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Medicare Advantage

If you are already enrolled in Medicare Parts A and B, you may want to consider adding Medicare Part C, also known as Medicare Advantage, for extra coverage. Anyone who qualifies for Original Medicare will also qualify for Medicare Advantage, except individuals with end-stage renal disease.

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What Is Medicare Advantage?

A Medicare Advantage plan will be provided through a private company and includes all the benefits of Medicare Parts A and B, usually with some additional services. All plans are approved by Medicare. Medicare Advantage works like an HMO or PPO, meaning that you’ll have to follow the stipulations set forth in the plan regarding which physicians you see, how to get referrals to see specialists, and which healthcare facilities you go to.

How Is Medicare Advantage Different From Other Medicare Plans?

Medicare Advantage is different in that it operates like a private health insurance plan, even though Medicare will be paying a fixed amount toward its costs each month. Each plan is different, so you’ll need to make sure you understand the benefits, rules, stipulations, and costs before signing up. There are several different types of Medicare Advantage plans you may consider:

  • Health Maintenance Organization Plans (HMO)—Most HMOs require a monthly fee but have low deductibles and co-payments. You’ll be restricted to doctors and specialists in the plan, but most options will cover emergency care that you receive outside the provider group.
  • Preferred Provider Organization Plans (PPO)—With a PPO, you can visit a health care provider outside the network and still receive some coverage, but it will be at a lower percentage than if you use a network provider.
  • Fee For Service Plans—Fee for service plans provide payment for each service received rather than as a monthly fee. Plans will differ as to the patient’s financial responsibility for each service.
  • Special Needs Plans—Some Medicare Advantage plans have been designed specifically for patients with certain health care needs such as autoimmune disorders, cancer, liver disease, diabetes, and other chronic conditions.
These are the most common types of Medicare Advantage Plans; however, you may come across other plan types in your area. The key is to understand the benefits and costs of each plan in order to make the best decision for your needs.

What Is Covered Under Medicare Advantage?

All benefits received under Medicare Parts A and B will also be covered under your Medicare Advantage plan except, in some cases, hospice care. In addition, Medicare Advantage usually covers services such as dental care, vision care, and prescription drugs. Not all plans cover all services, and some cover more than others, so it’s important to look at the details of an individual plan before you sign up so you’ll know what to expect. If your Medicare Advantage plan does not cover prescription drugs, you can still apply for Medicare Part D to help cover the cost of prescription medication.

What Is the Cost of Medicare Advantage?

Medicare will pay a fixed amount toward your Medicare Advantage plan each month. Depending on the type of plan you choose, you may also be responsible for a monthly fee, deductible, and/or co-payments for services rendered. Because plans differ so widely, you’ll need to talk to the private provider about what your financial obligations will be for the specific plan you are considering.

Can Medicare Advantage Be Used With Other Medicare Supplement Plans?

Medicare supplement plans are private health insurance plans that may cover some of the costs not covered by Medicare Parts A and B. They are also known as Medigap plans because they cover the “gaps” in original Medicare. These costs may include monthly premiums, deductibles, and co-payments. Legally, you may not enroll in both Medigap and Medicare Advantage. That means it’s important for you to take a close look at the costs and benefits of each option in order to determine which one provides the coverage you need at an affordable cost.

How Do I Enroll in a Medicare Advantage Plan?

You can join the Medicare Advantage plan of your choice by contacting the private provider through which the plan is offered. Medicare offers information on how to determine plan quality in order to help you choose the best plan. Most Medicare Advantage plans require you to join during a specified enrollment period. Once you are enrolled, you can still appeal decisions through Medicare.

Medicare Advantage is an excellent option for people who need additional coverage above that provided in Medicare Parts A and B. Because the plans are so varied, it’s likely that you’ll be able to find one offering the services and payment options you need. Once you are enrolled, always check the stipulations of the plan before visiting a doctor or specialist to ensure that you follow plan rules to receive the greatest benefit.

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