For folks who are new to Medicare, one of their biggest questions is, What is a Medicare Advantage Plan? Because the word “supplemental” gets thrown around so much, it is often assumed that Medicare Advantage plans are the same as Medicare Supplement plans, but they are not. If you are unsure about Medicare Advantage plans, this article can help you better understand what they are and if they are for you.
Medicare Advantage plans are a way to get your Part A and Part B benefits through a private insurance company rather than the Federal Government. The insurance carrier has a contract with the Center for Medicare and Medicaid Services which runs Medicare, and is obligated to cover you for all the same conditions and treatments for which Original Medicare would cover you. Medicare approves these plans and rates them on how well they work for their members. When you are in a Medicare Advantage Plan, Medicare won’t be paying your claims when you see a medical provider. Instead, Medicare sends money to the insurance company each month, and the insurance carrier pays the claims. The Medicare Advantage plan pays instead of Medicare rather than paying after Medicare pays.
Medicare Advantage plans usually also have a Part D Prescription Drug plan built in, so you won’t have to purchase a separate plan. There are plans that don’t include Part D coverage if you don’t want it or get your drug coverage from another source. As with any plan, you should be sure that the plan you are considering, provides coverage for the particular drugs you need.
Medicare Advantage plans are generally either an HMO or PPO. That means there will be a network of providers that have have contracted with the plan. HMO plans usually restrict you to seeing only in-network providers except in the case of an emergency. PPO plans usually allow you to go out-of-network, but you may have to pay a larger share of the costs.
With a Medicare Advantage plan, you will generally have co-pays or co-insurance amounts that you are responsible for if you see a medical provider. You may also have deductibles you have to meet. These may be less than what you might pay if you were using Original Medicare.
One of the advantages to Medicare Advantage plans is the additional services that may be offered. These may include, dental, vision, hearing, gym memberships, and other discounts and programs. Each plan will vary, so you must consider what is available and whether it meets your needs.
Medicare Advantage is an increasingly popular way for people to manage their Medicare coverage. You should consult with an agent to see if Medicare Advantage is right for you.