Frequently Asked Questions About Medicare Advantage Plans
Are you currently enrolled in a Medicare Advantage Plan or are you thinking of joining a Medicare Advantage Plan? Choosing the right Medicare plan can feel overwhelming, and it’s normal to have questions. Here are the top questions we receive as Medicare insurance brokers about Medicare Advantage Plans and what you need to know about them before signing up.
What is a Medicare Advantage Plan?
A Medicare Advantage Plan, also known as Medicare Part C, is a health plan that is offered by a private insurance agency and provides all of the benefits of Part A and Part B Medicare. In most cases, a Medicare Advantage plan also offers Part D drug prescription coverage. It’s designed to “fill in the gaps” left by Medicare alone between coverage and actual needs.
There are a variety of types of Medicare Advantage Plans. The different types of Medicare Advantage plans include:
- Preferred Provider Organizations (PPO)
- Health Maintenance Organizations (HMO)
- Private Fee-for-Service plans (PFFS)
- Special Needs plans (SNP)
- Medicare Medical Savings Account plans (MSA)
Is a Medicare Advantage Plan Better Than Original Medicare?
Is having a Medicare Advantage Plan better than having Original Medicare alone? The answer to that question is: it depends on your needs.
The reason why some people choose a Medicare Advantage Plan is that the coverage offered under Original Medicare is often not sufficient for all of their needs – these plans are required to cover the same services as original Medicare, but can often add additional benefits that Original Medicare does not – this might be routine vision and hearing exams with discounted eyewear and hearing aids, routine annual physicals, and dental. Additionally, all Medicare Advantage plans have an annual maximum out-of-pocket, or a limitation on what you could be responsible for, for covered healthcare services within a given year. This can provide financial protection that Original Medicare does not. If you have a chronic condition, frequently visit the doctor, need prescription drug coverage, or just require more care than Medicare accounts for, this can be an attractive option.
Some people choose a Medicare Advantage Plan because, for them, it is more affordable than signing up for Medicare and then a separate Medicare Supplement (Medigap) plan to fill in the gaps. Deciding if you want a Medicare Advantage Plan is best decided through careful thought and a conversation with a dedicated agent.
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What Services Do Medicare Advantage Plans Cover?
By law, a Medicare Advantage Plan must provide all of the benefits of Original Medicare. This includes hospital stays, doctor visits, and specialist visits, as well as preventive care like screenings, vaccines, and annual wellness visits. Many plans also provide prescription drug coverage, along with additional benefits such as dental cleanings, eye exams, hearing aids, and health and wellness programs. Essentially, this is the portion of your plan that affects your day-to-day healthcare and helps you maintain overall well-being.
A Medicare Advantage plan typically provides urgent care and emergency coverage both inside and outside the plan’s service area in the United States. Keep in mind that when you sign up for a Medicare Advantage plan, you are required to continue paying your Part B premium.
How Much Do Medicare Advantage Plans Costs?
The cost of Medicare Advantage plans is as varied as the plan types and benefits. In general, the monthly premium can range anywhere from $0 to $200.
It's true that some Medicare Advantage plans have no premium costs; however, these plans generally have higher annual maximums, higher copays and coinsurance, and potentially fewer added benefits. Whereas a higher monthly premium typically has lower copays, enhanced coverage and additional services. It's important to compare the specific benefits and costs of each plan, as this can greatly affect overall healthcare expenses.
Find out How Can Medicare Advantage Plans Have No Premium Cost
Do you have other questions about Medicare Advantage Plans? Join us at one of our Free Medicare workshops to get your Medicare-related questions answered!
When Can You Enroll In a Medicare Advantage Plan?
You can sign up for a Medicare Advantage plan when you are first eligible for Medicare, either when you turn 65 or have a qualifying special election period, such as retiring and leaving employer-sponsored health insurance coverage.
There are several other times throughout the year you can enroll in a Medicare Advantage plan or change your enrollment from one plan to another. The most common time of year Medicare beneficiaries make medicare coverage changes during the Medicare Annual Election Period, or AEP. AEP occurs annually from October 15th - December 7th, and changes made during that time will go into effect on January 1st the following year.
Learn How to Change Your Medicare Plan During the Annual Election Period
For those who are already enrolled in a Medicare Advantage plan, they can also make coverage changes during the Medicare Advantage Open Enrollment Period, or MA OEP. This occurs annually from January 1st to March 31st, and plan changes made will go into effect on the 1st of the month following when you make enrollment changes.
Get Reliable Answers to All Your Medicare Questions
Still have questions on Medicare, Medicare Advantage Plans or other coverage options? At Twin City Underwriters, we are a team of Medicare brokers representing many insurance companies that offer Medicare plans in the Midwest area. This means we can help you understand and compare all of your plan options and enroll in the most suitable plan for your unique needs. Contact us today for more information and a complimentary, no-obligation consultation to determine if a Medicare Advantage Plan is right for you.
This is an updated blog post that was originally published in 2021.
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