How Do Medical Advantage Plans Work?

Medicare Advantage Plan is another way to obtain Medicare gains through private insurers, offering a more comprehensive coverage package, but with certain limitations on healthcare providers and facilities. 

Private insurance providers approved by Medicare can offer Medicare Advantage [MA] plans [Medicare Part C]. It is a combination of –

‘Medicare Part A (hospital insurance) + Medicare Part B (medical insurance) + extra benefits’

You can contact Jason Rubin Insurance Services to learn more about the Medicare Advantage Plans and which is suitable to your specific needs. 

MA Plans offer different options, including –

  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)
  • Others. 

These plans typically include coverage for essential medical services such as –

  • Doctor visits
  • Hospital stays
  • Preventive care, 

Some plans may also –

  • Cover prescription drugs (Medicare Part D) 
  • Offer extra benefits [coverage for dental, vision, and hearing] 

While MA Plans can offer more comprehensive coverage, they often have specific networks of doctors and hospitals that you must use to receive full benefits. Additionally, individuals who choose a Medicare Advantage Plan still need to pay their monthly Medicare Part B premium along with any additional premium required by the specific plan.

How do Medicare Advantage plans work?

  • Enrollment: You must be eligible for Medicare Part A and Part B to enroll in a Medicare Advantage plan. You can join during specific enrollment periods, such as –
  • The Initial Enrollment Period
  • The Annual Enrollment Period
  • Special Enrollment Periods
  • Coverage: MA Plans provide the same coverage as Original Medicare, but some of them may also include extra benefits like coverage for –
  • Prescription drug 
  • Vision, dental, hearing, and wellness programs

Each plan can have different coverage options, so review the plan details before deciding.

  • Network: Most MA plans have a network of healthcare providers you must use to get the full benefits. These networks can include Health Maintenance Organizations, Preferred Provider Organizations and other plan types.
  • Costs: Besides, the Medicare Part B premium [compulsory], you have to pay monthly or zero premium for the chosen MA plan. Other costs to consider are coinsurance, copay, and deductibles for services used. 
  • Benefits: With basic coverage, you can benefit from payments for gym membership, over-the-counter medication, and transportation services. 
  • Prescription Drug Coverage [Medicare Part D]: This coverage level helps you save on your overall medication costs. Make sure to review the plan’s formulary category (list of covered drugs) to ensure your medications are included.
  • Flexibility: You’re required to stay enrolled in Medicare Part A and Part B while on a MA plan. If you need care that isn’t covered by the plan’s network, you may need to pay more or get referrals to see specialists.
  • Annual Review: It’s important to review your MA plan annually during the Annual Enrollment Period. Plans can change their benefits, costs, and networks from year to year.

Medicare Advantage [MA] plans offer extra benefits and are cost-effective, but they can have limitations in comparison to Original Medicare. Before you sign up for a plan, it is crucial to carefully consider your healthcare needs and preferences.