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What is Medicare Advantage and How Does it Work?

Medicare Advantage, also known as Medicare Part C, is an alternative to original Medicare (Part A and Part B). It is offered by private insurance companies that are contracted with Medicare. In this article, we will explore what Medicare Advantage is and how it works, including its benefits, costs, and enrollment process.

Understanding Medicare Advantage

Medicare Advantage plans are required to provide the same benefits as original Medicare, but many also offer additional benefits, such as vision, hearing, dental, and wellness programs. These plans typically have networks of doctors and hospitals that you can choose from, and some plans require you to get referrals to see specialists.

Unlike original Medicare, Medicare Advantage plans have an out-of-pocket maximum. Once you reach this limit, the plan pays for all covered services for the rest of the year. Additionally, some plans may offer lower out-of-pocket costs than original Medicare, depending on the specific plan.

How Medicare Advantage Works

When you enroll in a Medicare Advantage plan, you will still pay your Medicare Part B premium, along with any premium the plan charges. Some plans have a $0 premium, while others may charge a higher premium for additional benefits.

Each Medicare Advantage plan has its own rules, costs, and coverage limitations, so it’s important to carefully review the plan documents before enrolling. Most plans require you to use doctors and hospitals within the plan’s network, and some plans may require referrals to see specialists.

If you need prescription drug coverage, you can choose a Medicare Advantage plan that includes this coverage, or you can enroll in a separate Medicare Part D plan.

Benefits of Medicare Advantage

In addition to the added benefits that Medicare Advantage plans may offer, many people choose these plans because they often have lower out-of-pocket costs than original Medicare. Some plans also offer vision, hearing, and dental coverage, which are not covered by original Medicare.

Medicare Advantage plans also have an annual out-of-pocket maximum, which can help protect you from unexpected medical costs. Additionally, some plans may offer benefits such as gym memberships or wellness programs that can help you stay healthy and active.

Enrollment in Medicare Advantage

You can enroll in a Medicare Advantage plan during your Initial Enrollment Period (IEP), which is the seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. You can also enroll during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year.

You can switch from one Medicare Advantage plan to another or go back to original Medicare during the Annual Enrollment Period. Additionally, if you have a special circumstance, such as moving to a new area or losing your current coverage, you may be eligible for a Special Enrollment Period.

In conclusion, Medicare Advantage plans offer additional benefits and lower out-of-pocket costs for many people. However, it’s important to carefully review plan documents and compare costs and coverage before enrolling. If you have any questions, you can contact Medicare or a licensed insurance agent for assistance.