Medicare Advantage Frequently Asked Questions

//Medicare Advantage Frequently Asked Questions

Medicare Advantage Frequently Asked Questions

Are Medicare Advantage Plans Good?

Some seniors may find better value in Medicare Part C, called Medicare Advantage. Such plans are run by private insurance companies but regulated by the government, and must offer coverage that’s comparable to original Medicare parts A and B. Most also include prescription drug coverage, which is an optional add-on called Part D for seniors who keep original Medicare.

Medicare Advantage Plans Vs Original Medicare

A Medicare managed care plan is one way to get coverage for the health care bills that Medicare doesn’t pay. Medicare managed care plans are HMOs or PPOs that provide basic Medicare coverage plus other coverage to fill the gaps in Medicare coverage.

What Is A Medicare Advantage Policy?

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.

How Are Medicare Advantage Plans Rated?

The Five-Star Quality Rating System for Medicare Advantage Plans rates Medicare Advantage (MA) plans on a scale of 1 – 5 stars. There are different domains for MA plans versus Prescription Drug Plans (PDPs)

Who is Eligible for Medicare Advantage Plan?

If you are thinking about purchasing a Medicare Advantage plan, you can rest assured that you are highly likely to be accepted if:

You are currently covered under Medicare Parts A & B
You are within 6 months of turning 65
You are within 6 months of receiving Part B coverage
If you are about to lose your group health insurance plan

Medicare Advantage Plans HMO vs PPO

Medicare Advantage plans that are designated HMOs could require you to see a primary care doctor first. PPO plans would allow you to see a specialist without a referral, but seeing an out-of-network doctor or specialist would cost you more. Most Medicare Advantage plans are either HMOs or PPOs.

Are Medicare Advantage Plans A Good Deal

If you want a cap on your out-of-pocket health spending. Original Medicare has no out-of-pocket maximum. You keep paying a portion of the cost of services as you use them. Medicare Advantage plans, by law, have an out-of-pocket maximum of no more than $6,700 per year. Once you hit that limit, the plan pays for all covered expenses.

Are Medicare Advantage Plans Guaranteed Renewable?

Plan benefits can change from year to year. Make sure you understand how a plan works before you join.

How Do Medicare Advantage Plans Make Money?

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

However, each Medicare Advantage Plan can charge different out-of-pocket costs. Each plan can also have different rules for how you get services, like:

Whether you need a referral to see a specialist
If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care

These rules can change each year.

How To Compare Medicare Advantage Plans

You want the broadest possible choice in doctors and other medical providers. More doctors and other providers accept original Medicare than private Medicare Advantage insurance. Private plans tend to be restricted to a home network, like an HMO doctor network. If you travel frequently, you may want to consider staying with original Medicare for this reason.

Medicare Advantage Plans Compared (verus) To Medigap/Supplements

With a Medicare Midigap/Supplement you will continue to be covered by original Medicare. After Medicare has paid your claims, it will automatically forward them to your Medigap plan. The Medigap plan will then pay its portion of the bill.

Medigap plans do not cover prescription drugs. Therefore you must also purchase a stand-alone Part D plan if you want drug coverage.

With a Medicare Advantage plan, you continue to pay your Part B premium as usual. You may also pay an extra premium for the plan. You are not allowed to have a Medigap and Medicare Advantage plan simultaneously.

Medicare Advantage plans typically come with deductibles and co-pays. But unlike original Medicare, they have an annual out-of-pocket limit. That means that once you have paid deductibles and co-pays that add up to the annual out-of-pocket limit, the plan will pay 100 percent of your medical bills for the rest of the year.

Medicare Advantage Plans With Zero Premium

If you can’t afford or don’t want to pay additional monthly premiums. Medicare Advantage plans, like other private health plans, typically charge premiums. The recent average was about $30 a month for an HMO and $32 to $63 for a PPO,

Medicare Advantage Plans Under 65

If you are under 65 but have Medicare because of a disability or other qualifying condition, after 2 years of disability you have the blanket right to buy a medicare plan guaranteed issue and a Medicare Advantage Plan.

Coverage while traveling. Many plans will only pay for emergency care when you are away from home. If you divide your time between two homes or pay extended visits to your adult children, this could pose a problem if you need something routine such as a lab test. A few plans have national networks you can use, but you can’t see this information on You will have to call the plan directly to ask about it. The plan’s listing on has numbers for you to call.

Which Medicare Advantage Plan To Choose

The first thing to do is make sure you are seeing all the plans in your area. Does the plan have a good star rating?

What are the Co-pays, Deductibles, out of pocket limit?

Is your Hospital & doctors in the networks list of providers?

Does it offer dental and vision coverage and additional benefits?

Medicare Advantage Plans With Dental

Dental coverage through Medicare Advantage plan. You may be able to get dental coverage under some Medicare Advantage plans. Medicare Advantage plans (Medicare Part C) can include extra benefits like routine dental, routine vision, and Medicare prescription drug coverage.

Medicare Advantage Plans With Dental & Vision coverage. Many Advantage plans come with some dental and vision coverage

Medicare Advantage Plans With Silver Sneakers

SilverSneakers is the premier fitness program provided at no cost by more than 60 health plans nationwide. Millions of members. Thousands of gyms.

Medicare Advantage Plans With Nationwide Coverage

If you divide your time between two homes or pay extended visits to your adult children, this could pose a problem if you need something routine such as a lab test. A few plans have national networks you can use

Enrollment Periods

If you decide to buy a Medicare Advantage plan, you must enroll between Oct. 15 and Dec. 7 – the period known as open enrollment – in order for your coverage to start the first of the following year. (Original Medicare has separate enrollment periods for seniors who aren’t automatically enrolled.) Because of government regulation, Medicare Advantage premiums are not influenced by age, health status or the method by which a consumer signs up (through an insurance agent, for example, or directly through an insurer).

Medicare Advantage Lock-In Period

Individuals with a Medicare Advantage plan are “locked-in”, meaning they can only switch Medicare plans during certain times of the year unless they qualify for special circumstances or choose to switch to a plan with a Plan Performance Rating of 5 stars during the year in which that plan has the 5-star overall rating, provided the individual meets the other requirements to enroll in the plan (e.g., living within the plan’s service area as well as requirements regarding end-stage renal disease).

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By |2017-02-12T18:30:53+00:00February 12th, 2017|Articles|Comments Off on Medicare Advantage Frequently Asked Questions

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