MEDICARE ADVANTAGE

Medicare Advantage plans, also called Medicare Part C, are plans offered by private health insurance companies and approved by Medicare. These popular plans cover Part A and B of Medicare, and many include extra benefits.   Prescription drug coverage (Part D) is usually also provided through the plan--all for a small, or sometimes zero additional premium. When you have a Medicare Advantage plan you are still obligated to pay your Part B premium.  

To join an Advantage Plan, you must:

• Have Medicare Part A and Medicare Part B 
• Live in the plan's service area

Points to remember about Medicare Advantage: 

Most Advantage plans require you to choose among a specific network of doctors. If continuing to see your current doctor is important to you, an agent can research the various plans offered in your local area to find those that include your doctor.  

Medicare Advantage plans may be an HMO, PPO, POS, or PFFS. As you explore plans, an agent can help you understand the difference, and how one may be preferred over another for your situation. 

Travel plans need to be considered when choosing a plan.   If  you plan to travel extensively inside or outside of the US, coverage  away from home is something you may wish to compare.   Some Advantage plans do not offer any coverage outside the United States, others offer some emergency coverage.  

Co-pays and Co-insurance: Depending on the plan, a primary care visit is usually a low or zero dollar co-pay, but otherwise most doctor visits and other clinical services involve a co-pay and/or co-insurance. Unlike Original Medicare however, a significant benefit to a Medicare Advantage plan, is the fact there is an-out-of-pocket maximum limit. 

Check your prescription drugs. Similar to the importance of checking to see if your doctors are on the plan, current prescription drugs should be considered as well. Most Advantage plans include prescription drug coverage, but formularies differ from one plan to another.  It is important to verify that your specific medication is covered and what your co-pay will be.  
 

Be aware of enrollment dates. Medicare Advantage plans have specific enrollment periods. You can change mid-year only in the event of specific qualifying events, such as moving out of state, which would give you a special election period. Therefore, choose your plan wisely. During the "Annual Enrollment Period" (which runs every year from October 15th thru December 7th),  Medicare beneficiaries can make changes without restrictions, from one Advantage plan to another, or switch back to Original Medicare. Changes made during this enrollment period are effective the following January 1st.