What Is It? Medicare Advantage plans (also known as Medicare Part C) provide your Basic Medicare benefits (Parts A & B), along with additional medical coverage, all in one convenient private insurance plan. The additional coverage limits and helps pay for your out-of-pocket medical expenses.
Unlike Basic Medicare, many Medicare Advantage plans also include coverage for prescription drugs (also known as Part D). Medicare Advantage plans can also include dental, vision, and wellness benefits.
Most plans tend to be HMOs or PPOs. HMOs involve a set network of doctors and hospitals. They typically require you to coordinate your care through a primary care physician, who can refer you to specialists when needed. PPOs tend to have larger networks and do not require referrals for specialists. Since Medicare Advantage HMOs and PPOs provide all of your health coverage in a single plan, they can seem similar to the insurance you may have had through an employer.
Why Get It? Medicare Advantage plans can substantially reduce the amount you pay out-of-pocket for health care. Basic Medicare requires you pay for 20% of medical costs when needing outpatient care. It also requires you pay several hundreds of dollars per day when hospitalized for 60 days or more. Further, there is no cap on your out-of-pocket costs. There also is no coverage for prescription drugs, meaning you pay for 100% of costs at the pharmacy.
Medicare Advantage plans help pay for all of these out-of-pocket costs, with many plans including prescription drug coverage. They also place a "worst-case" maximum limit on your out-of-pocket costs. These limits vary from plan to plan, but can be very affordable. Medicare Advantage maximum out-of-pocket limits keep your costs both affordable and predictable.
Some people may prefer Medicare Advantage over Medigap because they enjoy the convenience of having one plan. Medigap plans work on top of, or in addition to, Basic Medicare.
- Who Is Eligible? Those who are eligible for Basic Medicare (Parts A & B) can enroll in Medicare Advantage. To be eligible for Basic Medicare, you must be 65 or older. Those under 65 are eligible if they are disabled.
When Can I Enroll? There are three enrollment periods for Medicare Advantage. The first is the Initial Enrollment Period. Initial Enrollment is the 7 month period surrounding your 65th birthday -- 3 months before, the month of, and 3 months after your birthday.
You can also enroll in a Medicare Advantage Plan during the Open Enrollment Period. This year's Open Enrollment Period begins on October 15 and ends on December 7. If you already have a plan, but would like a new one, this is also the time where you are permitted to change plans.
The last way to enroll is during the Special Enrollment Period. The Special Enrollment Period is only open to those who recently had a major life change, such as if you recently moved or lost health coverage.
Since Special Enrollment is limited, it is important that you do not miss the Initial or Open Enrollment Periods. Your coverage can be delayed.
- How Much Does It Cost? Monthly premiums for Medicare Advantage Plans greatly vary based on the plan you choose and the state you live in. Some plans cost $0** per month, others much more. The average premium for Medicare Advantage is around $39** per month.
- How to Enroll? The enrollment process is simple. To begin, speak with a licensed sales agent today by calling 855.402.1472 and apply right over the phone.