This information is not a complete disclosure of all information regarding Medicare Advantage. Limitations and restrictions may apply regarding benefits, premiums, co-pay and co-insurance.

What is a Medicare Advantage plan?

Medicare Advantage plans are offered through private insurers as part of the Federal Medicare program. Medicare Advantage or Medicare Part C acts as a secondary insurance to provide hospital (Part A), medical (Part B), and drug coverage (Part D).

When is open enrollment for Medicare Advantage?

Enrollment in a Medicare Advantage or Part D plan is during the 7 months initial enrollment period (IEP) the year you qualify for Medicare, typically 3 months before and after you turn 65 and the month of the 65th birthday or 21 months after receiving Medicare due to a disability if under 65 years old or ESRD.

The annual election period (AEP) from October 15th to December 7th every year.

Does Medicare Advantage have co-pays?

Typically, there are fixed copays for doctor visits and yearly out-of-pocket limits for healthcare costs. Some plans may include a deductible.

What types of plans does Medicare Advantage have?

There are various plans offered through private insurance; HMO, PPO, and Private Fee-for-Service.
Read our article: Types of Medicare Advantage Plans

Do you have to be enrolled in Medicare to enroll in a Medicare Advantage Plan?

Yes. You must be enrolled in Medicare Part A and Medicare Part B

Who can enroll in a Medicare Advantage plan?

A few requirements need to be met to be eligible for a Medicare Advantage plan.

  • Be eligible for Medicare
  • Be enrolled in both Medicare Part A and Medicare Part B (If you are not sure, check your Medicare card.)
  • Live within the country of plan’s service area (this is not based on your state of residence)
  • Not have end-stage renal disease (ESRD). (There are special circumstances and plans for ESRD)

Do you lose your Original Medicare Part A and Part B when you enroll in a Medicare Advantage plan?

No, you do not lose your original Medicare. However, after enrollment in a Medicare Advantage Plan, the private insuring company offering your plan may handle some of the administrative processes to implement your Medicare benefits.

Once enrolled in Medicare Advantage, can I opt out or end my plan?

You can return to your Original Medicare A and B coverage during October 15th through December 7th. This period is called the Annual Election Period (AEP).

Do you lose Original Medicare if you sign up for a Medicare Advantage plan?

Medicare is not supplemental insurance, and a Medicare Advantage plan does not replace it.

Do all medical providers accept Medicare Advantage plans?

A Medicare Advantage plan works differently than a Medicare supplement plan, and doctors and hospitals before providing medical or health care services must agree to accept the plan’s “Terms and Conditions.” Emergencies are the exception.

Does each Medicare Advantage plan offer the same type of health coverage?

Just like many insurance companies, Medicare Advantage plans are different from each other. Even though all Medicare Advantage plans must cover at least the Medicare “Medically-Necessary Services,” they can charge different deductibles, offer co-payments, various co-insurance terms, and limits on yearly spend.  Many plans offer eye care, dental and fitness programs as additional services.

How do I choose a Medicare Advantage plan ?

Just like choosing any insurance, you must compare the benefits offered in various plans to shop for the best coverage. Pay close attention to understand the freedoms and additional benefits you could lose by changing from a current plan.

Here are a few questions to ask:

  • Can you change your current doctor, or is your doctor in the new plan’s network?
  • Are your medications covered on the prescription plan’s formulary?
  • How much does the monthly premium or coverage cost?
  • Are the co-payments and co-insurance explained in the plan’s Summary of Benefits or Evidence of Coverage?
  • Are additional services offered; preventive care, vision, dental, and fitness?
  • Do you have medical treatments that are not covered by the plan?
  • Are there extra costs when you visit a doctor who is out-of-network?

How to choose between a Medicare Part D Prescription Drug Plan (PDP) and a Medicare Advantage Plan that includes prescription drug coverage (MAPD)?

Medicare prescription drug plan coverages are available with both stand-alone Medicare Part D prescription drug plans (PDPs) or with Medicare Advantage plans with prescription drug coverage (MAPDs) included. However, when choosing between PDP and MADP, this depends on the type of coverage you want and your personal preference. You will need to decide if you wish to have only prescription drug coverage or if you want the prescription drug coverage along with healthcare coverage.

