Overview

Medicare Advantage (Part C) is a private alternative to Original Medicare (Parts A & B) and typically offers additional benefits. Medicare Advantage plans often limit your coverage to a particular network of healthcare providers; plans that allow you to see out-of-network providers charge you more.

You may pay a premium for your Medicare Advantage plan, in addition to your Part B premium.

    Benefit Period

    is the way the Original Medicare program measures your use of inpatient hospital and skilled nursing facility (SNF) services. It begins the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row.
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  • What is the premium for a Medicare Advantage plan?

    Short Answer:

    Premiums for Medicare Advantage (Part C) plans vary depending on which plan you choose. Many Medicare Advantage plans charge no additional monthly premium beyond your Part B premium, which you must continue to pay.

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    Medicare Advantage plans are sold by private insurance companies, and their coverage, premiums, and out-of-pocket costs can differ widely depending on the carrier and plan features.

    Medicare Advantage plans must offer at least the same benefits as Original Medicare, and they may also offer prescription drug coverage. In some cases you may be an additional premium for extra benefits that aren't offered by Original Medicare, such as routine vision, hearing, and dental coverage.

    In addition to any monthly premiums, you may have to meet a deductible and pay copayments or coinsurance for doctor visits and other medical services. Check your plan’s Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) for specific information about costs.

     

  • When can I change my Medicare Advantage plan?

    Short Answer:

    You can change your Medicare Advantage (Part C) plan only at certain times of the year. Your main opportunity to change plans is during the Annual Election Period (AEP), which takes place between Oct. 15th and Dec. 7th each year. Your new coverage begins on Jan. 1.

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    Aside from during the Annual Election Period (AEP), you can potentially change your Medicare Advantage plan at these times:

    • Initial Enrollment Period. This is the time frame when you first become eligible for Medicare. It is a seven-month window that runs from the three months before the month of your 65th birthday, your birthday month itself, and the three months following your birthday month.
    • Medicare Advantage Open Enrollment Period (January 1 to March 31). New in 2019, you can switch from one Medicare Advantage plan to another. However, you must be enrolled in a Medicare Advantage plan on January 1 to be eligible for this enrollment period. You cannot switch into a Medicare Advantage plan from Original Medicare during this time.
    • Special Enrollment Period (SEP). Becoming eligible for a SEP allows you to make changes outside the regular open enrollment period. You qualify for a SEP under certain circumstances, such as permanently moving out of your Medicare Advantage plan's service area or other changes to your health insurance situation. You can see a comprehensive list of SEPs here.
    • Anytime for LIS or PACE. If you are currently qualified as Low Income Subsidy (LIS) or in a PACE program with your state, you can generally change Medicare Advantage plans at any time, with an effective date of the 1st of the following month.
  • Do Medicare Advantage plans have deductibles?

    Short Answer:

    Whether you'll need to meet a deductible depends on which Medicare Advantage (Part C) plan you choose. Costs among plans vary widely. Even if your plan has a $0 deductible for medical care, you may have a separate deductible for your prescription drugs. Plus you may face other charges, such as copayments or coinsurance.

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    Medicare Advantage is a replacement for Original Medicare (Parts A & B) and must offer at least the same benefits as Original Medicare; many plans offer more.

    But unlike Original Medicare, there is no set deductible for Medicare Advantage plans. Instead, the deductibles in individual Advantage plans typically range from $0 to $200, depending on the insurer and the benefits offered, but can go as high as $1,000 or more for medical services that would be covered under Part B.

    By contrast, under Original Medicare in 2018, Medicare Part A (hospital insurance) has a deductible of $1,340 per benefit period. Meanwhile, Medicare Part B (medical insurance) has an annual deductible of $183.

    Research the costs before you choose a Medicare Advantage plan and be sure to read your plan’s Evidence of Coverage (EOC) and Annual Notice of Change (ANOC), which detail your coverage and your expected costs. These costs can change each year, and your plan will notify you of any changes in your ANOC.

