What is Medicare Advantage?
Medicare Advantage (MA), also called Part C, is a type of plan that provides all of the benefits of Part A and Part B. MA plans are part of the federal government’s Medicare program, but they are contracted through private insurance companies. This article helps answer the basic frequently asked questions you or a loved one might have about MA to make sure you pick a health care plan that fits your needs.
What are the types of plans?
There are several types of plans that meet the needs of different individuals. These types of Advantage programs are as follows:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNPs)
- HMO Point of Service (HMOPOS) Plans
- Medical Savings Account (MSA) Plans
If you’re looking for the benefits of Part A and Part B but want more coverage, Part C might be a good option. When you purchase an advantage plan, you will purchase through a private insurance company on the open market. You will continue to pay your part B premium, but there may not be any additional premium required. Rather than paying the deductibles and coinsurance on Part A and B, you will have predictable copayments for hospital visits, doctor office visits and other outpatient care.
What are the main benefits?
With MA, you get the coverage of Part A and Part B, and you also often get some extra benefits. Benefits may include the following:
- Low or no premiums
- Low or no deductibles
- Prescription drug coverage (must add Part D)
- Vision, dental, hearing, and health and wellness programs
- Hospital visits
- Doctor visits
- Preventative and screening services
- Medical equipment
In short, it often provides more coverage than traditional Part A and B does.
What is not covered?
MA plans don’t cover hospice care. Additionally, procedures that are deemed medically unnecessary are not covered, but if a procedure or service is deemed medically unnecessary, you may have the option to appeal. Contact your insurer directly to find out if you can submit a written appeal for coverage.
What are the out-of-pocket costs?
The costs you pay depend on the services you need, as well as your plan’s premiums, deductibles, copayments, and coinsurance. Your out-of-pocket costs will vary, but it is comforting to know that federal law states the maximum out-of-pocket limit will never exceed $6,700.1 These limits can be lower, however, and they vary from plan to plan.
We know it can be difficult to understand all of the ins and outs. That’s why we created a tool to help you find the plan you need. Get a plan recommendation now!
1Centers for Medicare and Medicaid Services, “Strengthening Medicare Advantage”