medicare Part B, such as: •preventive services •diagnostic services and testing •treatment-related services and equipment •durable medical equipment •inpatient and outpatient mental healthcare
Prescription drugs
Medicare Part D is prescription drug coverage. Most Medicare Advantage plans include this coverage, which helps pay for the cost of your medications. Only certain types of prescription drugs are required to be covered under Part D, however — so you’ll want to make sure to check for coverage of your medications before enrolling in an Advantage plan.
Here are some costs you may need to pay if you choose a Medicare Advantage plan:
•Part B premium. Even if you’re enrolled in Medicare Advantage, you’re still responsible for paying the Part B premium. This amount can cost up to $170.10 per month. However, some Advantage plans cover a portion — or even all — of this premium cost.
•Coinsurance and copayments. Most Medicare Advantage plans charge a copayment or coinsurance amount for services rendered. These services could include a doctor’s office visit, specialist’s office visit, or even a prescription drug refill. Specific coinsurance and copayment amounts are set by the plan you’re enrolled in.
•Medicare Advantage plan costs. Medicare Advantage plans can charge a monthly premium that’s separate from the Part B premium. Other Advantage plans may be premium-free. In addition, Advantage plans can charge separate drug and health plan deductibles.
Individual healthcare needs play a huge role in how much you may end up paying out of pocket for your Medicare Advantage plan. For example, your plan costs can be affected by:
•how often you seek services
Original Medicare eligibility includes individuals who:
•are 65 years old or over
•have been receiving Social Security or Railroad Retirement Board disability benefits for 24 months
•have been diagnosed with end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
Medicare beneficiaries who are already enrolled in Medicare Part A and Part B are eligible to enroll in a Medicare Advantage plan.
When a Medicare Advantage plan might work for you
Once you’ve enrolled in original Medicare, you can begin searching for Medicare Advantage plan options in your area.
Unlike with original Medicare, you must live in the service area of the Medicare Advantage plans you’re shopping for — companies don’t offer nationwide coverage. This means that even if you find better Medicare Advantage plan options elsewhere, you can only enroll in a plan in your state.
If you’re ready to shop for Medicare Advantage plans in your area, you can use Medicare’s plan finder tool to look for an Advantage plan that meets both your healthcare and financial needs.
Medicare Advantage enrollment deadlines
If you’re considering enrolling in Medicare Advantage, you’ll need to know these important enrollment deadlines and dates:
•Initial enrollment period. This is a 7-month window around your 65th birthday when you can sign up for Medicare. It begins 3 months before your birth month, includes the month of your birthday, and then extends 3 months after your birthday. During this time, you can enroll for all parts of Medicare without a penalty.
•Medicare Advantage plans are a great option for Medicare beneficiaries who want to have all their healthcare coverage under one roof.
•In addition to covering both hospital and medical insurance, most Medicare Advantage plans cover prescription drugs plus dental, vision, and hearing services, as well as other healthcare needs.
May 24, 2022 · Some Medicare Advantage plans, called special needs plans (SNPs), provide coverage for certain groups of people, including plans that focus on coverage for those with chronic conditions, such as diabetes, heart failure or kidney failure.
Aug 19, 2021 · Medicare Advantage (MA), or Medicare Part C, offers six plan types. To weigh the pros and cons of MA plans, you must first understand your coverage options. That includes knowing the differences between plan types and whether you prefer the open networks of preferred provider organization (PPO) plans, the cost-saving structure of health ...
Explore My Options. Your costs. Learn about Medicare health plan costs. Understand My Costs. Your eligibility. Find out if you’re eligible for a plan and how to join. Joining a Plan. Medicare Advantage plans provide Part A (Hospital Insurance) and Part B (Medical Insurance) benefits to people with Medicare.
Nov 3, 2022 · Consumer Reports fills you in the pros and cons of Medicare Advantage as Medicare open enrollment draws near, noting that there can be hidden risks to this health insurance coverage.
Feb 15, 2024 · Medicare Advantage plans, also known as Medicare Part C, are run by private insurance companies regulated by the government, and they must offer coverage comparable to original Medicare...
