Medicare Advantage Plans – Part C Coverage

Medicare Advantage is an alternative to original Medicare (parts A and B) that offers health plans through private insurance companies that contract with Medicare. These plans may be available with drug coverage (MAPD) or without prescription drug coverage (MA).

Medicare Advantage (part C) = part A benefits + part B benefits + a few added perks

The few added perks might include:

  • Prescriptions
  • Dental
  • Vision
  • Hearing
  • Sometimes a gym membership

How to Qualify For a MA/MAPD Plan

To qualify for a Medicare Advantage plan, you must:

  • Be eligible for Medicare.
  • Must continue to pay your part B premium.
  • Must pay your Medicare Advantage plan premium (if applicable).
  • Cannot have End Stage Renal Disease (ESRD).

How a MA/MAPD Plan Works

By definition, Medicare Advantage plans replace original Medicare.

  • You are still a part of Medicare, but you get all of your Medicare-covered health care from the private health plan.
  • Again, you must continue to pay your part B premium.
  • Important note:  Medicare Advantage plans are NOT supplemental coverage.
  • To keep your costs down, you might have to choose doctors that are in the plan’s network.
  • When you go to the doctor, you use the insurance card from the MA/MAPD plan. Do not use the original Medicare card.
  • Each plan provider can charge different out-of-pocket costs and have different rules for how you access services. These plans vary throughout the United States and plans are available by county.
  • You cannot be enrolled in MAPD/MA and a stand-alone PDP at the same time.

Benefits of an Advantage Plan

  • The copays, deductibles, and coinsurance under a MA/MAPD plan is typically lower
  • Limits your maximum out-of-pocket
  • Might offer extra benefits like dental and vision
  • MAPDS have prescription drug coverage built in to the plan versus having to purchase it separately.

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