Medicare Advantage plans are offered to eligible disabled adults and people ages 65. It is a part of the Medicare program. In addition, these plans are known as Medicare Part C. Not the federal government but private insurance companies offer these plans. Medicare Advantages plans (MA) include medical, prescription drug coverage, and hospital. If a person purchases an MA plan still has Medicare.
- Coverage of Medical Advantage plans is the same as Part A (Hospital), Part B (Medical coverage), and Part D prescription drug coverage, with hospital care.
- Every month insurance companies get a certain amount for a specific plan. However, an insurer may have to pay his out-of-pocket money to the company.
Eligibility for Medical Advantage Plan
People with end-stage diseases such as amyotrophic lateral sclerosis (ALS), permanent kidney failure requiring transplant or dialysis, adults with disabilities, and people age 65 or older. Medical Advantage is a type of Medicine health plan offered by insurance companies. Advantage plans are considered another option for Original Medicare.
These plans cover all the expenses which are come under Medicare. Companies receive a fixed amount for the plan, and the company may charge some money from the policyholder. These companies can make their own terms and conditions for their services.
Some services like hearing, dental, and vision are covered in Medicare Advantage plans. One thing you should know is that Advantage and Medicare Supplement plans (Medigap) don’t work together. People can’t buy these two plans at the same time.
Cost of Medicare Advantage plans
Medicare pays the premium for policyholders in Medicare Advantage plans. In 2022, the Medicare Advantage plan’s average monthly premium is projected to be $19 and $21.22 in 2021. Furthermore, in 2022 annual deductible and a monthly premium for Part B are $233 and $170.10 in 2021.
Regional preferred provider organizations (PPOs) were established to cover entire multi-state regions or statewide and provide greater access to rural beneficiaries to Medical Advantage plans. In 2020, regional PPOs had 5% of all Medicare Advantage enrollees. In 2021, about 26 million people, or 42% of those who get Medicare benefits, were enrolled in a Medicare Advantage plan.
How to enroll in a Medicare Advantage plan?
Once you research and select a Medicare Advantage plan which is according to your needs and preference, there are numerous ways to join:
- To find the plan in the area, use the finding tool for the Medicare plan. Then, click on the button “Enroll.”
- If you enroll online, Visit the website to see the plan. You can also contact the provider to get a complete enrollment form. Fill and then return it out to the provider.
- To get a desirable plan, contact the provider of the company
- Call Medicare at 800-Medicare
All you need is a Medicare number and the date the Medicare Part A and Part B for starting the coverage. Before buying a Medicare Advantage plan, it is necessary y to enroll n Medicare Part A and Part B.
During the Open Enrollment Period from October 15 to December 7 or the initial Enrollment Period (When a person first becomes eligible for Medicare), people can only enroll or join a Medicare Advantage plan. Once people are enrolled in a Medicare Advantage plan, they can change plans from January 1 to March 31 each year during Medicare Advantage Open Enrollment.
How To change Medicare Advantage plans?
You can change the Medicare Advantage plan once a year. Remember one thing you can only do so during the Medicare Advantage open enrollment period from January 1 to March 31 or the fall open enrollment period of Medicare from October 15 to December 7.
During these periods, people can also switch to Original Medicare. If policyholders switch after the first year, receiving a Medicare Supplemental Insurance policy could be more complicated. In many states, insurers must issue policyholder Medigap policies during a person’s initial Medigap enrollment period (generally six months after turning 65 and enrolling in Medicare Part b).
If any person changes his Medicare Advantage plan in the first year, if a person has any health-related issues, insurers can deny his Medigap policy. Then, before the preexisting conditions are covered, they can require a waiting period.
Different Parts of Medicare
- Medicare Part A (Hospital insurance)
- Medicare Part B (medical insurance)
- Medicare Part C (Medicare Advantage)
- Medicare Part D (prescription drug plan)
- Medicare Supplement Insurance (Medigap)
Do all doctors accept Medicare Advantage?
Not all doctors accept Medicare Advantage. In addition, you must contact the health care providers within the Medicare Advantage plan’s network. However, some Medicare Advantage plans allow you to use out-of-network providers in an emergency.
The pros of Medicare Advantage plans
- Advantage plans include some money savings or provide dental, hearing, and vision care services.
- Potentially less premium for coverage
- Limit how much a policymaker may have to pay for medical and hospital coverage. The centers decide on this limit for Medical services and Medicare. The limit is $7,550 in 2022.
Covered Services in Medicare Advantage Plans
Medical Advantages Plans covered all Part A and Part B benefits, except for hospice service and clinical trials. In addition, for a period, a few new benefits come from national or legislation coverage determinations. The plans should cover basic medical needs for urgent care and emergency.
If you need a service that, according to the plan, is not medically important, you may pay the cost. People have the right to an organization’s determination, either written or oral, to know whether service, supply, or drug is covered if they have a Medicare Advantage plan. There is no need to pay more than the usual cost for supply or service if a network provider didn’t get an organization and either of these true:
- The provider suggested you to an out-of-network provider for service
- The provider offers you a service that you reasonably thought could be covered.
If you buy a Medical Advantage plan, original Medicare will still help cover the cost of hospice care, some costs for clinical research studies, and some of the new benefits of Medicare. Things like a fitness program and hearing are covered in Medical Advantage plans which are not covered in Original Medicare.