Medicare Advantage FAQ

Some of the most common questions about Medicare Advantage plans include:

• What is a Medicare Advantage plan?
  
  A Medicare Advantage plan is a type of health insurance plan that is offered by a private company and provides Medicare benefits to beneficiaries. These plans are an alternative to Original Medicare (Part A and Part B), and typically include additional benefits such as prescription drug coverage and routine dental and vision care. Medicare Advantage plans must cover all of the services that Original Medicare covers, but they may have different rules, costs, and restrictions. Some plans may also offer extra benefits, such as fitness programs or routine vision and dental care.
  
  
• How does a Medicare Advantage plan work?
  

  A Medicare Advantage plan works by replacing Original Medicare (Part A and Part B) with a private health insurance plan that is administered by a private company. Beneficiaries who enroll in a Medicare Advantage plan will receive their Medicare benefits through the private plan, rather than through Original Medicare.

  To be eligible for a Medicare Advantage plan, beneficiaries must have both Medicare Part A and Part B, and must live in the plan's service area. They also cannot have certain medical conditions, such as end-stage renal disease (ESRD) or Lou Gehrig's disease (ALS).

  When enrolled in a Medicare Advantage plan, beneficiaries will typically pay a monthly premium to the private insurance company, in addition to any premiums they may already be paying for Medicare Part B. In most cases, beneficiaries will also be required to pay copayments, coinsurance, and deductibles for certain services.

  Beneficiaries can receive their Medicare-covered benefits through their Medicare Advantage plan, and may also be eligible for additional benefits that are not covered by Original Medicare, such as routine dental and vision care or fitness programs. It's important to note that Medicare Advantage plans may have different rules, costs, and restrictions than Original Medicare, so beneficiaries should carefully compare their options before enrolling.

• How do I enroll in a Medicare Advantage plan?
  

  To enroll in a Medicare Advantage plan, you must first have Medicare Part A and Part B, and must live in the plan's service area. You can enroll in a Medicare Advantage plan during your initial enrollment period, which begins three months before the month you turn 65 and ends three months after the month you turn 65. You can also enroll during the annual open enrollment period, which runs from October 15 to December 7 each year.

  To enroll in a Medicare Advantage plan, you can contact the plan directly, or visit the Medicare website at www.medicare.gov. On the website, you can compare different Medicare Advantage plans and enroll online. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227) to enroll over the phone.

  It's important to note that you may need to provide certain information when enrolling, such as your Medicare number and the effective date for your coverage. You should also make sure to carefully compare your options and consider factors such as costs, benefits, and any additional restrictions before enrolling in a Medicare Advantage plan.

• What is covered by a Medicare Advantage plan?
  

  A Medicare Advantage plan must cover all of the services that Original Medicare (Part A and Part B) covers, including hospital care, medical care, and preventive services. In addition, most Medicare Advantage plans include prescription drug coverage, and some plans may also offer additional benefits such as routine dental and vision care or fitness programs.

  However, it's important to note that Medicare Advantage plans may have different rules, costs, and restrictions than Original Medicare. For example, a Medicare Advantage plan may limit the number of visits you can make to a doctor each year, or may require you to see certain providers within their network. To find out what is specifically covered by a Medicare Advantage plan, you should contact the plan directly or visit the Medicare website at www.medicare.gov.

• How do Medicare Advantage plans differ from Medicare Supplement plans?
  

  Medicare Advantage plans and Medicare Supplement plans are two different types of health insurance plans that are available to beneficiaries who have Medicare. Medicare Advantage plans are an alternative to Original Medicare (Part A and Part B), and are offered by private insurance companies. Medicare Supplement plans, also known as Medigap plans, are designed to help cover the out-of-pocket costs of Original Medicare, such as copayments, coinsurance, and deductibles.

  One of the main differences between Medicare Advantage plans and Medicare Supplement plans is the way they provide benefits. Medicare Advantage plans replace Original Medicare with a private health insurance plan, and beneficiaries receive their Medicare-covered benefits through the private plan. Medicare Supplement plans, on the other hand, work alongside Original Medicare, and help beneficiaries pay for the out-of-pocket costs of their Original Medicare coverage.

  Another difference is the additional benefits that each type of plan offers. Medicare Advantage plans may include additional benefits such as prescription drug coverage, routine dental and vision care, or fitness programs. Medicare Supplement plans, on the other hand, do not typically include additional benefits, but may cover some of the out-of-pocket costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles.

