Medicare Advantage (MA) Plans 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 members need to follow.for the extra benefits.
In most Medicare Advantage Plans, members generally get all their Medicare-covered healthcare 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. They are structured very similar to employer healthcare coverage.
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%
Medicare Advantage Plans are available to most people with Medicare. To be eligible to join a Medicare Advantage Plan, a person must:
It’s is important to know what a salesman or other representative of a Medicare Advantage Plan can and cannot legally do. Their representatives:
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