Confused about Medicare Advantage plans? Read on to find out more about these plans.
Medicare Advantage plans are health plans offered by private insurance companies that contract with the government. These plans can provide additional coverage for individuals looking for health benefits beyond Original Medicare, Part A and Part B.
Medicare Advantage plans are the only type of Medicare plans available now that can offer both health and prescription drug coverage in one plan.
Watch this short video on the three gaps in Medicare, and how you can fill in these gaps through private insurance programs.
What do Medicare Advantage plans cover?
Also known as Medicare Part C, Medicare Advantage plans provide all of the hospital and medical benefits included in Original Medicare coverage, with the exception of hospice care.
All Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan.
When you enroll in these plans, eligible services are covered through the plan and are no longer paid for by Original Medicare.
Extra benefits available through Medicare Advantage
|Extra Benefits||Original Medicare||Medicare Advantage Prescription Drug Plans|
|Part D prescription Drug Coverage||No||Yes*|
|Dental Care||No||Some plans|
|Vision Care||No||Some plans|
|Hearing Care||No||Some plans|
|Senior fitness programs like Silver Sneakers||No||Some plans|
* Most Medicare Advantage plans include Medicare Part D prescription drug coverage.A key feature of these plans is that they may offer additional benefits not covered by traditional Medicare coverage. Extra benefits may include routine dental, vision, and hearing care, as well as health and wellness programs. The majority of plans include Medicare Part D prescription drug coverage as well.What plan options are available?Medicare Advantage plans come in several different types, including:
- Health Maintenance Organization(HMO) – This type of plan has a set network of health-care providers and facilities from which you must receive care. Generally, you must select a primary care physician and get referrals in order to see a specialist. Drug coverage is generally included.
- Preferred Provider Organization(PPO) – These plans also have a network of health-care providers, but you have the flexibility to receive out-of-network care at a higher cost. You typically do not need to select a primary care doctor and may not need specialist referrals. Similar to an HMO, drug coverage is generally included.
- Privates Fee-For-Service (PFFS)– This plan type typically does not have network restrictions, but there is no guarantee that your doctor or hospital will accept the plan. While prescription drug coverage can be covered, you would be able to join a stand-alone Part D plan if it was not included.
- Special Needs Plans (SNPs)– These plans are designed for individuals with specific diseases or characteristics and tailor benefits, provider choices, and drug formularies based on the needs of the specific groups they serve. SNPs always include drug coverage
Other less common types of Medicare Advantage plans include Health Maintenance Organization – Point of Service (HMO-POS) plans and Medical Savings Account (MSA) plans.Who is eligible to enroll?Anyone who is enrolled in both parts of Original Medicare is eligible to sign up for a Medicare Advantage plan, with the exception of most individuals with End Stage Renal Disease (ESRD). To be eligible to enroll, you must live in the service area of the plan and sign up during an enrollment period for which you qualify.Many people enroll when they first become eligible, during their Initial Coverage Election Period. This period begins three months before you are eligible for Part A and Part B and ends on the latter of the two possible scenarios:
- The last day of the month before you are eligible for Part A and part B, or;
- The last day of your Part B Initial Enrollment Period
Eligible individuals can also make changes to their Medicare Advantage coverage during the Annual Election Period, which lasts from October 15 to December 7 of each year. Then, there is a Medicare Advantage Disenrollment Period, which lasts from January 1 through February 14. During this time, you can only drop your health plan and return to Original Medicare coverage. You cannot switch or join a new Medicare Advantage plan. Outside of these yearly enrollment periods, there are limited opportunities to make changes to your Medicare Advantage coverage, unless you have a special life circumstance that allows you to qualify for a Special Enrollment Period.Why should I consider a Medicare Advantage plan?Original Medicare doesn’t cover everything. If you’re enrolled in Medicare, you probably already know that if you go 63 or more days without creditable coverage, you will be subject to a penalty for as long as you are enrolled in a Part D plan. Creditable drug coverage is prescription drug coverage that is as good as or better than the standard Medicare prescription drug coverage.However, many people don’t realize that Original Medicare doesn’t cover several other health-care benefits you may have taken for granted in the past, including routine eye exams and dental care. That’s where Medicare private insurance plans, like Medicare Advantage plans, come in. Many of these plans offer prescription drug coverage, in addition to extra benefits like the routine eye and dental benefits mentioned before. There are even $0 premium Medicare Advantage plans available in certain areas. Please note that if you enroll in these plans, you must continue to pay your Part B premium.Whether a Medicare Advantage plan is right for you will depend on your needs and budget. Be sure to compare all Medicare plan options in your area to find the coverage you need.Medicare has neither reviewed nor endorsed this information.