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Easy Medicare Advantage

Medicare Advantage Made Easy

Easy Medicare Advantage

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare: 

  • Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). If you want drug coverage, you can join a separate Medicare drug plan (Part D).
  • Medicare Advantage (also known as “Part C”) is an “all-in-one” alternative to Original Medicare.

These “bundled” plans include Part A, Part B, and usually, Part D. Most plans offer extra benefits Original Medicare doesn’t cover–like vision, hearing, dental, and more. Your Medicare health plan decisions affect how much you pay for coverage,
what services you get, what doctors you can use, and your quality of care. Learning about your Medicare coverage
choices, getting help from people you trust, and comparing different plans can help you understand all the options
available to you.

What are Medicare Advantage Plans?

A Medicare Advantage Plan is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” are offered by Medicare-approved private companies that must follow rules set by Medicare.
Most Medicare Advantage Plans include drug coverage (Part D). There are several types of Medicare Advantage Plans (see page 15). Each of these Medicare Advantage Plan types has special rules about how you get your Medicare covered Part A and B services and your plan’s supplemental benefits.

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.

You must use the card from your Medicare Advantage Plan to get your Medicare-covered services. Keep your red, white, and blue Medicare card in a safe place because you’ll need it if you ever switch back to Original Medicare.

How do Medicare Advantage Plans work?

When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the company offering your Medicare Advantage Plan. Companies that offer Medicare Advantage plans must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you must go to doctors, facilities, or suppliers that belong to the plan’s network for non-emergency or non-urgent care). These rules can change each year. The plan must notify you about any changes before the start of the next enrolment year. If you join a Medicare Advantage Plan, you’ll have all the same rights and protections that you would have under Original Medicare.

What do Medicare Advantage Plans cover?

Medicare Advantage Plans cover all Part A and Part B services. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost of hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care.

Most Medicare Advantage Plans offer coverage, for some things Original Medicare doesn’t cover, like some vision,  hearing, dental, and fitness programs (like gym memberships or discounts). Plans also have a yearly limit on your out-of-pocket
costs for all Part A and Part B medical services. Once you reach this limit, you’ll pay nothing for services Part A and Part B cover. Medicare drug coverage (Part D) Most Medicare Advantage Plans include Medicare drug coverage (Part D). In certain types of plans that don’t include Medicare drug coverage (like Medical Savings Account Plans and some Private-Fee-for-Service Plans), you can join a separate Medicare drug plan. However, if you join a Health Maintenance Organization or Preferred Provider Organization plan which doesn’t cover drugs, you can’t join a separate Medicare drug plan. See pages 15–24 for more information.

Who can join a Medicare Advantage Plan?

To join a Medicare Advantage Plan, you must:

  • Have Part A and Part B.
  • Live in the plan’s service area.

What if I have a pre-existing condition?

You can join a Medicare Advantage Plan even if you have a pre-existing condition. What if I have End-Stage Renal Disease (ESRD)? If you have ESRD, you can enroll in a Medicare Advantage Plan during Open Enrollment (October 15–December 7, 2020) for coverage starting January 1, 2021.

In many Medicare Advantage Plans, you’ll need to use health care providers who participate in the plan’s network and service area. Before you enroll, you may want to check with your providers and the plan you’re considering making sure the providers you currently see (like your dialysis facility or kidney doctor) or want to see in the future (like a transplant specialist), are in the plan’s network. If you’re already in a Medicare Advantage Plan, check with your providers to make sure they’ll still be part of the plan’s network in 2021. Read the plan materials or contact the plan you’re considering for more information.

What if I have other coverage?

Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage for yourself, your spouse, and dependents and you may not be able to get it back. In other cases, if you join a Medicare Advantage Plan, you may still be able to use your employer or union coverage along with the Medicare Advantage Plan you join. Your employer or union may also offer a Medicare Advantage retiree health plan that they sponsor.

Note: If you’re in a plan that doesn’t offer drug coverage, and you don’t have a Medicare drug plan, you may have to pay a late enrollment penalty if you decide to join a Medicare drug plan. Visit Medicare.gov/drug to learn more about the Part D late enrollment penalty.