Medicare Advantage plans can serve as your “one-stop” center for all your health and prescription drug coverage needs. Most Medicare Advantage plans combine Original Medicare and prescription drug coverage. Many also coordinate the delivery of added benefits, such as vision, dental, and hearing care.
Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. In most cases, you can only use doctors who are in the plan's network.
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
A Medicare Advantage (MA) plan is a type of health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Parts A and B benefits. MA plans include health maintenance organizations, preferred provider organizations, private fee-for-service plans, and Special Needs Plans.
Original Medicare vs.
Original Medicare covers inpatient hospital and skilled nursing services – Part A - and doctor visits, outpatient services and some preventative care – Part B. Medicare Advantage plans cover all the above (Part A and Part B), and most plans also cover prescription drugs (Part D).
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. In 2022, the standard Part B premium amount is $170.10 (or higher depending on your income). If you need a service that the plan says isn't medically necessary, you may have to pay all the costs of the service.
Under Medicare Advantage, you will get all the services you are eligible for under original Medicare. In addition, some MA plans offer care not covered by the original option. These include some dental, vision and hearing care. Some MA plans also provide coverage for gym memberships.
For 2022, Kaiser Permanente ranks as the best-rated provider of Medicare Advantage plans, scoring an average of 5 out of 5 stars. Plans are only available in seven states and the District of Columbia.
Can Doctors Refuse Medicare? The short answer is "yes." Thanks to the federal program's low reimbursement rates, stringent rules, and grueling paperwork process, many doctors are refusing to accept Medicare's payment for services. Medicare typically pays doctors only 80% of what private health insurance pays.
The Best Medicare Advantage Provider by State
Local plans can be high-quality and reasonably priced. Blue Cross Blue Shield, Humana and United Healthcare earn the highest rankings among the national carriers in many states.
UnitedHealthcare is the largest provider of Medicare Advantage plans and offers plans in nearly three-quarters of U.S. counties.
A Medicare Advantage plan (Medicare Part C) is structured to be an all-in-one option with low monthly premiums. Medicare Supplement plans offer additional coverage to Original Medicare with low to no out-of-pocket costs.
People with End-Stage Renal Disease (permanent kidney failure) generally can't join a Medicare Advantage Plan. How much do Medicare Advantage Plans cost? In addition to your Part B premium, you usually pay one monthly premium for the services included in a Medicare Advantage Plan.
Recently, 42 percent of Medicare beneficiaries were enrolled in Advantage plans, up from 31 percent in 2016, according to data from the Kaiser Family Foundation.
Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been covered by traditional Medicare. The Medicare Advantage spending amount includes the cost of extra benefits, funded by rebates, not available to traditional Medicare beneficiaries.
The average premium for a Medicare Advantage plan in 2021 was $21.22 per month. For 2022 it will be $19 per month. Although this is the average, some premiums cost $0, and others cost well over $100. For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Advantage (MA) plans, as an alternative to Original Medicare, also cover cataract surgery. MA plans provide the same benefits as Original Medicare does, so if a service is covered under Original Medicare, in this case, cataract surgery, it is also covered under a MA plan.
In the case of inpatient hospital stays, Medicare Advantage plans generally do not impose the Part A deductible, but often charge a daily copayment, beginning on day 1. Plans vary in the number of days they impose a daily copayment for inpatient hospital care, and the amount they charge per day.
Medicare defines a pre-existing condition as any health problem that you had prior to the coverage start date for a new insurance plan. If you have Original Medicare or a Medicare Advantage plan, you are generally covered for all Medicare benefits even if you have a pre-existing condition.
If you currently have Medicare, you can switch to Medicare Advantage (Part C) from Original Medicare (Parts A & B), or vice versa, during the Medicare Annual Enrollment Period. If you want to make a switch though, it may also require some additional decisions.
Take advantage of it. UnitedHealthcare Medicare Advantage (Part C) plans—including the only plans with the AARP name—are designed to give you more for your Medicare dollar, offering benefits and services beyond Original Medicare. Most Medicare Advantage plans include coverage for prescription drugs.
Medicare Advantage doesn't replace Original Medicare Part A and Part B coverage; it simply delivers these benefits through an alternative channel: private insurance companies. Medicare Advantage plans are offered by private insurance companies that contract with Medicare.