Medicare Advantage (Part C)

How Does Medicare Advantage Work?

Medicare Advantage allows beneficiaries to receive healthcare coverage from a private insurance company. These companies contract with the federal government to provide Medicare benefits to eligible individuals. When you enroll in a Medicare Advantage plan, the plan becomes your primary insurer and provides you with all of the benefits covered by Original Medicare (Part A and Part B). Medicare Advantage plans must offer at least the same benefits as Original Medicare, but many plans offer additional benefits. You may need to use providers within the plan’s network to receive care, and some plans may require referrals to see specialists. Medicare Advantage plans often have lower out-of-pocket costs than Original Medicare, but there may be additional costs, such as monthly premiums and copayments for services. It’s important to carefully review the plan’s details to understand how it works and what services are covered.

What Benefits Does Medicare Advantage Provide?

Medicare Advantage (also known as Medicare Part C) is an alternative to traditional Medicare, which is run by private insurance companies approved by Medicare. Some potential benefits of Medicare Advantage include:

Additional benefits

Medicare Advantage plans often include additional benefits not covered by traditional Medicare, such as vision, dental, and hearing coverage, as well as fitness programs, wellness programs, and transportation to medical appointments.

Lower out-of-pocket costs

Medicare Advantage plans may have lower out-of-pocket costs than traditional Medicare, particularly for services such as hospital stays and outpatient care.

Simplified healthcare

Medicare Advantage plans typically have a more coordinated approach to healthcare, with one provider as the point of contact for all medical needs. This can make it easier for patients to manage their healthcare and get their needed care.

Prescription drug coverage

Many Medicare Advantage plans include prescription drug coverage, which can help patients save money on their medications.

Flexibility

The Medicare Advantage program includes several types of plans, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), and Medical Savings Account (MSA) plans. This allows patients to choose a plan that best meets their healthcare needs and preferences.

Enrollment and Eligibility

To be eligible for Medicare Advantage, you must be enrolled in Medicare Part A and B and live in the service area of the Medicare Advantage plan you wish to join.

You may be eligible for Medicare if:

• You’re 65 years or older

• You have a disability

• You have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

Once you are eligible for Medicare, you can enroll in a Medicare Advantage plan during the following enrollment periods:

Initial Enrollment Period

This is a 7-month period that begins three months before you turn 65, includes the month you turn 65, and ends three months after you turn 65.

Annual Enrollment Period

This is also known as the Open Enrollment Period and occurs every year from October 15th to December 7th. During this period, you can enroll in a Medicare Advantage plan, switch from one Medicare Advantage plan to another, or switch from Medicare Advantage to Original Medicare.

Special Enrollment Period

You may be eligible for a special enrollment period if you experience a qualifying life event, such as moving out of your plan’s service area, losing employer coverage, or becoming eligible for Medicaid.