Medicare Advantage

What is a Medicare Advantage (MA) Plan?

A Medicare Advantage Plan (like an HMO or PPO) is considered “Part C” of Original Medicare. Part C gives you the option to choose a Medicare Advantage (MA) plan in which you assign your Medicare Parts A and B benefits to a private health plan that administers your benefits on behalf of Medicare. Most MA plans cover Medicare prescription drug coverage (Part D). Some Medicare Advantage Plans may include extra benefits, discounts, and value added services for an extra cost.

MA Plan Facts

  • Private insurance companies approved by Medicare provide this coverage
  • You will get your Part A (Hospital Insurance) & Part B (Medical Insurance) coverage from the MA plan, not Original Medicare
  • Most plans have lower out-of-pocket costs than Original Medicare
  • Provides Medicare beneficiaries a choice in how they receive Medicare coverage
  • MA plans are NOT Medicare Supplement insurance plans
  • MA plans must offer all benefits of Original Medicare and can include Part D prescription drug coverage
  • All plans offer maximum out-of-pocket protections
  • MA plans include emergency coverage when traveling outside the US

What does it cover?

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. They must cover all services that Original Medicare (Part A & Part B) covers except hospice care and some care in qualifying clinical research studies, although Original Medicare covers hospice care and some costs for clinical research studies even if you’re in a Medicare Advantage Plan.

MA plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most plans also include prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.

Eligibility

You are eligible for a Medicare Advantage plan if at least one of following applies to you:

  • First day of the month of your 65th birthday
  • You have Original Medicare Part A and Part B
  • You are declared eligible for Original Medicare due to disability

Enrollment

You can enroll, switch, or drop a Medicare Advantage Plan during these times:

  • When you first become eligible for Original Medicare–you can enroll three months before and up to three months after you become eligible for Medicare Part A and Part B.
  • Between October 15th – December 7th–anyone can enroll, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1st, as long as the plan gets your request by Decrmber 7th.
  • Special Enrollment Period–only applies in certain situations, ask a Insurance Specialist.
Call 1-800-842-7799 to speak with an Insurance Specialist.

*Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. (2012) Centers for Medicare & Medicaid Services.