The Most Important Things You Need to Know About Medicare Advantage

Updated: Jul 25

Medicare Advantage is a bundled plan that enables you to receive the benefits of Original Medicare (Part A and Part B), Part D (Drug coverage), and additional healthcare services under one umbrella.


Considering signing up for a Medicare Advantage plan? Great choice. Enrollment in MA plans continues to surge in 2022, with 28 million participants - about 45% of Medicare beneficiaries -enrolled in Medicare Advantage.


However, you need to understand the plan to be sure you're making the right decision.


Local Medicare Participants

What Does Medicare Advantage Cover?

Medicare Advantage covers all Part A and Part B benefits, including all medically necessary services in hospitals, doctors' offices, and other healthcare facilities. While it won't cover clinical trials and hospice care, you'll still be able to get those under Original Medicare. MA plans should also cover emergency healthcare.

  • MA plans also offer some benefits you won't get with Original Medicare, such as gym memberships, vision, hearing, and dental services.

  • MA plans vary from provider to provider. As such, you may be able to get even more benefits such as over-the-counter drugs, transport to the doctor's office, and other services that add to your overall well-being.

  • MA Plans can also be customized to treat individual patients' needs. For instance, applicants with specific chronic ailments can have MA plans individualized for treatment services.

  • Before signing up, check the plan to see if its benefits align with your medical needs.

  • If you're already enrolled in an MA plan, you can get all the information you need, such as the plan's coverage, cost, etc., from the Evidence of Coverage. However, this is usually sent by your plan in September. If you can't wait, you have the right to ask your plan whether a drug, service, or supply you need is covered or not.


Who is Eligible for Medicare Advantage Plans?

Anyone eligible for and already has Medicare Part A and Part B can sign up for Medicare Advantage plans.


Also, you can only sign up for a MA plan in the state where you live.


If you have to live in another state, it's best to ask the plan representative if you'll be able to receive benefits.


Who Manages and Regulates Medicare Advantage Plans?

Individuals who choose Medicare Advantage plans have to go through private insurance companies to access the benefits of the plans.


These private insurance companies have been approved by Medicare. And every month, Medicare pays a specific amount of money to these private insurers, enabling them to offer Medicare services to beneficiaries.


While private companies manage MA plans, the federal government regulates the program through the Center for Medicare and Medicaid Services.


What are In-Network and Out-of-Network Medicare Providers?

In-network providers consist of accredited doctors and healthcare centers that have agreed to accept discounted rates for Medicare beneficiaries.


On the other hand, out-of-network doctors and facilities have not contracted by your plans.

Receiving MA benefits at out-of-network facilities costs more than in-network because they charge full price and not the discounted rate of in-network providers.


Medicare Provider

How Much Do Medicare Advantage Plans Cost?

Medicare plans aren't standardized.


Hence, how much you'll pay depends on the benefits your plan covers, the state you're in, your provider, whether your doctor is in-network or out of network, etc.


While it's possible to have a zero-dollar premium, you'll probably still have to pay your part B premium, which is $170.10 as of 2022. Though, the premium may be higher for those with higher income. The average monthly premium for 2022 is $19, which is lower than 2021's figure of $21.22.


Premiums are not the only cost. There are out-of-pocket costs such as deductibles, copayments, and co-insurance, which are capped at a maximum of $7,550 for in-network and $11,300 for both in and out-of-network.


Plans that use in-network providers include:

  • Health Maintenance Organizations (HMO)

  • Preferred Provider Organization (PPO)

  • Private Fee-for-Service (PFFS)

  • Special Needs Plans (SNPs)

Now that you have a good understanding of what Medicare Advantage entails, our licensed Medicare agents will be proud to help you find the most suitable MA plans for your budget and needs.

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