| Fri, Jul 06, 2012 @ 09:00 AM

What is Medicare Advantage?

Posted by Medicare Made Clear

What is Medicare Advantage?Medicare Advantage (or Medicare Part C) plans offer an alternative to Original Medicare (Medicare Parts A and B) for getting Medicare benefits. They were created in 1997, when the U.S. Congress passed the Balanced Budget Act.

Medicare Advantage plans are offered by private companies approved by Medicare. Medicare pays a fixed amount for your care every month to these companies, and they have to follow rules set by Medicare. This is different from Original Medicare, which is provided directly by the federal government.

Medicare Advantage plans differ from Original Medicare in other ways, too. Here’s a quick overview.

What does Medicare Advantage cover?

Medicare Advantage plans provide your Medicare Part A (hospital) and Medicare Part B (doctors’ visits) coverage. They may also give you extra benefits, which may include some or all of the following:

  • Dental care coverage

  • Eye care coverage

  • Hearing care coverage

  • Wellness and fitness programs

  • Worldwide urgent care and emergency coverage

  • Mail-order pharmacy program

  • 24/7 nurse line

Most Medicare Advantage plans include Medicare Part D prescription drug coverage as well. Or you can choose a Medicare Advantage plan without prescription drug coverage.

Who can sign up for a Medicare Advantage plan? What does it cost?

You can sign up for a Medicare Advantage plan as soon as you’re eligible for Medicare. You need to also join Medicare Parts A and B.

All Medicare Advantage plans have “service areas.” These are areas where they offer coverage. Generally, you need to live in a plan’s service area in order to join it.

Unlike Original Medicare, the private companies that offer Medicare Advantage plans set their own plan costs. After enrolling in a Medicare Advantage plan, you continue to pay your Medicare Part B premium to Medicare. Some Medicare Advantage plans charge an additional premium, though some do not.

Each Medicare Advantage plan sets its own cost-sharing terms and amounts. So you’ll need to look into each plan to understand the potential out-of-pocket costs. However, all plans are required to put a limit on yearly out-of-pocket spending. For 2012, that limit for the year is $6,700. This yearly limit isn’t a part of Original Medicare.

Which doctors can you see with Medicare Advantage?

It depends on which Medicare Advantage plan you have. In some plans, your health care is “coordinated.” That means the plan coordinates your coverage through a primary care physician who manages the care you receive from specialists and hospitals. You may have to choose specific doctors and hospitals. In other plans, you can get care from any Medicare-eligible provider who accepts the terms, conditions and payment rates of the plan before providing coverage.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.

Resources:

An Overview of Medicare Advantage (Part C) – MedicareMadeClear.com

Medicare Made Clear™ Answer Guide – MedicareMadeClear.com

Medicare Plan Finder – Medicare.gov

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