What is Medicare Advantage?

What is Medicare Advantage?

Medicare Advantage is a private insurance plan that includes Original Medicare (hospital and medical insurance, also known as Parts A and B), certain specified inclusions, and sometimes even Medicare Part D (prescription drugs). This is why it is often referred to as Medicare Part C.

Medicare Advantage Plans are designed to give any Medicare-eligible beneficiary a wider range of choices than the federally-provided Parts A and B. These Plans often include coverage above and beyond Original Medicare.

Who Can Apply for Medicare Advantage?

Anyone originally eligible for Medicare can apply for Medicare Advantage, except those with End-Stage Renal Disease (ESRD), who are usually covered by a Special Needs Plan. However, you should already be enrolled in Medicare Parts A and B before you get Medicare Advantage. You are also barred from Medicare Advantage if you have a Medicare Supplement or Medigap policy simultaneously.

As with regular health insurance, you need to be within the geographic area covered by the health insurance provider when you apply for Medicare Advantage.

What is Included in Medicare Advantage?

Medicare Advantage providers need to be reviewed and approved by Medicare, even though they are private companies. Because of this, they need to offer, at the very least, the same coverage provided by Medicare Parts A and B. This means all inpatient and additional medical care, extending to tests, consultations, medications, and so forth.

The “advantage” of Medicare Advantage is the add-ons the private companies cover through the premiums you pay them. These add-ons include services not provided by Medicare, such as dental, vision, and hearing services, depending of course on the plan you get. They can also include prescription drug coverage through Medicare Part D.

What some prefer through Medicare Advantage Plans is the healthcare professional network. Because it is a private insurance provider, it has a specific network of healthcare professionals who will treat you based on your coverage. You may want to take part in Medicare Advantage due to this network. Just review the process to know whether you need a referral to see a specialist.

How Does Medicare Advantage Payment Work?

You pay no premiums for Medicare Part A (although you do have a deductible), so you will not need to include it in your calculations. However, you do pay the Medicare Part B monthly premium rate, and you will continue to pay it even while paying the Medicare Part C premium.

But because of its comprehensive design, you are still paying less for more than if you had Medigap or opted for Medicare Part D (depending on how you structure your insurance).

You will also need to pay deductibles, co-payments, and coinsurance depending on your healthcare provider. This is where you can take a closer look at the best way to put your insurance plans together.

When is it Better to Get a Medicare Advantage Plan?

It is better to get a Medicare Advantage Plan when you anticipate procedures or illnesses that will demand more than your Medicare covers. Because there is no out-of-payment cap, there is potentially no limit to how much you will pay in deductibles, co-payments, and coinsurance in the event of a long hospital stay or severe illness.

Because Medicare Part C is provided by a private health insurance organization, it usually has a limit on your total out-of-pocket expenses. This means no matter how unexpected a covered illness or condition is, you will not have to pay beyond the agreed-on rate with the healthcare provider.  

If you travel often for your job or for other reasons, you might want to consider traditional Medicare rather than a Medicare Advantage Plan. Medicare Advantage is region- or locality-bound, so if you find yourself in need of medical care while away from the area covered by your insurance provider, you might have more expenses than you want.

Medicare Advantage is Your Choice

When considering which structure of Medicare to get for yourself, note all the options available to you. Preset plans look convenient and all-preventing, but there might be a certain combination of benefits that would be better for you.

So whether you are getting Original Medicare, Part C, or a combination that includes Medicare Part D, carefully consider your medical history, your future plans, and then make the choice that is most ideal for you and your lifestyle.

James Donaldson

I like to blog about insurance, health and the great outdoors. Memphis born and raised.