  Finally, Medicare Advantage plans and Medicare Supplement plans also differ in terms of their costs and restrictions. Medicare Advantage plans typically have lower premiums than Medicare Supplement plans, but may have higher out-of-pocket costs, such as copayments and deductibles. Medicare Supplement plans, on the other hand, may have higher premiums, but typically have lower out-of-pocket costs. Additionally, Medicare Advantage plans may have more restrictions, such as requiring beneficiaries to see certain providers within their network, while Medicare Supplement plans do not typically have such restrictions.

• Are there any limitations or exclusions with Medicare Advantage plans?
  

  Yes, there are some limitations and exclusions with Medicare Advantage plans. Medicare Advantage plans are required to cover all of the services that Original Medicare (Part A and Part B) covers, but they may have different rules, costs, and restrictions.

  For example, a Medicare Advantage plan may limit the number of visits you can make to a doctor each year, or may require you to see certain providers within their network. Additionally, a Medicare Advantage plan may not cover certain services that are covered by Original Medicare, such as long-term care or health care services you receive while traveling outside of the United States.

  It's important to carefully review the terms of your Medicare Advantage plan to understand any limitations or exclusions that may apply. You can find more information about your plan's coverage and restrictions by contacting the plan directly or visiting the Medicare website at www.medicare.gov.

• Can I switch from a Medicare Supplement plan to a Medicare Advantage plan?
  

  Yes, you can switch from a Medicare Supplement plan to a Medicare Advantage plan if you are eligible for both types of plans. You can do this during the annual open enrollment period, which runs from October 15 to December 7 each year.

  To switch from a Medicare Supplement plan to a Medicare Advantage plan, you will need to enroll in a Medicare Advantage plan that is available in your area. You can do this by contacting the plan directly, or by visiting the Medicare website at www.medicare.gov. On the website, you can compare different Medicare Advantage plans and enroll online.

  It's important to carefully compare your options and consider factors such as costs, benefits, and any additional restrictions before switching from a Medicare Supplement plan to a Medicare Advantage plan. You should also be aware that if you switch from a Medicare Supplement plan to a Medicare Advantage plan, you may not be able to switch back to a Medicare Supplement plan at a later date.

• How much does a Medicare Advantage plan cost?
  

  The cost of a Medicare Advantage plan will vary depending on the specific plan and the insurance company that offers it. Most Medicare Advantage plans have a monthly premium, in addition to any premiums you may already be paying for Medicare Part B. Additionally, you may be required to pay copayments, coinsurance, and deductibles for certain services.

  To find out the specific cost of a Medicare Advantage plan, you can contact the plan directly or visit the Medicare website at www.medicare.gov. On the website, you can compare different Medicare Advantage plans and see the specific costs and benefits of each plan.

  It's important to note that the cost of a Medicare Advantage plan may be different from the cost of Original Medicare (Part A and Part B). Medicare Advantage plans may have lower premiums than Original Medicare, but may have higher out-of-pocket costs, such as copayments and deductibles. Additionally, Medicare Advantage plans may have more restrictions, such as requiring you to see certain providers within their network, which could affect the overall cost of your coverage.
  
  
• Can I have a Medicare Advantage plan and a Medicare Supplement plan at the same time?
  

  No, you cannot have a Medicare Advantage plan and a Medicare Supplement plan at the same time. If you enroll in a Medicare Advantage plan, you will be enrolled in a private health insurance plan that provides your Medicare benefits, and you will no longer be enrolled in Original Medicare (Part A and Part B).

  Medicare Supplement plans, also known as Medigap plans, are designed to help cover the out-of-pocket costs of Original Medicare, such as copayments, coinsurance, and deductibles. Because you are no longer enrolled in Original Medicare when you have a Medicare Advantage plan, you cannot also have a Medicare Supplement plan.
  
  If you have a Medicare Advantage plan and want to switch to a Medicare Supplement plan, you can do so during the annual open enrollment period, which runs from October 15 to December 7 each year. However, it's important to carefully compare your options and consider factors such as costs, benefits, and any additional restrictions before switching from a Medicare Advantage plan to a Medicare Supplement plan. You should also be aware that if you switch from a Medicare Advantage plan to a Medicare Supplement plan, you may not be able to switch back to a Medicare Advantage plan at a later date.

These are just some examples of the questions that people often have about Medicare Advantage plans. It's always a good idea to do your own research and to talk to a licensed insurance agent if you have specific questions about your own situation.