Medicare Advantage Plans

Click on words in blue for definitions.

 

Medicare Advantage plans replace Medicare as the primary payor.

You won’t use your Medicare card to get medical benefits, but instead you’ll use the card issued by the Medicare Advantage insurance company.

Medicare Advantage plans are offered by Medicare approved insurance companies and cover all the benefits of Medicare Part A & Part B, plus offers extra coverage, such as vision, hearing, dental and gym membership. Most include Part D Prescription Drug coverage.

Premiums for Medicare Advantage plans can be as low as $0 per month and medical care is generally offered with pre-established co-payments.

 

Maximum Out-of-Pocket Limit – With a Medicare Advantage plan, there is a limit to the amount you have to pay for Part A & Part B services for the year. Should you reach that limit, the plan pays 100% of these services for the balance of the year.

 

You can enroll in a Medicare Advantage plan if you:

1. have Medicare Part A & Part B and
2. live in the plan’s service area and
3. don’t have End Stage Renal Disease (however, there is an exception to this requirement)

 

Medicare Advantage plans have some restrictions about how you get medical care, so before enrolling in a plan, make sure:

1. you understand how the plan works
2. your doctors accept the plan
3. your prescription drugs are covered by the plan
4. other benefits that are important to you are covered by the plan.

 

Enrollment in a Medicare Advantage Plan

You can enroll in a Medicare Advantage plan only during your Initial Election Period, a Special Election Period, or during Annual Open Enrollment Period.

Note: Some people get their Medicare benefits by enrolling in their employer’s retirement health plan instead of enrolling in a Medicare Advantage plan. Some rely on VA benefits, TRICARE, or other federal programs.