What is a Medicare Advantage plan?
Medicare Advantage plans come from a variety of private health plans — most often HMOs and PPOs — that private health insurers offer as a coverage alternative to Original Medicare. With Medicare Advantage, the health provider you choose manages your Medicare benefits, not the Federal Government, meaning that you are not on Original Medicare anymore. A Medicare Advantage plan is not a Medicare Supplement or Medigap plan. Here are some characteristics of Medicare Advantage plans.
- Every plan must cover all the same benefits that traditional Medicare covers, however the plans can charge different copayments.
- Some charge a monthly premium in addition to the Part B premium.
- Most include prescription drugcoverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium.
- All plans, by law, have annual limits on out-of-pocket costs.
- A big difference from Original Medicare is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Note: If you enroll in a Medicare Advantage health plan you cannot use a Medigap policy to cover your out-of-pocket expenses. It’s illegal for an insurance company to sell you a Medigap policy if you’re enrolled in a Medicare Advantage plan. If you stay in traditional Medicare, you would need to join a separate Part D prescription drug plan to get prescription drug coverage and pay an extra premium for it. Medigap does not cover out-of-pocket drug expenses.
- If you have Medicare because of disability: Medicare Advantage plans are all available to beneficiaries under age 65, regardless of past and present health conditions, with one exception. You cannot enroll in any of these plans if you already have end-stage renal disease, defined as needing regular dialysis or a kidney transplant, but you can still receive care under the traditional Medicare program.
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