Medicare advantage plan

How medicare advantage plans work

A Medicare Advantage is a second option to obtain Medicare Part A or Part B benefits. Medicare Advantage Plans sometimes known as “Part C” or “MA Plans,” are provided by private companies that are Medicare-approved and have to adhere to the rules of Medicare. If you sign up for the Medicare Advantage Plan, you’ll remain covered by Medicare but you’ll be able to get the bulk part of coverage under Part A as well as Part B coverage through the Medicare Advantage Plan, not Original Medicare.

The “bundled” plans include

Medicare Part A (Hospital Insurance) and Part B Medicare  (Medical Insurance), and generally Medicare drugs coverage (Part D).

Rules for Medicare Advantage Plans

Medicare provides a set amount every month to companies that offer Medicare Advantage Plans. They must adhere to the regulations set out by Medicare.

Every Medicare Advantage Plan could be charged different fees.

out-of-pocket costs. These can also come with different regulations for the way you pay for services, such as:

  • If you require assistance in locating an expert
  • If you must visit doctors, facilities, or other providers that belong to the plans for non-urgent or non-emergency medical care

The rules may change every year.

Costs for Medicare Advantage Plans

The amount you pay for the Medicare Advantage plan is based on a variety of factors. In the majority of cases, you’ll have to choose health providers that are within the network of the plan. Some plans don’t accept services from outside of the plan’s network or coverage zone.

Medicare Advantage Plans have an annual cap on your out-of-pocket expenses to cover the entirety of parts of medicare Part A and B benefits. If you exceed the limit, you’ll be charged no fees for services that are covered under Part A or Part B provide.

Find out more about these by reaching out to one of our agents.

The coverage for drugs in Medicare Advantage Plans

The majority of Medicare Advantage plans include coverage for prescription drugs (Part D). You can sign up for an individual Medicare drug plan with specific kinds of plans which:

  • It isn’t able to provide drug coverage (like Medicare Medical Savings Account plans)
  • Do not offer the coverage of drugs (like certain Private Fee-for-Service plans)

You’ll be ejected from Medicare Advantage Plan and returned to Original Medicare if both of these are true:

Take note that if you are a member of an HMO or PPO that does not cover drugs, then you’re not eligible to sign up for an additional Medicare drugs plan. In this instance, you’ll have to take advantage of other insurance for prescription drugs (like retiree or employer-sponsored coverage) or you can go without your insurance for drugs.

If you choose not to take advantage of Medicare drug coverage while you first become eligible, and the other coverage you have doesn’t provide covered by a creditable prescription drug plan or you’ll be required to be charged a late-enrollment fee when you enroll in the plan later. Find out more about Part D’s medicare late enrollment penalty.

What is the procedure? Medicare Supplement Insurance (Medigap) policies interact with Medicare Advantage Plans

You aren’t able to purchase (and do not require) Medigap while you’re in a Medicare Advantage plan. You aren’t able to utilize Medigap to cover any cost (

copayments, deductibles, as well as premiums) that you are covered as part of copayments, deductibles, and premiums) you have under a Medicare Advantage Plan. Learn more about the medicare choices with regards to Medigap guidelines as well as Medicare Advantage plans.

Locate Medicare Advantage Programs in your region.

The covered services are included in Medicare Advantage Plans

If you have the Medicare Advantage plan, you might be covered for items Original Medicare doesn’t cover, such as health plans (gym subscriptions, discounts) as well as some hearing, vision, or dental services (like regular checkups or dental cleanings). 

Plans also have the option to provide additional benefits. Some plans might cover things like transportation to doctors’ appointments, prescription drugs, and other services that help improve the health and well-being of your members. 

Plans may also customize their benefits packages to provide these benefits to specific chronically ill members. The packages can be that are specifically tailored to address certain conditions. Make sure to check with the plan prior to when you decide to enroll to find out the benefits it provides to see if you qualify for it, and what limitations are there. Find out more about the benefits Medicare Advantage Plans cover.

If you need help with this, it’s best to speak with our insurance agent. You can contact us at our website.  We’re happy to answer any questions you have about these plans and how they can help your loved ones. If you’d like some more information about the Medicare Advantage Plans, please visit our blog for additional resources.