What is Medicare Advantage?
Medicare Advantage (also known as Medicare Part C) is an alternative way for individuals to receive Medicare benefits.
Medicare Advantage provides at least the same level of coverage as Medicare Part A and Medicare Part B, but unlike Original Medicare, Medicare Advantage is offered by private insurance companies.
When you become eligible for Medicare, you’ll probably wonder whether Original Medicare or Medicare Advantage is the better choice. The truth is, the best option for you depends on your personal preferences.
Medicare Advantage plans may come with additional benefits that aren’t included under Original Medicare. The benefits range from insurer to insurer but some plans may include routine vision care, hearing aids, routine dental care, prescription drug coverage, and fitness center membership.
Depending on your lifestyle, these benefits might or might not match your personal preference.
According to www.medicare.gov:
- Medicare Advantage is a Medicare-approved plan from a private insurance company that offers an alternative to Original Medicare for your health and drug coverage.
- In most cases, you can only use doctors who are in the plan’s network.
- In many cases, you may need to get approval from your plan before it covers certain drugs or services.
- Plans may have lower out-of-pocket costs than Original Medicare.
- Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.
How does Medicare Advantage Work?
Medicare Advantage (Part C) does not operate in the same way that original Medicare does, but you do need to have Original Medicare Part A and Part B in order to enroll in a Medicare Advantage plan. Medicare Advantage plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow the rules set by Medicare.
In addition, Medicare Advantage plans may offer additional coverage for healthcare needs such as dental, vision, hearing, and prescriptions. You can enroll in a Medicare Advantage plan by contacting your current Original Medicare provider.
Medicare Advantage enrollees must continue to pay the Part B premium alongside the Medicare Advantage plan premium (determined by the insurer). This MA premium varies from one plan to another, and some may have premiums as low as $0 a month.
In terms of out-of-pocket costs, Medicare Advantage plans have a yearly limit on your out-of-pocket costs for all Part A and Part B services.
What Does Medicare Advantage Cover?
Medicare Advantage covers:
- Hospital Insurance: short term inpatient care, short-term skilled nursing facility care, limited home healthcare services, and hospice care.
- Medical Insurance: preventive services, treatment services and equipment, diagnostic services and testing, durable medical equipment, mental health care (inpatient or outpatient).
- Prescription drugs: Advantage helps pay for the cost of your medications, but only certain drugs are covered under Part D – check with your provider to see if your medications are covered in a potential Advantage plan.
What are the Types of Medicare Advantage Plans?
Of the five types of Advantage plans available, you can choose from:
- Preferred provider organization (PPO): This plan allows you to see in-network and out-of-network healthcare providers. PPOs are networked in a local area and may expand to a bigger region.
- Private fee-for-service (PFFS): This plan allows you to see Medicare-approved providers as long as they accept the plan’s payment terms and will see you. You can also have access to a network of providers or see doctors who don’t accept the plan’s payment terms (but you may pay more).
- Health maintenance organization (HMO): This plan requires you to see an in-network provider unless it’s an emergency, and you will also require a referral if you want to see a specialist.
- Medical savings account (MSA): This plan combines high-deductible insurance plans with a medical savings account that comes in handy for healthcare costs.
- Special needs plan (SNP): This plan improves the care for Medicare beneficiaries who are eligible for Medicare and Medicaid, require an institutional level of care, or have certain chronic conditions like dementia or diabetes.
What is the difference between Medicare and Medicare Advantage?
Medicare Advantage Plans must provide at least the same coverage as Original Medicare Parts A and B. This means that you will have the services of Original Medicare Parts A and B, no matter which plan you choose.
Aside from the minimum coverage, there are other differences between Original Medicare and Medicare Advantage Plans. Where Medicare Advantage plans differ is that they may offer benefits/coverage not covered by Original Medicare.
The following are differences in which Medicare Advantage plans may offer you more than the Original Medicare option:
Under Original Medicare, Part A covers medical, and Part B covers hospital costs. In addition to the medical and hospital costs, some Medicare Advantage plans may offer dental, prescription drug, hearing, and vision coverage, and more.