What is the difference between Medicare Advantage Plans and Medicare Supplements or Medigap Plans?

Medicare Supplements (or Medigap plans) work simultaneously with your Medicare plan. By having a Medicare Supplement, this helps fill in any “gaps” such as your deductibles and co-payments within your Medicare Part A and Medicare Part B. 

Medicare Advantage Plans manage your Medicare Part A or Medicare Part B health coverage. When choosing a Medicare Advantage Plan, the policy must provide additional coverage such as dental, vision, hearing, or wellness programs.

What is the Medicare Advantage Plan Part C?

Medicare Advantage – also known as Medicare Part C, offers Part A (Hospital), Part B (Medical), and often Part D (Prescription) coverage. The Medical Advantage Plans are governed by the Federal Medicare Program and can be available through private insurance companies, including Cigna. 

Individuals looking at Medicare Advantage plans have different options, including HMO, PPO, and Private Fee-for-Service plans available. Those who opt for Medicare Advantage is still responsible for paying a deductible, but instead have set co-pays for doctor visits. To participate in the Medical Advantage Plan, you must first have the Original Medicare Part A and Part B coverage. 

Who can join a Medicare Advantage Part C plan?

There are some requirements an individual must meet to be eligible for a Medicare Advantage Part C plan. These requirements include: 

  • Eligible for Medicare 
  • Enrolled in both Medicare Part A and Medicare Part B  
  • Reside within the plan’s service area 
  • No End-Stage Renal Disease (ESRD)

Can you lose Original Medicare Part A and Part B when enrolling with the Medicare Advantage Plan Part C?

You will not lose your Original Medicare Part A and Part B plan when you enroll with Medicare Advantage Part C. Once you have opted for the Part C plan, the insurance company will apply these benefits. However, if you opt-out of the Medicare Advantage Plan, you are can revert to your Original Medicare Part A and Part B plan in the next Annual Enrollment Period (AEP). AEP runs October 15th through December 7th.

Will the Medicare Advantage Plan Part C replace Medicare?

The Medicare Advantage Part C will not replace your Medicare plan. Instead, the Medicare Advantage Plan will work differently than your Medicare supplement.

What are the different types of Medicare Advantage Part C Plans?

There are a few common types of Medicare Advantage Part C Plans. Many of these plans include prescription drug coverages: 

  • Health Maintenance Organization (HMO) – this plan allows you to work with a network of both doctors and hospitals. However, care may not be covered if you seek treatment outside of your HMO network without seeking prior approval. 
  • Preferred Provider Organization (PPO) – PPO plans allow individuals to access a network of hospitals and doctors but will enable you to choose which hospital and doctor you want. Also, with PPO plans, you can see out-of-network doctors and hospitals, but there could be a higher coinsurance or copay. 

Do all Medicare Advantage Part C Plans have the same health coverage?

Each Medicare Advantage Part C Plan offers different coverage. Medicare Advantage plans do cover Medicare “Medically-Necessary Services.” Also, Advantage plans vary in deductible prices, copays, and coinsurance terms. Depending on the Medicare Advantage plan you choose, there could be a limit on how much you spend yearly. Medicare Advantage plans can also provide fitness programs along with eye and dental coverage.

How to choose a Medicare Advantage Part C Plan?

When choosing a Medicare Advantage Part C Plan, be sure to compare the different benefits available with your current insurance plan. Also, research the benefits that you could lose by choosing this plan. Other things to consider include: 

  • If you can change your current doctor, and is this doctor within your network? 
  • Do you have prescription coverage? 
  • Monthly premium cost
  • Co-payment and Co-insurance cost 
  • If any additional coverage is available such as preventive care, dental, vision, or health club memberships. 
  • Are there any treatments that are not covered in your new plan that you need?

Does Medicare Advantage help reduce the costs of medical bills?

Some Medicare Advantage plans can help reduce long-term medical expenses. However, some individuals can see these expenses increase. This information can depend on the average spending of the beneficiaries. 

