Medicare Advantage (sometimes called Part C) is the name for the system in which health insurance companies offer Medicare benefits through private plans. People with Medicare may choose to join these plans. They still have Medicare; they just receive their Medicare coverage (Parts A & B) through the Medicare Advantage plan.
There are many different types of Medicare Advantage plans, including health maintenance organizations (HMOs), preferred provider organizations, special needs plans (SNPs), private fee-for-service plans, and Medicare Savings Accounts. Not all types of plans are available in all areas or to all Medicare beneficiaries.
Why choose Medicare Advantage?
Medicare Advantage plans must cover the same services offered under Original Medicare, but they may also additional services that Original Medicare doesn’t cover, such as eyeglasses, hearing aids, health club membership, and other wellness benefits.
Many Medicare Advantage plans also include coverage of prescription drugs.
It’s important that anyone considering enrollment into Medicare Advantage weigh the pros and cons to make an informed decision based on the four C’s: coverage, cost, convenience, and choice. It’s also crucial to remember that a person with Medicare Advantage cannot also have a Medigap (supplemental insurance) policy.
Costs in Medicare Advantage
People who enroll in Medicare Advantage plans still pay their monthly Part B premium. They also may pay an additional monthly premium on top of the Part B premium and, for some services, a deductible and a portion of the cost of the services received. The extra premium helps pay for the extra benefits some Medicare Advantage plans offer their members. How the costs are structured varies by the type of Medicare Advantage plan.
People who choose to get their Medicare through a Medicare Advantage plan may be able to receive help paying for their coverage if they qualify for programs such as Medicaid, or Medicare Savings Programs.
In Original Medicare, a beneficiary can go to any doctor, hospital, or other health-care provider that takes Medicare. People who join a Medicare Advantage plan have to follow the rules of the plan to get Medicare coverage. For example, some Medicare Advantage plans require members to stay within a network of providers (with which the plan has a contract). Certain plans won’t cover members who go to a doctor’s office or a hospital outside of this network. Other plans might cover people who go outside the network of providers, but they may require the member to pay more out-of-pocket for getting this care out-of-network.
Some Medicare Advantage plans also offer Part D prescription drug coverage. Others are “stand-alone” plans that only offer health coverage, and people can buy a Part D drug plan to cover their prescriptions.
How to enroll in Medicare Advantage
There are limited times of the year during which people with Medicare can enroll (and disenroll) from a private Medicare Advantage health plan.
People joining Medicare for the first time have an Initial Enrollment Period, during which they can also select a Medicare Advantage plan. People can also join, switch, or disenroll from a Medicare Advantage plan during the annual Open Enrollment Period from Oct. 15 to Dec. 7. There are also Special Enrollment Periods for certain circumstances, such as when a senior moves from one plan’s service area to a new location.
Note: It is very important to carefully consider enrollment/disenrollment from a Medicare Advantage plan, especially as it relates to the ability to pick up a supplemental (Medigap) plan. Use My Medicare Matters®, NCOA’s consumer educational site, to learn more about comparing coverage between Original Medicare, Medicare Advantage, and Medigap. Or find the local office of your State Health Insurance Assistance Program (SHIP) by calling 1-877-839-2675.