  • Will I pay coinsurance with Medicare Advantage?

    Short Answer:

    Cost vary widely among Medicare Advantage (Part C) plans, and you may need to pay coinsurance, depending on which plan you choose. Even if basic medical and hospital care is 100% covered, you may have to pay coinsurance for other specific services such as outpatient surgery, durable medical equipment, cancer treatments, and prescription drugs.

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    Research the costs before choosing a plan, and check your chosen plan’s Evidence of Coverage (EOC) and Annual Notice of Change (ANOC), which detail your coverage and  your expected costs.

    These costs can change each year. Your plan will notify you of any changes in your ANOC.

  • Are there copayments with Medicare Advantage?

    Short Answer:

    You may have copayments, depending on which Medicare Advantage (Part C) plan you choose. Each plan typically has different policies on out-of-pocket costs, including whether or not you’ll pay a flat-dollar copayment for doctor visits.

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    You should always research plan costs before you enroll, and be sure to read the Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) documents your plan provides. These detail not only what coverage you have, but also your expected costs.

    These costs can change each year. Your plan is required to notify you of any changes in the ANOC. These documents are typically mailed to you, but they can be emailed as well, depending on the insurer and your delivery preferences.

  • What does Medicare Advantage cover?

    Short Answer:

    Medicare Advantage is a private-insurance alternative to Original Medicare (Parts A & B) that is required to offer the same benefits as the government program, along any extra coverage individual plans want to offer. These additional benefits vary widely from plan to plan but most commonly include prescription drug coverage, as well as dental, vision, and hearing services.

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    By law, all Medicare Advantage plans will cover your hospital treatment (Medicare Part A) and basic medical care (Medicare Part B), just as Original Medicare does.

    These plans can and usually do, though, offer additional benefits that you can't get under Original Medicare. In addition to the most common extras—prescription drug, vision, dental, and hearing care coverage—some plans offer various types of wellness benefits that may include options such as discounted gym memberships and weight loss counseling. In addition, starting in 2019, some plans may offer transportation services to and from doctors, access to telemedicine, coverage to install bathroom safety devices, and other newly available benefits.

    Even if you have Medicare Advantage, Original Medicare will still be the go-to insurer for coverage of hospice care and some costs for clinical research studies, if you need these services.

    It's important to remember that Medicare Advantage's extra benefits typically come with different rules and restrictions: In most cases, you have to visit a healthcare provider who’s in your plan's designated network or, if this option is offered, face higher costs to see an out-of-network provider. You also commonly need a referral to see a specialist.

  • Does Medicare Advantage cover dental?

    Short Answer:

    Unlike Original Medicare (Parts A & B), many Medicare Advantage (Part C) plans offer some degree of dental care.

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    Medicare Advantage is offered by private insurance companies and must cover the same services Original Medicare (Parts A & B) covers. In addition, many Medicare Advantage plans provide extra benefits, and  dental coverage is among the most common.

    The degree of coverage, though, differs widely among Advantage plans. Among those that have dental benefits, the most commonly offered are coverage of cleanings, X-rays, and annual exams. Many also include some coverage of fillings, extractions, root canal, dentures, crowns and bridges, and gum disease treatment.

    To see if your plan covers dental services and, if so, which ones, read the Evidence of Coverage (EOC) document you received, or contact your insurer.

    You can also explore affordable, stand-alone private dental plans here.

  • Does Medicare Advantage cover hospice care?

    Short Answer:

    You can get hospice care if you have Medicare Advantage (Part C), but it will be covered under Part A of Original Medicare.

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    You can get hospice care if you have a Medicare Advantage plan, but the coverage will actually come under Part A of Original Medicare.

    To be eligible for hospice care under Medicare:

    • Your hospice doctor and your regular doctor must certify that you’re terminally ill (expected to live six months or less).
    • You opt for palliative care (for comfort) instead of care to cure your illness.
    • You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

    Learn more about hospice and Medicare here.