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What to Know About Medicare Advantage Plans

Updated: Nov 28, 2022

Medicare Advantage, also known as Medicare Part C, is a bundled plan available through private insurers. If you meet Medicare eligibility requirements, you'll also be able to sign up for a Medicare Advantage plan.

Before you enroll, here are some things to know about Medicare Advantage (MA) plans.

Offers Original Medicare coverage and more

Medicare Advantage plans cover Original Medicare. So you still enjoy all the benefits of Part A and Part B. In addition to covering the same benefits as Original Medicare, MA plans offer additional benefits that Original Medicare does not cover, such as drug prescription, fitness programs, and dental, vision, and hearing services.

Medicare Advantage plans have out-of-pocket limits

To protect you from paying high treatment costs, federal regulations require all Medicare Advantage plans to set out-of-pocket limits for Part A and Part B.

This means that if you are receiving services covered under Part A or Part B, you'll not be required to pay for the remainder of the year once you reach a certain limit.

You may also be able to pay less for healthcare, especially if the services you need are not covered by Original Medicare.

Medicare Advantage plans are regulated

While Medicare Advantage plans are available through private insurance companies, they are regulated by the federal government through the Center for Medicare and Medicaid Services.

So you still have certain rights and protection, such as the right to get emergency care when and where you need it and the right to appeal certain decisions.

You can enroll if you have a pre-existing condition

You can't be prevented from enrolling in a Medicare Advantage plan if you have pre-existing health conditions. Also, you can't be charged more for having pre-existing conditions such as diabetes, heart disease, or cancer. However, people with end-stage renal disease (ESRD) may not be able to sign up for an MA plan and will need to use a Special Needs Plan.

You can sign up or switch plans from Oct. 15 to Dec. 7

The first opportunity to sign up for a Medicare Advantage plan is during the initial enrollment period (IEP). The IEP is a 7-month window that includes three months before you turn 65, the month you turn 65, and three months after. You can also switch plans if you’re not happy with your existing plan during this period The other period in which you can sign up or switch plans is the open enrollment period from Oct. 15 to Dec. 7 every year.

Benefits vary from plan to plan

All Medicare Advantage plans are required to cover Part A and Part B services. However, all MA plans do not offer the same benefits. For example, some MA plans may cover transportation to the doctor's office but don't pay for fitness programs.

So before enrolling in Medicare Advantage and choosing a plan, talk with a doctor to know your health needs.

And for FREE, our independent Medicare brokers can then help you compare the coverages, costs, deductibles, and copays of multiple MA plans and guide you in choosing one that fits your health and financial situation. Call now to get started.



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