Medicare Advantage Plans (also known as
Medicare Part C) are health plan options that are part
of the Medicare program. If you join one of these plans,
you generally get all your Medicare-covered health care
through that plan. This coverage can include Medicare
Part D prescription drug coverage or you can enroll in a
separate Medicare Part D prescription drug coverage
plan. Medicare Advantage Plans include:
- Medicare Health Maintenance Organization (HMOs)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service (PFFS) Plans
- Medicare Special Needs Plans
No health questions are asked.
Acceptance is guaranteed for all Medicare
eligibles every year during the appropriate
enrollment period regardless of health conditions
(except End Stage Renal Disease). People on Medicare due
to a Disability as well as Dual Eligibles -- people on
both Medicare and Medicaid -- can enroll year-round.
However, most Medicare Advantage plans require you to
pay a co-pay each time you see a doctor, receive medical
treatment, or visit a hospital. The maximum
out-of-pocket expenses you are required to pay are often
capped on a per-year basis, but not always.
When you join a Medicare Advantage Plan, you use the
health insurance card that you get from the plan for
your health care. In most cases there are extra benefits
and lower co-payments than in the Original Medicare
Plan. However, with PPO and HMO plans you may have to
see doctors that belong to the plan or go to certain
hospitals to get services or risk higher out-of-pocket
expenses for going "out-of-network". PPFS plans enable
you to see any health care provider that accepts
Medicare.
To join a Medicare Advantage Plan, you must have
Medicare Part A and Part B. You will have to pay your
monthly Medicare Part B premium to Medicare. In
addition, you might have to pay a monthly premium to
your Medicare Advantage Plan for the extra benefits that
they offer. Depending on where you live, some Medicare
Advantage Plans have a $0 premium plan option, and some
even reimburse you for part of your Medicare Part B
premium. Some plans include dental and vision benefits
in addition to coverage for hospital stays, doctor
visits, diagnostic tests, inpatient and outpatient
services, skilled nursing, and more. Some plans even
include free health club memberships.
If you join a Medicare Advantage Plan, your Medigap
policy won’t work. This means it won’t pay any
deductibles, copayments, or other cost-sharing under
your Medicare Health Plan. Therefore, you may want to
drop your Medigap policy if you join a Medicare
Advantage Plan. However, you have a legal right
to keep the Medigap policy. |
