Medicare Advantage (Part C) Guide: What You Need to Know
What is Medicare Advantage (Part C)?
While many people opt to get their Medicare coverage in separate components through the government with Original Medicare (Primarily Part A and Part B), Medicare Advantage is different. With a Medicare Advantage plan, you can receive the same Part A and B benefits (and oftentimes more) in one bundle through private insurance companies. In essence, Medicare Advantage is the alternative method for receiving Medicare coverage.
Also known as Medicare Part C, Medicare Advantage is not in addition to Part A and Part B; it's just the private counterpart for both. So like 1 + 2 = 3, for Medicare it’s A + B = C.
What does Medicare Advantage cover?
Medicare Advantage (or Part C, or MA plans—potato, potAHto) offers the same coverage as Original Medicare. By law, every Medicare Advantage plan must include all the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance).
However, many MA plans go even further, offering additional coverage Original Medicare won’t provide. Some of these benefits may resemble what you were used to through employer coverage, and there may be even more:
- Dental coverage
- Vision coverage
- Prescription drug coverage (like the add-on Part D for Original Medicare)
- Hearing aid coverage
- Health Programs (such as Silver&Fit or SilverSneakers)
Do these benefits sound appealing to you? We can help you find an MA plan that works best for your needs. Just give us a call.
How does Medicare Advantage work?
Medicare Advantage plans can provide coverage in various ways but, in general, you'll find most plans nested under one of the five categories below. Once you pick a plan from one of those categories, you’ll receive all your benefits through the methods that plan dictates.
- Health Maintenance Organization (HMO). In this type of plan, you choose a primary care physician and visit only hospitals, doctors, or specialists in a set network.
- Preferred Provider Organization (PPO). This plan is much like an HMO, only you can go out of network if you’re willing to pay more out of pocket.
- Medicare Private-Fee-for-Service (PFFS). These plans give you the freedom to visit any Medicare-approved doctor or facility, but the doctor or facility must agree to accept the plan’s payment.
- Special Needs Plan (SNP). These plans cater to people with certain diseases or mental conditions, people living in institutions, or people who qualify for both Medicare and Medicaid (dual eligibles). SNPs tailor their care to the group they cover.
- Medical Savings Account (MSA). Much like a Health Savings Account, an MSA deposits money into an account which you can use for medical expenses. These plans typically have very high deductibles.
Side note: Medigap vs. Medicare Advantage
A common point of confusion for people is Medigap vs. Medicare Advantage. These plans are not the same:
Medigap (or Medicare Supplement) is supplemental insurance a beneficiary can buy to supplement their coverage under Original Medicare. Medigap helps pay for things like coinsurance, deductibles, or other areas where Original Medicare coverage falls short.
Medicare Advantage is the counterpart to Original Medicare. While Original Medicare takes an á la carte approach to healthcare, where you can choose to add a Medigap plan and prescription drug coverage (Part D), Medicare Advantage is more like bundling all your health care into one package.
Once you know the distinctions between what Medicare Advantage provides and what Medigap provides, you’ll have an easier time deciding which Medicare plan is best for you.
Read our Medicare Advantage vs. Medigap comparison to learn about how else they differ and what that means for your coverage.
How much does Medicare Advantage cost?
First of all, whether you get your Part A and B benefits through Original Medicare or Medicare Advantage, you still pay a monthly premium to the government for Part B. That premium is $144.60 in 2020 (up from $135.50 in 2019).1 If you decide to enroll in an MA plan, the government gives your plan a flat rate for your enrollment. In plans with enough enrollees, you may not be charged any additional premium on top of your Part B premium. But the fewer enrollees, generally the more an MA plan will cost on top of the Part B premium.
With all of that said, over half of all beneficiaries don’t pay a premium for their Medicare Advantage plan (besides the Part B premium). As for the half that does pay a Medicare Advantage plan premium, the average estimate premium in 2020 is $23 (down from $26.87 in 2019).2 These numbers relate specifically to Medicare Advantage Prescription Drug (MAPD) plans.
However, the differences in cost vary primarily based on location as well as what additional benefits the plan covers.
When can I enroll in Medicare Advantage?
If you’re new to Medicare, you’ll want to enroll in an MA plan during your Initial Enrollment Period (IEP).
This period lasts for seven months—three months before your 65th birthday month and three after.
If you’ve delayed signing up for Medicare because you still have coverage from your current employer, you can sign up during a Special Enrollment Period. There’s also a Fall Open Enrollment Period (October 15 through December 7) during which you may sign up. This article explains enrollment periods and when they apply to you.
How do I join a Medicare Advantage plan?
After enrolling in Original Medicare, you'll be able to join a Medicare Advantage plan. Then, you’ll want to compare plans and see which one best fits your needs. Our guide explaining how to apply for an MA plan will help you figure that out.
Alternatively, if you would rather have an experienced agent help you find the best MA plan for your needs, call us.
1. Centers for Medicare and Medicaid Services, "Medicare Costs at a Glance"
2. Centers for Medicare & Medicaid Services, "Trump Administration Drives Down Medicare Advantage and Part D Premiums for Seniors"
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