Here’s a brief overview of how Medicare Advantage plan differ from other coverages.
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join an Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not through Original Medicare.
An Advantage Plans cover all Medicare services. Medicare Advantage Plans may also offer extra coverage. This section covers the rules, costs, and coverage of Medicare Advantage plans to help you determine if one is right for you.
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 all follow the same rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you receive services (like whether or not you need a referral to see a specialist, or if you have to see specific doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care group). These rules can change each year.
Costs for Medicare Advantage Plans
What you pay under a Medicare Advantage Plan can depend on many factors. Your out of pocket costs in a Medicare Advantage Plan depend on the following:
- Whether the plan charges a monthly premium.
- The plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
- The type of health care services you need and how often you get them.
- Whether you go to a doctor or supplier who accepts assignment (if you’re in a PPO, PFFS, or MSA plan and you go out-of-network).
- If you follow the plan’s rules, like using network providers.
- Whether you need extra benefits and if the plan charges for it.
- The plan’s yearly limit on your out-of-pocket costs for all medical services.
- You have Medicaid or get help from your state.
NOTE: Each year, plans establish the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan may change only once a year, on January 1.
If you’re in a Medicare plan, review the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC) your plan sends you each fall. The EOC gives you details about what the plan covers, how much you pay, and more. The ANOC includes any changes in coverage, costs, or service area that will be effective in January.
If you don’t get these important documents, contact us at 855-205-4928 to obtain them.
Drug Coverage in Medicare Advantage Plans
You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don’t offer drug coverage, you can join a Medicare Prescription Drug Plan.
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 (Part D), you’ll be unenrolled from your Medicare Advantage Plan and returned to Original Medicare.
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan (Part D) when you’re first eligible, or if you decide not to join a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, you’ll likely pay a late enrollment penalty unless you have other creditable prescription drug coverage, or you get Extra Help.
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
- Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
- Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance)and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
Once you choose a Medicare drug plan, here’s how you may be able to join:
- Enroll with our expert advisors, or on the plan’s website.
- Complete a paper enrollment form.
- Call the plan directly
- Call 1-800-MEDICARE (1-800-633-4227).
When you join a Medicare drug plan, you’ll give your Medicare number and the date your Part A and/or Part B coverage started. This information is on your Medicare card.
NOTICE: JOINING A MEDICARE DRUG PLAN
MAY AFFECT YOUR MEDICARE ADVANTAGE PLAN
If your Medicare Advantage Plan (Part C) includes prescription drug coverage and you join a separate Medicare Prescription Drug Plan (Part D), you’ll be unenrolled from your Medicare Advantage Plan and returned to Original Medicare.
How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans
Medigap policies (also known as Supplemental Insurance), can’t work with Medicare Advantage Plans. Learn about your options related to Supplemental Medicare Policies here, or by calling 855-205-4928 to speak with a knowledgeable Customer Care Specialist today.