How do Medicare Advantage Plans work?
A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you’ll still have Medicare but you’ll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
These “bundled” plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).
Covered services in Medicare Advantage Plans
Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like fitness programs (like gym memberships or discounts) and some vision, hearing, and dental services. Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.
Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like:
- Whether you need a referral to see a specialist
- If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care
These rules can change each year.
Costs for Medicare Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors. In most cases, you’ll need to use health care providers who participate in the plan’s network. Some plans won’t cover services from providers outside the plan’s network and service area.
Drug coverage in Medicare Advantage Plans
Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:
- Can’t offer drug coverage (like Medicare Medical Savings Account plans)
- Choose not to offer drug coverage (like some Private Fee-for-Service plans)
You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:
- You’re in a Medicare Advantage HMO or PPO.
- You join a separate Medicare Prescription Drug Plan.
How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans
You can’t enroll in (and can’t use) Medigap while you’re in a Medicare Advantage Plan. You can’t use Medigap to pay for any costs (copayments, deductibles, and premiums) you have under a Medicare Advantage Plan.
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