Medicare Advantage (MA) Plans are health plan options that are approved by Medicare and run by private companies.
They are part of the Medicare program and are sometimes called “Part C.” Medicare Advantage Plans provide the same services as Medicare A and B and may offer extra benefits that Medicare doesn’t cover, such as vision or dental services. Some Medicare Advantage plans include prescription drug coverage (Part D). Members may have to pay an additional monthly premium for the extra benefits. The plan may have special rules that its member need to follow.
How do Medicare Advantage Plans work?
In most Medicare Advantage Plans, members generally get all their Medicare-covered health care through the plan. Some plans also include Medicare prescription drug coverage (Part D). Medicare pays a set amount of money for a person’s care every month to these private health plans, whether or not the member uses services. The plan is then responsible for all aspects of care from proof of coverage, processing of claims, payment of claims, determination of medical necessity, explanation of benefits, and statements.
What are the Costs of Medicare Advantage Plans?
Most people enrolled in a Medicare Advantage Plan must still pay their Part B premium. Members may also pay an additional monthly premium to the plan. Members also have cost-sharing in Medicare Advantage Plans. These could be in the form of co-payments or coinsurance. Cost-sharing in a Medicare Advantage Plan may be different from those in Original Medicare. Because of this, it’s important that people review plan materials carefully for details about co payments and co-insurance for the services they get. Plans set an annual out-of-pocket limit that is approved by Medicare. If a person reaches their out-of-pocket limit then the plan pays at 100%
What are the Benefits of Medicare Advantage Plans?
People who join a Medicare Advantage Plan are still in the Medicare program. They still have Medicare rights and protections. Extra benefits could be offered. These might include coverage for vision, hearing, dental and/or health and wellness programs. Enrollments in a Medicare Advantage Plans is available to most people with Medicare. These plans provide guaranteed protection high out-of-pocket expenses.
What Kind of Medicare Advantage Plans Are There?
There are currently four main types of Medicare Advantage Plans:
Who Can Join?
Medicare Advantage Plans are available to most people with Medicare. To be eligible to join a Medicare Advantage Plan, a person must:
When Can People Join?
People can join a Medicare Advantage Plan
Medicare Annual Enrollment Period
The Medicare Fall Open Enrollment occurs every year from October 15 – December 7. People can make changes in their plan enrollment. If they do not want to stay in their current plan, they can enroll into a different Advantage Plan or return to Original Medicare. Their new plan will start the following January 1.
This is the key time for individuals to review their health care and drug coverage and make changes for the following year, if they choose.
Medicare Advantage Disenrollment Period
You can switch from your Medicare Advantage Plan to Original Medicare (Part A and B) during Medicare Advantage Disenrollment Period (MADP). You can only make this coverage change if you have a Medicare Advantage Plan. The MADP occurs every year from January 1 to February 14. If you have a Medicare Advantage Plan you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan (Part D).
Special Enrollment Periods
There are Special Enrollment Periods for special circumstances. A person can make changes if:
Special Trial Rights
Those who join Medicare Advantage are entitled to a trial period that allows them to try the plan out and switch back to Original Medicare if they are dissatisfied.
You are eligible for this trial period if you:
The trial right allows you to dis-enroll from the MA plan during the first 12 months to join Original Medicare. You also have a guaranteed issue opportunity to purchase a Medigap policy.
Read the next section about Choosing a Medicare Advantage Plan.