Medicare Advantage

Medicare Advantage Plans, Part C

Medicare Advantage plans are an alternative way to get Medicare coverage through private insurance companies instead of the federal government. They provide the same benefits as Original Medicare and may include additional benefits such as dental, vision, drug, and wellness program coverage.

You enroll in a Medicare Advantage plan through a private insurance company, not the government. You must be enrolled in Original Medicare before you can enroll in a Medicare Advantage plan.

Eligibility

There are 3 general eligibility requirements to qualify for Medicare Part C:

1. You must be enrolled in Original Medicare (Part A and Part B)
2. There must be a Medicare Advantage plan offered in your area
3. You do not have End Stage Renal Disease (ESRD)

You cannot have a Medicare Advantage plan and a Medicare Supplement insurance policy at the same time.

Benefits

Medicare Advantage plans include the same standard benefits as Original Medicare. Some Medicare Advantage plans also provide extra benefits such as prescription drug, dental, and vision coverage. Additional benefits vary from plan to plan.

Enrolling in a plan

Medicare requires that you enroll in, disenroll from, or make changes to your Medicare Advantage plan only during pre-determined enrollment periods.

If you are enrolling for the first time, you may be able to join a plan during your Initial Enrollment Period, which occurs around your 65th birthday, or around your 24th month of disability (if you’re under 65 and eligible for Medicare).

You also may be able to join or switch plans during the annual Medicare Open Enrollment Period, which runs from October to December every year.

There are also Special Enrollment Periods that may let you join a plan outside of the main enrollment periods, depending on your circumstances.

Costs

If you enroll in a Medicare Advantage plan, you may have to pay some or all of the following expenses:

1. Original Medicare premiums
2. Medicare Advantage plan premiums
3. Out-of-pocket costs such as copayments, coinsurance, and deductibles

Plan options

The number of Medicare Advantage plans available to you will depend in part on where you live and how many companies offer coverage in your area.

There are 4 major types of Medicare Advantage plans:

1. Health Maintenance Organizations
2. Preferred Provider Organizations
3. Private Fee-for-Service plans
4. Special Needs Plans

The type of plan you choose may affect your prescription drug coverage options, referral requirements, and network restrictions.