Medicare Advantage, or Medicare Part C, is offered through private insurance companies that are approved and regulated by Medicare. More and more people are choosing Part C plans, with one-third of Americans (19 million in 2017) on Part C plans. Under Medicare Advantage, you still have all the rights you have under Medicare. Medicare Advantage plans include Part A and B, and sometimes Part D prescription drug coverage as well.
Benefits and drawbacks of Medicare Advantage
One advantage of Medicare Advantage plans is that they have a limit on what you will spend out of pocket each year. This limit will differ from plan to plan and can change from year to year. The mandatory maximum out-of-pocket limit for 2020 is $6,700, though plans can choose to have a lower maximum limit.
Some Medicare Advantage plans include extra coverage such as prescription drug, hearing, vision, dental, and fitness club and wellness benefits. Otherwise, the coverage you receive should be the same as Original Medicare with the exception of hospice care.
With Medicare Advantage, your premiums may be higher. Also, unlike Original Medicare,where you can go to any doctor or hospital that accepts Medicare, with Part C you may be limited to certain doctors and hospitals in your plan’s network. In addition, your Part C plan’s rules and coverage can change from year to year.
Types of Medicare Advantage plans
The following are the types of Medicare Advantage plans that may be available in your area. Check Medicare’s Plan Finder to see what is available to you.
- Health Maintenance Organization (HMO) plans
- HMO Point-of-Service (HMO POS) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs Plans (SNPs)
- Medicare Medical Savings Account (MSA) plans
When and how to enroll in Medicare Advantage
If you are looking to join a Medicare Advantage plan, you can do so during the open enrollment period from October 15 to December 7. If you are enrolling for the first time, you may enroll the 3 months before, the month of your birthday, or the 3 months after the date you turn 65. If you need to disenroll from an MA plan, the disenrollment period is January 1 to February 14. To enroll in Medicare Advantage, you must be enrolled in Parts A and B, and live in the service area of the plan you wish to join. You also cannot have ESRD (kidney failure), with some exceptions.
To find a Medicare Advantage plan in your area that’s right for you, use the Plan Finder on the official Medicare website. Try to select one with a 4 or 5 star rating by Medicare. Once you have chosen a plan, you can enroll on the insurance company’s website or by calling them, or call 1-800-MEDICARE. A plan should not call you to get you to join, and should never ask for your credit card info or bank numbers over the phone.
Do your homework when enrolling
Medicare Advantage plans and their coverage can change – be sure to double check each year for your plan’s copays and specific coverage. Also check the deductibles, star rating, and travel coverage to make sure your plan covers all of your needs. A study by Paul Jacobs and Eamon Molloy shows that beneficiaries tend to remain in the plan they are in (and end up paying more) without checking to see if there is one available with lower premiums.
Make sure to understand your policy’s rules and coverage before choosing it. Your favorite doctor or specialist may not be available under your new Medicare Advantage plan.
10 points about Medicare Advantage
- A Medicare Advantage plan is an alternative to Original Medicare that is administered through a private insurance company approved by Medicare.
- You can’t have Medicare Advantage and Medigap at the same time.
- You are not allowed to have Medicare Advantage that includes prescription drug coverage and a stand-alone Medicare Part D plan at the same time.
- If you have End-Stage Renal Disease (ESRD), you are not eligible for Medicare Advantage.
- Medicare Advantage plans differ by county, and some, but not all, offer vision, hearing, dental, and prescription drug coverage.
- Some plans include fitness club memberships.
- Under a Medicare Advantage plan, you must use the doctors and hospitals that are in your particular Medicare Advantage plan’s network. (With PPOs, you can use doctors outside the network, but you will usually pay more.)
- Unlike Original Medicare, Medicare Advantage plans include a limit on how much you will have to spend out of pocket each year.
- With Medicare Advantage, you still have Medicare Parts A and B and all the rights and protections that come with them.
- Plans and their coverage can change; be sure to review your plan’s copays and specific coverage each year. Also check the deductibles, star rating, Part D drug formulary, and travel coverage to make sure your plan meets all of your needs.
Medicare Advantage vs. Medigap
Since you cannot have both Medicare Advantage and Medigap, it may be a tough decision to make regarding your health coverage. Watch our video to see which choice might be best for you.