In 2016 a survey was completed and found a difference between traditional Medicare and Medicare Advantage plans. The adjusted health risks were $1,253. Therefore, it is said that Medicare Advantage can help an individual save money on medical bills.

Does Medicare Advantage lower long-term medical expenses?

With Medicare Advantage, there are multiple plans to choose from. Therefore, it can be challenging to determine if Medicare Advantage lowers long-term medical expenses per individual situations. Medicare is broken up into four different parts. Three of these parts include Part A, B, and D which provide Americans 65 years of age or older with basic health coverage. The fourth part is Medicare Advantage Part C, which helps provide coverage for accidents and illnesses that have a higher expense. 

What is an HMO POS Medicare Advantage Plan?

Health Maintenance Organization with a Point of Service Option (HMO POS) – The HMO policy allows you to have more freedom when choosing your network than the “traditional HMO.” However, you can incur some additional fees when using the POS (out-of-network).

What is a Medicare Advantage Medicare-Medicaid Plan (MMP)?

An MMP is provided through a private health plan made to offer Medicare and Medicaid coverage for individuals who are eligible for dual Medicare beneficiaries. 

What is a Medicare Advantage Special Needs Plan (SNP)? Who is eligible for this plan?

An SNP is a form of a Medicare Advantage Plan that provides healthcare coverage, drug prescription coverage for a list of covered medications, and freedom to choose providers. This plan was created for those who have specific personal or health needs, including those with chronic conditions, limited income, or those in a long-term healthcare facility. 

Individuals who are eligible for this plan must meet specific requirements such as living within the plan’s service area, no kidney-failure or End-Stage Renal Disease. Also, individuals are only eligible for SNP if they have a “Special Need” such as a chronic illness, financial hardships, or ESRD.

What happens when reaching the Medicare Advantage plan out-of-pocket maximum?

The Maximum Out-of-Pocket (MOOP) is the total amount you spend each year between co-insurance and co-payments or for Medicare Part A and Part B services. When you have met this maximum, the Medicare Advantage in-network services are now covered and are at no cost to you.

If I have an HMO Medicare Advantage plan, can I add prescription drug coverage with a stand-alone Medicare Part D plan?

Medicare Advantage plans are offered in two different plan options. Option one – Medicare Advantage with Prescription Drug Coverage (MAPDs). Option two – Medicare Advantage without Prescription Drug Coverage (MAs). 

When choosing an MA plan, there is no option to add a different Medicare Part D plan. However, this can be done if the MA plan is a Private Fee-for-Service (PFFS) plan without prescription drug coverage or a Medical Savings Account (MSA). 

By adding a Part D plan to your HMO or PPO Medical Advantage plan, this will remove your Medicare Advantage plan and revert you to the Original Medicare Part A and Part B. And vice versa, if you have a Medicare Part D and enroll in a Medicare Advantage HMO or PPO, you take the risk of losing your Medicare Part D coverage.

Will I be considered an Income Related Monthly Adjustment Amount (IRMAA) for Medicare Part D if I have a Medicare Advantage plan?

If your income is higher than the certain limits, and you have a Medicare Advantage plan, this provides drug coverage. This means your plan includes the Medicare Part D Drug Coverage, and you are subject to an IRMAA for your Part D and Part B coverage. 

With that said, if you have a Medicare Advantage plan where you do not have prescription coverage or Medicare Part D coverage, then you will not be charged for the Medicare Part D IRMAA. 

If I have a Medical Advantage plan, can I use this as I travel the country?

While Medicare Advantage plans require the individual to reside within the service area for a certain ZIP code or country, these plans are typically not as transferable as Medicare Supplement. With that said, you can travel with your Medicare Advantage Plan.

Is there a difference between a Medicare Part D prescription plan and a Medicare Advantage plan?

There is a difference between these two plans. The Medicare Part D prescription plan allows coverage for out-patient drug coverage.

What Medical Advantage plans can offer coverage when traveling through the United States at no additional cost?

Both Medicare Advantage HMO and PPO plans have well-known healthcare coverage and available networks. However, if you seek treatment from a provider who is not within your network, you can incur additional charges. Some Medical Advantage plans allow individuals to apply extended coverage options to their plans who spend time in multiple different states. 

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