Medicare Advantage

What is Medicare Advantage?

Private companies have contracted with the federal government to coordinate Medicare Part A and Medicare Part B to create a health plan option known as Medicare Advantage Plans (MA). When participants choose a Medicare Advantage Plan they are basically assigning their Medicare benefits over to the plan.

This allows the insurance company to coordinate with Medicare on your behalf. Many MA Plans fill in the benefit gaps left by Original Medicare. Almost all Medicare Advantage Plans include Medicare Part D, prescription drug coverage.

When enrollees choose a Medicare Advantage Plan that offers Medicare drug coverage, MA-PD, you are required to take the prescription coverage that the plan is offered. You may not seek out prescription drug supplemental insurance. Participant that enroll in a MA Plan that does not offer prescription drug coverage they may not sign up for a separate Medicare Part D Plan.

The MA Plan that is chosen may limit the doctors and hospitals that can be seen. Participant’s coverage is dependent upon the plan that is chosen and the network of doctors and hospitals within the plan.

Medicare Advantage vs Medigap Supplemental Plans

3 Main Medicare Advantage Plans

Here is a brief description of how each type of Medicare Advantage Plan works. Participants need to check with the individual plan offering for details and exceptions:

Medicare Advantage Costs

The premium that participants pay depends on the MA Plan that they have chosen to enroll in. Participants of a Medicare Advantage Plan will be responsible for paying for the premium as well as any applicable deductibles, co-pays, and/or coinsurance.

One nice feature of Medicare Advantage features is that they have what is known as a “maximum-out-of-pocket” expense. This puts in place a limit to the total amount of money participants are liable for within the plan year. This amount does not include payments applied.

Medicare Advantage Coverage

All of the services covered by Original Medicare come in each Medicare Advantage Plan. Additionally MA Plans offer supplemental insurance coverage that covers services that are not provided under Original Medicare, such as hearing aids. The MA-PD Plan integrates medical and prescription drug coverage.

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