Medicare Advantage, often referred to as Medicare Part C, comprises private insurance plans provided by companies approved by Medicare. These plans cover the majority of coverage from Part A (Hospital Insurance) and Part B (Medical Insurance), while also frequently including additional benefits like dental, vision, and hearing care. Some Part C plans even incorporate Medicare Part D prescription drug coverage, known as MAPD plans.
What does Medicare Advantage cover?
Medicare Advantage plans cover all the services provided by Medicare Part A and Part B for both inpatient and outpatient care, excluding clinical trials and hospice services.
Upon enrollment in a Medicare Advantage plan, Original Medicare will still contribute to hospice care costs, select new Medicare benefits, and some expenses related to clinical research studies.
Medically necessary services covered by both Medicare Advantage plans and Original Medicare cover:
- Visits to primary care physicians and specialists
- Conducting laboratory tests
- Performing X-rays
- Availing emergency ambulatory services
- Accessing durable medical equipment
- Undergoing preventive tests and vaccinations
- Engaging in physical therapy
Medicare Advantage plans can even integrate prescription drug coverage. To attain equivalent coverage with Original Medicare, a separate prescription drug plan would need to be purchased, entailing an additional premium.
Additional advantages incorporated into a Medicare Advantage plan
Given that Medicare Advantage plans are provided by private entities, they can be tailored to include supplementary benefits. These added advantages might encompass coverage for:
- Regular dental care (including dental exams, X-rays, and teeth cleanings)
- Routine vision care (encompassing eye exams, eyeglasses, and contact lenses)
- Routine hearing care (covering hearing tests and hearing aids)
- Fitness programs
- Gym memberships
- Transportation services for doctor appointments
- Over-the-counter medications
Furthermore, Medicare Advantage plans can be personalized to address specific health conditions and ailments.
How does Medicare Advantage differ from Original Medicare?
The primary distinction lies in the fact that Medicare Advantage plans are made available by private companies, whereas Original Medicare is overseen by the federal government.
Types of Medicare Advantage plans
- Health Maintenance Organization (HMO) HMOs often come with more affordable premiums compared to other plan options. Typically, you’ll need to stick to your plan’s network when seeking care or services.
- Preferred Provider Organization (PPO) PPOs may provide flexibility in seeking care outside the network. Opting for in-network providers usually results in lower costs.
- Private Fee-For-Service (PFFS) With PFFS plans, there may or may not be a network requirement. Non-network providers must usually accept Medicare reimbursement and adhere to the plan’s terms.
- Special Needs Plan (SNP) SNPs are tailored for individuals managing chronic conditions like diabetes or those eligible for both Medicare and Medicaid.
- Medical Savings Account (MSA) MSAs combine a high-deductible plan with a designated savings account. Note that these plans do not include prescription drug coverage.
- HMO Point-of-Service (HMO-POS) Hybrid HMO-POS plans offer the option to receive treatment outside the network, but this might incur higher costs. Separate deductibles might apply to in-network and out-of-network expenses.
How much do Medicare Advantage plans cost?
The cost for Medicare Advantage plans depend on the plan and the company. The projected average premium for a Medicare Advantage plan in 2023 is $18 per month, but there are other costs to consider, such as copays and deductibles.
How do I enroll in a Medicare Advantage plan?
Your initial opportunity to enroll in a Medicare Advantage plan occurs during your Medicare Initial Enrollment Period (IEP). This period spans from three months prior to the month you turn 65, extending until three months after.
Should you possess Original Medicare and intend to sign up for Medicare Advantage for the first time, you can make your selection during Medicare’s Annual Enrollment Period (AEP). The AEP for Medicare occurs between October 15 and December 7.
For individuals who are already enrolled in Medicare Advantage, the option to switch plans is available during the Medicare Advantage Open Enrollment Period (OEP). This OEP takes place from January 1 to March 31, or aligns with the annual enrollment period for Medicare.
Learn more about Medicare Enrollment Period here.
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