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A Guide to Medicare Advantage

What Is Medicare Advantage?

Medicare Advantage plans (Medicare Part C) are provided by private insurance companies that are approved by Medicare. This alternative to traditional Medicare will cover all items under Part A and Part B (except for hospice), and you may also enjoy additional coverage benefits.

How Does Medicare Advantage Work?

If you choose a Medicare Advantage plan, then you are still technically enrolled in the Medicare program. Every month, Medicare pays a fixed amount to the private insurer who provides your Medicare Advantage plan, and that insurer will cover your costs based upon Medicare’s rules.

How Does Someone Qualify for Medicare Advantage?

To qualify for Medicare Advantage, you must first enroll in both Medicare Part A and Part B. Then, to choose a particular plan, you must live within its service area. Finally, if you are diagnosed with end-stage renal disease, you may not be eligible to enroll.

What Are the Benefits of Medicare Advantage?

There are three significant benefits to enrolling in a Medicare Advantage plan:

  1. Medicare Advantage may cover items that are not covered by Original Medicare, such as dental, vision, and prescription drug benefits.
  2. While you will still be paying your Original Medicare premium, you could pay as little as $0 per month for your Medicare Advantage plan.
  3. Every plan comes with a maximum annual out-of-pocket limit. Once your healthcare spending reaches that limit, you will pay nothing more for the rest of the year. Depending on your plan, however, this out-of-pocket limit may change each year.

What Are the Possible Downsides of Medicare Advantage?

All Medicare Advantage plans are administered by private insurance companies, so the rules and guidelines can vary. This leads to issues such as:

  1. The specifics of each policy will vary based on the insurance company.
  2. A plan’s benefits, premiums, and copayments may change each year.
  3. Medicare Advantage plans have annual contracts with Medicare, and they may choose not to renew for the following year.
  4. You may need to follow strict rules to get coverage for certain health products or services, such as getting a referral in order to see a specialist.
  5. Additionally, most Medicare Advantage plans restrict you to a network of medical providers, so you may have to switch to a different doctor or pay more to see your usual physician.

How Do Medicare Advantage Plans Compare to Medicare Supplement Plans?

Both Medicare Advantage and Medicare Supplement (Medigap) plans are offered by private insurance companies. While Medicare Advantage is an alternative to Original Medicare, however, Medicare Supplement works alongside your Part A and Part B coverage. Both of these options are great ways to reduce your out-of-pocket costs from Medicare, but you can only enroll in one plan at a time.

Which Medicare Advantage Plan Is Right For Me?

Now that you understand what Medicare Advantage is, you may be considering purchasing a Medicare Advantage plan. Fortunately, the experts at My Medigap Plans can help you find the right plan for your needs. Just contact us today!

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