Medicare Advantage

Medicare Advantage Plans, also known as Medicare Part C, feature coverage similar to Original Medicare but they have additional benefits.

How Medicare Advantage Plans work

With Medicare Advantage Plans, you will still be enrolled in Medicare Part A and B while enrolled in your Medicare Advantage Plan. Then, Medicare pays the insurance company for administering your benefits. That’s how, sometimes, you can receive this plan at no additional cost to you.

When you go to receive healthcare covered by Medicare, you will present your Advantage Plan card as a form of payment. 

You will have a network of doctors and hospitals that you are allowed to visit. It may be HMO or PPO networks. Most HMO plans don’t cover any out-of-network visits except in an emergency. PPO plans do offer some out-of-network coverage but it will result in much more cost-sharing by you. HMOs will also require a referral from your primary care physician if you wish to see a specialist.

Enrollment periods

Your initial enrollment period is three months before you turn 65 and lasts until three months after. 

There is also an annual election period and an open enrollment period. 

Your annual election period, or AEP, begins October 15 and runs through December 7 every year.  Coverage will begin January 1 the following year. 

Medicare Advantage’s open enrollment period is from January 1 through March 31. 

During this time you can switch to another MA plan or disenroll and go back to Original Medicare. 

You may also qualify for a special election period. If you have missed your initial enrollment or AEP and are interested in adding an Advantage plan to your health coverage, you can speak to a licensed Medicare agent to see if you qualify for a special election period.

What do Medicare Advantage Plans cover?

MA plans offer the same benefits of Parts A and B along with some additional benefits. Your basic coverage is inpatient hospital care, skilled nursing facility care, hospice, lab tests, surgery, home health care, outpatient care, medical equipment, and some preventative services. 

Additional benefits your plan may include are: 

  • Adult day-care services
  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Over-the-counter drugs
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness programs

If you have a chronic health condition, you may also receive additional benefits specific to your situation. These could include things like meal delivery, home cleaning, education programs for your disease, visits to a nutritionist, or transportation to grocery stores.

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