Medicare Advantage, also known as Medicare Part C, makes it possible for people with Medicare Part A (hospital insurance) and Part B (medical insurance) to receive their Medicare benefits in an alternative way. Medicare Advantage plans are offered by private insurance companies contracted with Medicare and provide at least the same level of coverage that Medicare Part A and Part B provide.
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You may be wondering which is the better choice: sign up for a Medicare Advantage plan or Original Medicare. There isn’t a simple answer because Medicare Advantage plans have key features that many people find attractive and other characteristics that may not match with your personal preferences and/or lifestyle. Let’s take a closer look at some of the important pros and cons of Medicare Advantage plans
Costs for Medicare Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors. Learn about these factors and how to get cost details.
Drug coverage in Medicare Advantage Plans
Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:
- Can’t offer drug coverage (like Medicare Medical Savings Account plans).
- Choose not to offer drug coverage (like some Private Fee-for-Service plans).
You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:.
- You’re in a Medicare Advantage HMO or PPO.
- You join a separate Medicare Prescription Drug Plan.
While the majority of people with Medicare get their health coverage from Original Medicare, some choose to get their benefits from a Medicare Advantage Plan, also known as a Medicare private health plan or Part C. MA Plans contract with the federal government and are paid a fixed amount per person to provide Medicare benefits.
The most common types of MA Plan are:.
- Health Maintenance Organizations (HMOs).
- Preferred Provider Organizations (PPOs).
- Private Fee-For-Service (PFFS).
You may also see:.
- Special Needs Plans (SNPs).
- Provider Sponsored Organizations (PSOs).
- Medical Savings Accounts (MSAs).
Remember, you still have Medicare if you enroll in an MA Plan. This means that you likely pay a monthly premium for Part B (and a Part A premium, if you have one). If you are enrolled in an MA Plan, you should receive the same benefits offered by Original Medicare. Keep in mind that your MA Plan may apply different rules, costs, and restrictions, which can affect how and when you receive care. They may also offer certain benefits that Medicare does not cover, such as dental and vision care, caregiver counseling and training, and certain in-home support like housekeeping. Not all MA Plans cover additional benefits, so check with a plan directly to learn what benefits it covers.
All Medicare Advantage Plans must include a limit on your out-of-pocket expenses for Part A and B services. For example, the maximum out-of-pocket cost for HMO plans in 2019 is $6,700. These limits tend to be high. In addition, while plans can not charge higher copayments or coinsurances than Original Medicare for certain services, like chemotherapy and dialysis, they can charge higher cost-sharing for other services.