Medicare Advantage Plans are health plans that are approved by Medicare and are provided by private insurance companies. Medicare pays money to private insurance companies to provide your Medicare benefits. These plans are sometimes referred to as “Medicare Replacement” plans and are part of Part C of Medicare.
When you enroll in a Medicare Advantage (MA) or Medicare Advantage with Prescription Drugs (MAPD), you are still enrolled in Medicare, but the plan provides all of your Part A (hospital), Part B (medical) and Part D (drug) benefits and must provide coverage at least as good as Medicare’s.
Almost all Medicare Advantage plans include Part D (prescription drug coverage) and some offer extra benefits like dental and vision.
You Can Enroll in a Medicare Advantage Plan If…
- You live in the plan’s service area,
- You have Medicare Part A and Part B,
- and you do not have end-stage Renal Disease (ESRD.)
We find that Medicare Advantage plans are a good option for people on disability who cannot get a Medicare Supplement or those denied a Supplement, because they limit your out of pocket costs. They also give you the ability to know how much your care will cost because each plan has a set copay for each service. MAPDs may not be the best fit for everyone. We can help you determine if these plans are the right type of coverage for you.
How Medicare Advantage Plans Differ from Original Medicare
Medicare Advantage plans are different from the Original Medicare program. Below are some key points to understanding how they work.
- You must continue to pay your Part B premium.
- You do not use your Medicare card. Instead, you use your plan’s ID card and your doctor bills to your insurance company.
- All services have a copay (primary care doctor visit, specialist visit, x-ray, blood work, in-patient hospital stay, physical therapy, etc).
- You do not need, and should not buy, a Medicare Supplement if you choose a Medicare Advantage Plan. They cannot work together.
- There may be extra benefits such as some dental, vision and hearing coverage.
- Plans have an annual maximum-out-of-pocket which puts a cap on your financial responsibility.
- Every plan has a network of doctors. There are two types of networks: HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization).
- With an HMO, you can only see doctors in the network. If you go out-of-network, you pay 100%.
- With a PPO, you can go to doctors in or out of the network. If you go out-of-network, you will pay a higher copay, but still have coverage.
Make Sure to Do An Annual Review with Imagine Insurance Advisors
The only time you can change your Medicare Advantage plan is during the Annual Enrollment Period (October 15th to December 7th) unless you have a Special Enrollment Period (SEP.)
We recommend evaluating your coverage every two years as the networks of doctors and formulary of medicines can change annually. Imagine Insurance Advisors offers a complementary review of your plan.
We look up your doctors to make sure they are still in your selected network and look up your medications to ensure they are on the formulary. We are appointed with all the carriers in our area to ensure you get an unbiased recommendation. Contact us to get your free review, we are here to help!