Understanding Medicare Advantage

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Read about the latest trends in Medicare Advantage in our spotlight analysis.

Are you interested in enrolling in Medicare Part C, but are confused about options that fit your needs? Let’s get started to help you and everyone else get a clear understanding of Part C.

What is Medicare Advantage?

Medicare Part C, also known as Medicare Advantage, is offered by private companies approved by Medicare. You still have Medicare when you join a Medicare Advantage Plan. If enrolled in Medicare Part C, you get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not from Original Medicare.

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you will pay nothing for covered services. This limit may be different between Medicare Advantage Plans and it can change each year. Keep that in mind when considering a plan.

What Does Medicare Advantage Cover?

Medicare Advantage Plans cover all Medicare services and offer extra coverage. It may offer extra coverage like vision, hearing, dental, and/or health and wellness programs. Most Advantage plans include Medicare prescription drug coverage (Part D).

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. With a Medicare Advantage plan, you will always be covered for emergency and urgently needed care. However, the plan you choose can decide to not cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

How Much Does Medicare Advantage Cost?

In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. 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.

However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.

Another important rule is that you can’t have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you’re in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.

Thankfully, you now have the tools you need to select the Medicare Advantage plan that is right for you.

Related Links

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Medicare World Editorial Team
The Medicare World editorial team works diligently to make sure our stories are informative, unbiased, and of utmost relevance to our readers. Our team of researchers and writers presents the best and latest information on all things Medicare, including legislation, enrollment rules, changes in coverage and costs, and health information. We enjoy keeping our readers up-to-date and helping them navigate the often-complicated Medicare maze.

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