Knowing The Details of Medicare Advantage
Once you are enrolled in Original Medicare, you will need to decide whether you want to insure yourself using a Medicare Supplement Plan or a Medicare Advantage Plan.
When you join a Medicare Advantage plan (Medicare Part C), you move completely onto a private health insurance plan, so you are no longer insured by the Original Medicare provided by the government. Instead, private insurance pays the majority of the bills, and you pay a coinsurance or copay per visit. However, you are still in the Medicare program, and these private health plans are strictly regulated by Medicare.
What is the cost of a Medicare Advantage plan?
Medicare advantage plans availability and premiums vary by county. To determine if a Medicare Advantage plan is the right fit for you, we will go over the options available in your area with you in detail.
Many of the Medicare Advantage plans have Part D prescription drug coverage built-in. These plans require that you make more copayments whenever you use most medical or hospital care. This option can allow for significant savings in some situations.
If you select a Medicare Advantage plan that does not have prescription drug coverage in it, and you do not have other credible coverage such as the Veterans Administration (VA), then you may be penalized. (See the Medicare Part D page)
What doctors can I see?
Some Medicare Advantage plans are HMOs that require you to choose a Medicare-eligible primary care doctor and then utilize a network of physicians with which the plan has a contract. Most HMO companies have extensive networks.
Other Medicare Advantage plans are Preferred Provider Organization (PPO) or Private Fee for Service (PFFS) that allow you to choose whatever Medicare-eligible provider you want provided they accept the plan’s terms, conditions and payment rates.
While Medicare Advantage plans do have appointed service areas, they do offer worldwide coverage for emergencies. If you are traveling and need non-emergency care many plans have some mechanism for accessing non-emergency care outside the plan’s service area.
When can I join?
Medicare Advantage plans require that you be enrolled in original Medicare A & B, and then the standard open enrollment dates apply. That is three months before your 65th birthday month, the month that you turn 65 and 3 months after your 65th birthday. (Important: if you worked past age 65 these enrollment dates change. See the working past age 65 page for more information.)
Need some help navigating the options?
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