Medicare Advantage enrollees must continue to pay the Part B premium alongside the Medicare Advantage plan premium (determined by the insurer). This Medicare Advantage premium varies from one plan to another, and some may have premiums as low as $0.
In terms of out-of-pocket costs, Medicare Advantage plans limit how much you spend in a year. Once you reach the cap maximum, the insurer will usually pay 100% for some covered services. However, Original Medicare has no cap on out-of-pocket costs, so your potential expenses are limitless.
Often a Medicare Advantage plan can be less expensive than comparable coverage under Original Medicare.
Original Medicare does not include coverage outside of the country, even if it is an emergency. However, certain Medicare Advantage plans may cover you if you travel outside the country and have an emergency.
Copay Vs. Coinsurance
Original Medicare covers the first 80% of the cost. You are then responsible for the remaining 20% of the bill for doctor office visits, outpatient surgery, and other basic medical services. With a Medicare Advantage Plan, you typically pay a fixed copayment.
With Original Medicare, you have the choice of any provider or facility which accepts Medicare. Depending on the type of plan you choose, Medicare Advantage plans will usually have a closed network or a preferred network of providers.
Changes to Medicare Advantage Plans in 2023
Changes to Medicare Advantage Plans in 2023
Medicare Advantage Plans are going to decrease in 2023 to $18.
Some small changes made to Medicare Advantage plans in 2023 include expanded telehealth coverage (for video calls with your healthcare provider or therapist), long-term care coverage, and more enrollment options for those with End-Stage Renal Disease.
If you are looking to enroll in a plan for 2023, there are many great options. Medicare Advantage plans are more popular than ever, with seniors across America realizing how economical the plans can be.
Medicare Advantage plans are available through private insurance companies
A licensed insurance agent will guide you through available plans in your area and give you an idea of the benefits and cost you can expect. Then, they can help you find a plan that offers you coverage that aligns with your healthcare needs.
Compare Medicare Advantage Plans for 2023
As you review Medicare Advantage plans, we believe it’s essential to familiarize yourself with all the available options.
Not only do Medicare Advantage plans vary in terms of premiums, out-of-pocket costs, and network plans, but they also come with different benefits. As a result, a Medicare Advantage plan that has coverage that aligns with your healthcare needs may not be the same as your neighbor.
When comparing plans, we suggest considering factors such as, whether your prescriptions will be covered, if the plan is within your budget, and your needs and preferences. You should also visit the plan’s website to understand everything about what they offer, along with calling the carriers to ask any questions you may have.
Medicare Advantage Plans: Enrollment Period 2023
You may only make changes to your coverage during pre-determined enrollment periods. Therefore, it isn’t possible to change your enrollment status at any time, and before you can enroll, switch, or drop Medicare Advantage, you must enroll in Original Medicare (Part A and B).
The Initial Enrollment Period
Your Initial Enrollment Period is when you first become eligible for Medicare and begins three months before you turn 65, includes the month of your birthday and continues for three months after – totaling seven months.
The Annual Enrollment Period
The Open Enrollment Period (sometimes called the Annual Open Enrollment Period) runs from October 15 to December 7. During this period, individuals enrolled in Original Medicare can enroll in a Medicare Advantage plan.
Special Enrollment Period
The Special Enrollment Period has no set beginning or end date. The period is available to individuals who experience qualifying life events, such as moving to another plan area or losing employee health coverage. Special Enrollment Periods vary, with some granting a window of up to eight months.
The Open Enrollment Period for 2023 is coming up soon. Being fully informed is the first step in knowing your options. Make sure to consult with a Licensed Insurance Agent to be guided in finding the best plan for you.
If You’re Already in a Medicare Advantage Plan and Want to Switch
Suppose you are currently enrolled in a Medicare Advantage Plan but want to switch to Original Medicare or a different Medicare Advantage plan. In that case, you can do so during the Medicare Advantage Open Enrollment Period, which is from January 1 and ends on March 31.
Throughout this period, Medicare Advantage plan enrollees can switch to an alternative Medicare Advantage Plan, re-enroll in Original Medicare, and sign up for a Part D Prescription Drug plan.